Building systems for preparedness: Global scoping studies on institutional governance and National Public Health Agencies

Public health emergencies remain a persistent threat to global health security, with the COVID-19 pandemic exposing critical weaknesses even in advanced health systems. National Public Health Agencies (NPHAs), particularly National Public Health Institutes (NPHIs), have emerged as central actors in coordinating preparedness and response functions. However, institutional maturity, financing, and subnational integration remain uneven, especially in low- and middle-income countries. This scoping review consolidates evidence on governance, institutional arrangements, workforce development, financing, and cross-cutting determinants shaping public health emergency preparedness and response. A scoping review of literature published between 2000 and 2025 was conducted following the Arksey and O’Malley framework and reported according to PRISMA-ScR standards. Systematic searches were performed in PubMed, Scopus, Web of Science, and relevant WHO repositories. Eligible studies were screened and charted using a standardized data extraction template, and findings were synthesized using an inductive thematic approach. A total of 4,163 records were identified, 538 duplicates removed, 3,625 records screened, 98 full texts assessed, and 60 studies included. Evidence was organized into seven domains: institutional landscape, governance and autonomy, preparedness functions, workforce, financing, subnational presence, and cross-cutting enablers. National public health institutes were widely established but frequently operated with unclear mandates and limited subnational implementation. Core functions such as surveillance, laboratory systems, risk communication, and emergency operations were inconsistently institutionalized, with recurrent constraints in financing, workforce capacity, and digital interoperability across regions. Public health emergency preparedness and response systems function most effectively when embedded within stable governance, financing, and accountability frameworks. Strengthening statutory authority, predictable domestic investment, workforce sustainability, and interoperable information systems is critical to translating technical capacity into reliable operational performance. Durable, institutionally anchored preparedness is essential for moving from reactive crisis management to sustained and equitable national readiness.