©MINISTRY OF HEALTH AND SANITATION

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Sierra Leone, National Action Plan for Health Security, 2018 – 2022

Published by:

Ministry of Health and Sanitation, Government of Sierra Leone. 15A King Harman Road, 4th Floor Youyi Building, Freetown, Sierra Leone Telephone: +232 33 31 79 02 http://www. health.gov.sl

i Foreword

Sierra Leone has experienced many health The 2014 – 2015 Ebola Virus Disease (EVD) related emergencies spanning human, animal and outbreak that affected Sierra Leone and the West environmental health for millennia. For example, African Sub Region is likely to have originated from after a decade of absence, cholera re-emerged interactions between human populations and the in Sierra Leone 1994 – 1995 affecting more than tropical rain forest ecosystems. In Sierra Leone, 46,061 people and killing 1,465 people and again a total of 14,124 people were affected, including in 2012-2013 affecting 12 out of the then 13 districts 3,956 that died. The Ebola epidemic took a heavy in Sierra Leone and affecting 23,308 people with toll on the already scarce health workforce, a total 301 documented deaths. Lassa fever is a viral of 350 health care workers were affected with 221 hemorrhagic fever endemic in the country and deaths reported. that has continued to present a significant threat. The incidence of Lassa fever has been rising Following a review of the response to the West significantly in the last few years. By mid-2018, African EVD Epidemic, the World Health Assembly 20 cases of Lassa fever had been reported as (WHA) in its recommendation WHA 69/21.5, States compared to annual cumulative of 23 in 2017 and Parties were to adopt the Joint External Evaluation 33 in 2016. (JEE) and to develop National Action Plans for Health Security (NAPHS) within one year of the external The animal sector too has experienced numerous evaluation. In line with this recommendation, Sierra outbreaks that have caused devastation of animal Leone was the sixth country in the African region stocks and resulted in losses in agricultural to undergo the Voluntary JEE in October 2016. productivity and food security. Human populations The findings and recommendations from JEE have continue to suffer health consequences of informed development of this National Action Plan zoonosis. The death of 12 people from rabies for Health Security (2018-2022) through an all- between 1968 and 1972 necessitated a national inclusive multi-sectoral process. campaign with vaccination of 4,700 dogs in 1974. More recently, the risk of rabies has once again This plan presents costing and resource mapping come to the fore with well over 4,700 animal bites by technical areas, it is envisaged that the and 50 deaths reported in the last three years. development partners will supplement domestic funding for the implementation to be a success. The It is acknowledged that the environment plays plan will facilitate multi-sector engagement using a an important role in human health. Environmental One Health approach and guide implementation degradation with increasing population pressure of activities for progress towards attainment of are steadily playing a role in the transmission of International Health Regulations (IHR) 2005 core diseases and other public health threats to humans. capacities required for enhancing Global Health Security.

ii Acknowledgement

The published Sierra Leone Joint External This process would not be complete without the Evaluation (JEE) report proposes actions that Sierra participation of other One Health stakeholders that Leone needs to undertake to improve the country’s include the Office of National Security (ONS), Njala capacity to prepare for, detect, and respond to University, Sierra Leone Civil Aviation Authority adverse public health events. In order to guide (SLCAA), Sierra Leone Agricultural Research the implementation of the actions proposed in the Institute (SLARI) and the Republic of Sierra Leona JEE report, the Ministry of Health and Sanitation Armed Forces (RSLAF). The involvement of these (MoHS), and Environmental Protection Agency One Health players from the Government of Sierra (EPA with support of partners developed this Leone (GOSL) side is an assurance of the new National Action Plan for Public Health Security approach to health security in the country. (NAPHS). The NAPHS outlines what activities will be carried out in the medium term (2018- 2022) The successful development of this plan was in order for Sierra Leone to attain the desired made possible by the unwavering support and capacities required for IHR & GHSA compliance. leadership of Dr. Amara Jambai, who was then the Currently, it is the renewed focus of the Ministry Deputy Chief Medical Officer (Public Health) and of Health and Sanitation in collaboration with other now the Chief Medical Officer. We also appreciate ministries, government agencies and One Health the contribution of the late Dr. Foday Dafae who partner organizations as a means of accelerating served as the Director of Disease Prevention and achievement of national health security. Control at the Ministry of Health & Sanitation.

We wish to acknowledge the invaluable We are particularly grateful to the WHO for the contribution of all actors who were involved in the technical and financial support provided from all formulation of this plan. We would like to express three levels (HQ, AFRO and the Country Office). our gratitude to the Honorable Ministers of Health Special thanks to Dr. Charles Njuguna, WHO and Sanitation and Agriculture Forestry and Health Security and Emergency Coordinator for Food Security Dr. Alpha T. Wurie and Mr. Joseph his technical guidance throughout the process. We J. Ndanema respectively and the Minister of are also grateful to the leadership of the following Lands, Country Planning & Environment Dr. Dennis partner organizations for their contribution: FAO, Sandy for their high-level support to the process US CDC, USAID, IOM, DFID, Public Health England, of development of this plan. We would also like to China CDC and GIZ. thank the former Chief Medical Officer Dr. Brima Kargbo, the former Chief Agricultural Officer Mr. Their unreserved commitment to the development Ideara Sheriff and the former Chief Environmental of this plan is an assurance of the strength of Officer Mr. Edward P. Bendu together with the heads partnership towards its implementation. of directorates, programs, units and agencies and technical personnel for their contributions to the development of the NAPHS.

Dr. Amara Jambai Dr. Foday M. Joward Chief Medical Officer, Executive Chairperson, Ministry of Health & Environmental Protection Sanitation Agency

iii Executive Summary

The Sierra Leone National Action Plan for A resource mapping exercise was carried out, Health Security (NAPHS) is based on the this allowed the country to have an overview on recommendations of the 2016 Joint External the available or potential resources to support Evaluation (JEE). The JEE is a voluntary, building country capacities for health security. collaborative and multi-sectoral process to Implementation of this plan will enable the evaluate country’s capacity to prevent, detect and country to: prevent the likelihood and reduce rapidly respond to public health risks occurring the consequences of outbreaks and other public naturally or due to deliberate or accidental health hazards; build national capacities for events. The JEE process helps countries identify early detection and effective response to public the most critical gaps within their human and health emergencies and other events of public animal health systems, to prioritize opportunities health concern; foster all-sector partnerships for for enhanced preparedness and response, and effective prevention, detection and response to to engage with current and prospective partners public health emergencies and other events of and donors to effectively target resources. public health concern; establish a sustainable Sierra Leone was among first African nations financing strategy for the attainment of national to accept to undergo the JEE process which health security. Overall, this will enable the was conducted in between 31st Oct and 4th country to strengthen core capacities required November 2016. under IHR 2005 leading to enhanced health security of the country and the sub region. Some of the key areas for improvement that were identified through the process of JEE included; The overall cost of implementation of this plan is the need for revision of public health laws and about $291 million, the high-prioritized activities legislation, a budget line for IHR, accelerate the for implementation in year one and two will implementation of the One Health approach, cost about $50 million. It is envisaged that the development of a comprehensive multi-hazard health sector development partners will be National Public Health Emergency Preparedness enthusiastic to supplement domestic funding and Response plan, strengthening surveillance for the implementation to be a success. WHO at points of entry (PoEs), improve coordination will continue to coordinate a platform for donors and collaboration between human and animal and partners to share, inform, and collaborate health laboratory systems, Improve capacity in order to strengthen Sierra Leone IHR (2005) (human resources, laboratory) for the detection capacity and increase our contribution to global and response to chemical and radiation hazards health security. among several other key priorities.

Stakeholders, with broad representation, and using a one-health approach, reviewed the NAPHS so as to generate and prioritize activities planned in the 2018-2022 implementation period.

iv NAPHS EXECUTIVE SUMMARY | 2018 - 2022 v Table of Contents Foreword ii 3.4 Sector wide approach 19 Acknowledgement iii 3.5 Strategic partnership planning 20 Workshop scope and objectives Executive Summary iv 4. JEE FINDINGS AND COMPONENTS 23 List of Tables vii OF THE NATIONAL ACTION PLAN List of Figures FOR HEALTH SECURITY List of Abbreviations and Acronyms viii 4.1 Findings of Joint External Evaluation (JEE) 24 1. BACKGROUND 1 4.2 Components of NAPHS 24 1.1 Country Profile - Sierra Leone 2 4.3 Costing of activities and summary of 25 cost categorisation by JEE thematic 1.2 Situation analysis-burden of PHEs In 3 terms or morbidity and mortality areas 1.3 Progress towards achievement of 5 4.4 Cost breakdown by technical Area over 26 International and National targets In years Health indices 4.5 High prioritized activities 27 1.4 Health Service Organization 6 4.6 Sierra leone health security NAPHS 28 1.5 Human Resource for Health 8 Financial sustainability 4.7 Financing of national action plan 28 1.6 Health Financing 8 (Domestic, spp and further Donor 1.7 The International Health Regulations 8 engagements) 1.8 IHR JEE and other Complementary 9 4.8 Platform for National Action Plan 28 assessments 4.8.1 Linkage with existing plans 28 1.8.1 Joint External Evaluations - JEE 9 4.8.2 Interplay between relevant sectors 29 1.8.2 The Global Health Security Agenda 9 4.9 Contribution to Health System 31 (GHSA) Strengthening and UHC 2030 1.9 The journey from IHR JEE to Country 10 Planning 5. DELIVERY OF THE ACTION PLAN 33 13 5.1 Roles and responsibilities of Key 34 2. VISION, MISSION, OBJECTIVES, GUIDING stakeholders PRINCIPLES AND CORE VALUES OF THE 5.2 Coordination mechanisms and 35 ACTION PLAN Framework for delivery of Action Plan 3. METHODOLOGY/PROCESS FOR THE 17 5.3 Inter-ministerial committee for 36 DEVELOPMENT OF THE ACTION PLAN implementation of NAPHS 3.1 Review of JEE and other Assessments 18 5.4 District level implementation of NAPHS 36 recommendations 5.5 Monitoring and evaluation of the plan 36 3.2 Prioritisation of activities by technical 18 area LIST OF CONTRIBUTORS 37 3.3 Linkage with other programmes/ 19 Initiatives

vi List of Tables Table 1 Cholera Epidemics in Sierra Leone, 1998 to 2013 4 Table 2 IDSR diseases/conditions/events reported in Sierra Leone, 2016 4 Table 3 Costs of NAPHS activities by year of implementation 25 Table 4 High Priorited Activities 27 Table 5 Roles and Responsibilities of Key Stakeholders 34

List of Figures

Figure 1 Lassa Fever Laboratory Confirmed Cases in Sierra Leone, 2007- 2018 3 Figure 2 EVD outbreak in Sierra Leone, 2014 - 2016 5 Figure 3 MoHS Health Care Services Organization 7 Figure 4 Journey from IHR JEE to Country Planning 11 Figure 5 Benefits of the SWAp 19 Figure 6 Strategic partnerships for health security – Sierra Leone 21 Figure 7 JEE Average Score (Maximum 5) 24 Figure 8 JEE Technical Areas 24 Figure 9 NAPHS Costing by Technical Areas in USD 26 Figure 10 National Action Plan - Other Enablers 29 Figure 11 National Inter-ministerial Coordinating Committees structure 35

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 vii List of Abbreviations and Acronyms

AAR After-Action Review DMO District Medical Officer AEFI Adverse events following immunization Economic Community of West African ECOWAS States AFENET African Field Epidemiology Network electronic Integrated Disease Surveillance AFP Acute Flaccid Paralysis e-IDSR and Response A4P Agenda for Prosperity EPA Environmental Protection Agency AMR Antimicrobial Resistance EVD Ebola Virus Disease BPEHS Basic Package of Essential Health Services FAO Food and Agriculture Organization CAHW Community Animal Health Worker Field Epidemiology and Laboratory Training FELTP CBS Community Based Surveillance Programme Chinese Center for Disease Control and Field Epidemiology and Training China CDC FETP Prevention Programme US CDC Centers for Disease Control and Prevention GDP Gross Domestic Product CHC Community Health Centre GHSA Global Health Security Agenda CHP Community Health Post HCAI Health Care-Associated Infections CHWs Community Health Workers IPC Infection Prevention and Control CMO Chief Medical Officer JEE Joint External Evaluation CPHRL Central Public Health Reference Laboratory GEF Global Environmental Facility CSOs Civil Society Organizations GoSL Government of Sierra Leone DAO District Agricultural Officer German Agency for International GIZ Department for International Development Cooperation DFID (UK) International Center for AIDS Care ICAP DHIS2 District Health Information System2 and Treatment Programs Information Communication and DHMT District Health Management Teams ICT Technology Directorate of Health Security and DHSE Integrated Disease Surveillance and Emergencies IDSR Response Directorate of Livestock and Veterinary DLVS Services IHR International Health Regulations

viii International Health Regulations- PHEIC Public Health Events of International Concern IHR-NFP National Focal Point Public Health National Emergency PHNEOC IOM International Organization for Migration Operation Centre LTWG Laboratory Technical Working Group POCT Point of Care Testing MAF Ministry of Agriculture and Forestry PoEs Points of Entry MCHP Maternal and Child Health Post POPs Persistent Organic Pollutants MDAs Ministries Departments and Agencies Regional Disease Surveillance REDISSE Strengthening Enhancement MTHE Ministry of Technical and Higher Education RSLAF Republic of Sierra Leone Armed Forces MIA Ministry of Internal Affairs SDGs Sustainable Development Goals MLF Multilateral Fund Strengthening Laboratory Management MOFED Ministry of Finance and Economic Development SLMTA towards Accreditation MoHS Ministry of Health and Sanitation Stepwise Laboratory Quality Improvement MRU Mano River Union SLIPTA Process towards Accreditation SOPs NAPHS National Action Plan for Health Security Standard Operating Procedures National Multi-Agency Coordination NMCC SPP Strategic Planning Portal Committee SWAp Sector Wide Approach NPHA National Public Health Agency TBA Traditional Birth Attendant National Public Health Emergency NPHEMC Management Committee UHC Universal health Coverage OIE World World Organization of Animal Health UNEP United Nations Environment Program ONS Office of National Security United Nations International Children’s UNICEF Emergency Fund NLSP National Laboratory Strategic Plan UN Office for Disaster Risk Reduction National Public Health Emergency UNISDR NPHEPR Preparedness and Response Plan NSRPA VHF Viral Hemorrhagic Fever Nuclear Safety and Radiation Protection Agency WB World Bank PHEs Public Health Emergencies WHA World Health Assembly PHEMC Public Health Emergency Management Committee WHO World Health Organization PHE Public Health England

ix NAPHS EXECUTIVE SUMMARY | 2018 - 2022 1 BACKGROUND

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 1 1.1 Country Profile - Sierra Leone

AREA COVERAGE KILOMETRE SQUARE 78,000

POPULATION 2019

MORE THAN

Million People

WOMEN MEN WORKING LITERACY POPULATION RATE P/PERSON

RURAL POPULATION 59% BETWEEN ABOVE 15-65YEARS 10YEARS 50.8% 49.2% 55.6% 51.4%

URBAN POPULATION 41% PEOPLE PEOPLE 40.9% BELOW 3.5% ABOVE 15 YEARS 65 YEARS

2 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 1.2 Situation analysis-burden of health problem, with an estimated three new public health events in terms or infections per 1,000 each year. The national morbidity and mortality HIV prevalence rate is at 1.5%. Sierra Leone was severely hit by the most Sierra Leone experiences a high burden of widespread Ebola virus disease epidemic public health diseases/events in terms of in history. In total, 8,706 infections were morbidity and mortality. Some of the most recorded, of which 3,590 died between May common diseases include malaria, cholera, 2014 and March 2016. The risk of epidemics Lassa fever and measles. Over time, the and other public health concerns remains high country has also experienced an increased with 4,000 survivors. In 2015, the country was burden of non-communicable diseases, such estimated to have the world’s highest maternal as diabetes and cardiovascular conditions mortality ratio, at 1,360 maternal deaths per 100,000 live births. Child mortality is also very The overall life expectancy in Sierra Leone is high, with over 103 of every 1000 children 58.61 years. Infectious diseases are the leading dying before the age of five years. Almost cause of death and disease in Sierra Leone, one third of under-five children suffered from of which malaria is the single biggest killer, stunting in 2014. accounting for 38% of all hospital admissions. Tuberculosis is another significant public

LASSA FEVER CASES REPORTED ANNUALLY, SIERRA LEONE, 2007-2017 (N=782)

200

173 157 150 154 134

100

Figure 1: 50 47 Lassa Fever

Number of Cases 26 Laboratory 20 24 22 25 15 Confirmed 10 Cases in Sierra Leone, 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2007- 2018 Year

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 3 Table 1: Cholera Epidemics in Sierra Leone, 1998 to 2013 Year Cases Deaths Cfr % Remarks 1998 2096 57 2.7 Affected 3 districts: Freetown, Port Loko & Kambia 1999 863 5 0.6 Started in September 2004 513 42 8.2 Affected Western Area, Port Loko & Kambia 2006 2560 99 3.8 Affected Western Area (rural) Kambia, Tonkolili, Port Loko & Kailahun 2007 2219 84 3.79 Afected 11 out of 13 districts 2008 62 1 1.6 Affected Western Area, Port Loko & Kambia 2012 22,971 299 1.3 Affected 12 out of 13 districts 2013 369 2 0.54 Affecting 12 out of 13 districts

Table 2: IDSR diseases/conditions/events reported in Sierra Leone, 2016 Year 2016 2017 Case Case Disease/Condition/Event Cases Deaths Fatality Cases Deaths Fatality Rate % Rate % Animal Bite (dog, cat) 2,132 27 1.3 1.482 8 0.5 Diarrhoea with severe dehydration in 26,152 106 0.4 9,679 108 1.1 children under 5 years Suspected Measles 8,133 31 0.4 2,744 1 0 Severe Malnutrition in children under 5years 26,652 174 0.7 26,161 168 0.6 Malaria Tested 2,699,157 2,923,401 Malaria Positive 1,622,948 2,512 0.2 1,649,644 2,257 0.1 Suspected Meningococcal Menengitis 68 10 14.7 44 8 18.2 Maternal Death 618 490 Severe Pneumonia 88,568 469 0.5 25,559 449 1.8 Suspected Typhoid Fever 75,097 317 0.4 81,598 53 0.1

4 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 70

60

50

40

30

20 in average per day Newly infeted cases 10 Figure 2: EVD outbreak in Sierra Leone, 0 2014-2016 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 Dec 14 Jan 15 Feb 15 Mar 15 Apr 15 May 15 Year

1.3 Progress towards achievement by the launching of the one health platform at of international and national national and regional levels which is geared to enhance coordination of multi-sectorial targets in health indices response to health threats. The GHSA was launched in 2014 with the aim In 2004, Sierra Leone adopted the Integrated to build country capacity to control infectious Diseases Surveillance and Response (IDSR) diseases through a multi-lateral and multi- strategy and adapted the technical guideline sectoral approach. In early 2016, Sierra Leone with the selection of 22 priority diseases. became one of 50 partner countries to endorse The country successfully rolled out IDSR in the Global Health Security Agenda (GHSA). all government health facilities and some The Ministry of Health and Sanitation (MoHS) private and mission facilities also having in collaboration with the Office of National representatives. The country has also rolled Security (ONS), Civil Society Organizations out the electronic integrated diseases (CSOs) and partners developed a 5-year GHSA surveillance and response (e-IDSR) into the roadmap in April 2016 following an assessment District Health Information System (DHIS2) in of the twelve technical areas. all districts in 2016. In 2008, further revision of the IDSR guidelines was conducted to include The 2016 JEE complemented this initiative and the International Health Regulations (IHR) revealed challenges in the implementation 2005. of 19 IHR core capacities. Progress has been made to address some of these challenges

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 5 In 2015, the list of priority diseases was At the district level, the same two-division revised and updated from 37 to 47 diseases approach is adopted; district health services including Ebola. The majority of these and the district health management both diseases are reported on a weekly or monthly under the leadership of District Medical basis. Reporting completeness rate has Officer (DMO). Overall, the health service steadily improved over the years from 74.5% organization is based on the Primary Health in 2013 to 80% in 2014 and stands at 97% as Care concept. of September 2017. The public health delivery system comprises of three levels: 1.4 Health Service Organization (a) Peripheral health units (Community Health Sierra Leone’s health service delivery system Centre, Community Health Posts, and is diverse; comprising of Government, Maternal and Child Health Posts) for religious missions, local and international primary health care; NGOs and the private sector. There are also public, private for profit, private non-profit and (b) District hospitals for secondary care; and traditional medicine practices. (c) Regional/national hospitals for tertiary care. The Ministry of Health and Sanitation is responsible for overall policy direction and is organized into two main divisions at the central level: medical services and management services.

6 NAPHS EXECUTIVE SUMMARY | 2018 - 2022

Health Service organization

Tertiary Care

Secondary Care Regional/National Hospitals

Primary care (Public) (Private) DistrictGovernment Hospitals Regional/National Hospitals PrivateHospitals & Mission Chiefdom Peripheral Health Unit level Private/NGOClinics Section HealthCommunity Centre CHC level

Village HealthCommunity Post CHC level HealthMaternal Centre Child MCHP

Figure 3: MoHS Health Care Services Organization

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 1747 1.5 Human Resource for Health Councils for the District Health Management Team (DHMT). These grants cover activities As of 2010, Sierra Leone had only two skilled such as vaccination campaigns, epidemic providers per 10,000, ranking the country control, infrastructure improvements and the fourth lowest out of 49 priority low and expansion, and the operational expenses of middle income countries for health worker-to- the DHMT. population ratios. A survey of the payroll data and the HRIS database in 2015 found that the The per capita total expenditure on health country had 275 doctors, 291 midwives, 1,394 services is approximately $95 USD. The biggest nursing officers and state registered nurses contribution (76%) to this expenditure is from and 2,815 state- enrolled community health individual service seekers who pay for the user nurses in the civil service The health workforce fees (out of pocket expenditure) while 16% is suffered with the precipitated deaths of 221 from the government and 13% comes from health workers during the EVD outbreak in donors. Expenditure on health as a percentage 2014 and 2015. of total government expenditure is 10%, which is still significantly below the 15% target of the Sierra Leone therefore faces a chronic shortage Abuja Declaration. The government is heavily of skilled human health resources. In order reliant on donors and partner organizations to meet the WHO minimum standard of 22.8 for support of its health programs with funds skilled health workers per 10,000 population, flowing through budget support or directly to Sierra Leone requires approximately 14,000 the Ministry and implementing partners. more health workers.

1.7 The International Health 1.6 Health Financing Regulations-IHR

Health care costs remain very high in Sierra The revised International Health Regulations Leone, resulting in poor utilization (on average (IHR) were adopted in 2005 and entered into 0.5 visits per person per year) of health force in 2007. Under the IHR, States Parties services. reference Since the end of 2008, are obliged to develop and maintain minimum the 19 local councils (12 district councils, 5 core capacities for surveillance and response; city councils, the Freetown City Council and including at points of entry, in order to detect, the Western Area Rural Council) are now assess, notify, and respond to any potential responsible for managing health care delivery public health event of international concern. services in the country. Since 2005, tied grants amounting to about a quarter of the national health budget were transferred to the Local

8 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 These capacities were to be developed by report public health events. WHO plays the June 2012, with provision for two extensions coordinating role in IHR and, together with its up to June of 2016. In accordance with partners, helps countries to build capacities. paragraph 1 of Article 54 of the IHR, countries IHR also includes specific measures at must report on IHR implementation to the ports, airports and ground crossings to limit World Health Assembly (WHA) and the World the spread of health risks to neighbouring Health Organization (WHO) Executive Board. countries, and to prevent unwarranted travel and trade restrictions so that traffic and trade At the Sixty-eighth WHA in 2015, the IHR disruption is kept to a minimum. Review Committee on Second Extensions for Establishing National Public Health The JEE is a voluntary, collaborative, multi- Capacities and on IHR (2005) Implementation sectoral process to assess country capacity to recommended “options to move from exclusive prevent, detect and rapidly respond to public self-evaluation, to approaches that combine health risks occurring naturally or due to self-evaluation, peer review and voluntary deliberate or accidental events. The purpose external evaluations involving a combination of the external evaluation is to assess country- of domestic and independent experts”. specific status, progress in achieving the targets under the IHR, and recommend priority actions to be taken across the technical areas The WHO IHR Monitoring and Evaluation being evaluated. External evaluations are Framework was developed to address this regarded as an integral part of a continuous recommendation. The Framework consists process of strengthening capacities for the of four components; one mandatory, Annual implementation of the IHR. The JEE mission Reporting; and three voluntary, exercises reports are the result of these evaluations. (SimEx), after-action reviews (AAR) and joint external evaluations (JEE). In 2016, Sierra Leone conducted an internal self-assessment and later a full scale JEE 1.8 IHR JEE and other the findings of which were the basis for the complementary assessments development of this NAPHS 1.8.1 Joint External Evaluations-JEE

The International Health Regulations, or IHR 1.8.2 The Global Health Security Agenda(GHSA) (2005), represent an agreement between 196 countries including all WHO Member The Global Health Security Agenda (GHSA) States to work together for global health was launched in February 2014 to advance security. Through IHR, countries have agreed a world safe and secure from infectious to build their capacities to detect, assess and disease threats, to bring together nations from all over the world to make new, concrete

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 9 commitments, and to elevate global health Organization’s (WHO’s) International Health security as a national leaders- level priority. Regulations (IHR), the World Organization of The G7 endorsed the GHSA in June 2014. Animal Health’s (OIE) Performance of Veterinary GHSA acknowledges the essential need for Services Pathway, and other relevant global a multilateral and multi-sectoral approach health security frameworks. to strengthen both the global capacity and nations’ capacity to prevent, detect, and The GHSA partnership has aided several respond to infectious diseases threats whether countries to move faster towards attainment naturally occurring, deliberate, or accidental. of capacities spelt out under IHR (2005) and has in addition to individual countries, advisory In partnership with U.S. government sister partners that include the WHO, FAO, OIE, agencies, other nations, international Interpol, ECOWAS, the UN Office for Disaster organizations, and public and private Risk Reduction (UNISDR), and the European stakeholders, CDC seeks to accelerate Union. progress toward a world safe and secure from infectious disease threats and to promote global health security as an international 1.9 The journey from IHR JEE security priority. to Country Planning

Through a partnership of nearly 50 nations, The development of the Sierra Leone National international organizations, and non- Action Plan for Health Security (NAPHS) began governmental stakeholders, GHSA facilitates with the voluntary enrolment of Sierra Leone collaborative, capacity-building efforts to among the countries to undertake the JEE. achieve specific and measurable targets, Sierra Leone was among the very first nations while accelerating achievement of the core in Africa to accept to undergo the JEE. capacities required by the World Health

10 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 The journey from IHR JEE to Country Planning Sept Internal Self 2016 Assessment

JEE Nov Conducted 2016

Feb JEE Report 2017 Published

Stakeholder Mar Mobilization 2017

Oct NAPHS 2017 Developed

NAPHS Nov Costed 2017

NAPHS Apr Prioritazation and Resource 2018 Mapping

NAPHS Sep Launched 2019

Figure 4: Journey from IHR JEE to Country Planning

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 11 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 VISION, MISSION, OBJECTIVES, GUIDING PRINCIPLES AND CORE 2 VALUES OF THE ACTION PLAN

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 13 VISION A country safe and secure from health and economic consequences of public health”.

MISSION “A health system able to prevent, detect and respond to public health threats through all – sector collaboration.

14 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 Prevent the likelihood and reduce the consequences of outbreaks and other public health hazards.

General Build national capacities for Objectives early detection and e‡ective response to public health emergencies and other events of public health concern.

Foster all-sector partnerships for e‡ective prevention, detection and response to public health emergencies and other events of public health concern.

Core Values 2016 A minimum set of principles have been identified to guide behaviour and establish the right environment for inter-sectoral engagement during the implementation of this plan.

01 02 03 04 05 06 07

Strong National Mutual Community Research leadership Respect involvement

Muliti-sectoral Transparency Ethical collaboration Vision

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 15 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 3

METHODOLOGY PROCESS FORTHE DEVELOPMENT OF 3 THE ACTION PLAN

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 17 3.1 Review of JEE and other by the national experts in working groups Assessments Recommendations drawing representation from IHR-relevant sectors. The JEE report recommendations In accordance with the WHA recommendation were reviewed for relevance and to ensure WHA69/5.231 for States Parties to develop existing weaknesses and gaps are addressed National Action Plans within one year per thematic area. of the JEE, the MoHS started mobilizing other government agencies and partner organizations in March 2017 to set in 3.2 Prioritisation of Activities motion plans for the development of the by Technical Area country’s National Action Plan for Health Security (NAPHS). The JEE report, which Based on the result of the situation analysis, was published in February 2017, identified thematic working groups developed gaps in capacity and a series of coordination objectives and strategic actions that address meetings were held under the national One the weaknesses and gaps in the country’s Health coordination platform to move forward health security across the 19 thematic areas. in the process Responsible directorates, programs, agencies or authorities for implementation per strategic In October 2017, over 75 participants attended action were identified and relationships to a multi-disciplinary and multi-sectoral existing plans, project or activities spelled out. workshop organized by the Sierra Leone MoHS to develop the country’s NAPHS. These This prioritization process with cross-sector in-country experts were drawn from MoHS consensus ensured making the best use of directorates and disease control programs, resources, ensuring that the greatest needs other government departments and agencies are addressed and that both the planning and partner organizations (WHO, IOM, FAO, and resource allocation are rational and US CDC, China CDC, Public Health England, transparent. DFID and GIZ). Each strategic action was operationalised A situation analysis of the country’s IHR status through development of low level activities with was conducted to take stock of the current coherence to fully address the priority strategic level of capacities for health security. A actions, objectives and situation analysis review of the JEE report, draft 2016 IHR 2-year recommendations. A logical framework work plan and the CDC-supported GHSA for coordination and accountability among 5-year country roadmap was conducted in stakeholders was developed per activity with a participatory and inclusive process. This identification of level of responsibility, output was complimented by discussion and review indicators, implementation assumptions

18 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 and implementation schedule. This will be and Response Plan, the REDISSE project, essential for the monitoring and periodic the One Health coordination framework, review of implementation of the plan and the 5-year GHSA roadmap, the Environment inform necessary adjustments to the plan. Protection Agency Strategic Plan 2017-2021 The prioritization process will ensure that and the Sierra Leone Agenda for Prosperity. stakeholders are working towards common These linkages will enhance adequate and goals and expected outcomes. sustainable resource allocation, advocacy, monitoring, accountability and efficiency during implementation. 3.3 Linkage with other Programmes/ Initiatives 3.4 Sector Wide Approach In the process of developing the plan, a Preparedness for and management of health comprehensive review of the strategic actions security threats requires a coordinated was conducted to identify overlap with existing multisectoral approach as capacities for plans, programs and activities. While taking surveillance, identification of threats, laboratory note of this overlap for synergy and integration, confirmation, risk assessment, response and necessary adjustments in the plan were made coordination of efforts may involve many for efficiency and to eliminate duplication. sectors outside human health. The process of developing the NAPHS adopted a Sector Wide Approach (SWAp) with the government The MoHS has ensured that proposed activities agencies working together with development are linked with the draft National Health Sector Strategic Plan. This NAPHS is also partners. linked with other on-going national strategies, programs and projects including the Health Sector All Hazard Emergency Preparedness

Country Institutional Flow of Monitoring Leadership and Management Resources and Evaluation ownership Capacity

Setting of a clear Clear roles and Funds activities Institutionalised understanding responsibilities in the national of leadership established Plan mandates across sectors

Figure 5: Benefits of the SWAp

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 19 During the preparatory period leading to The MoHS also mobilised strategic partnership the JEE and to the development of the with other government ministries and agencies NAPHS, the MoHS took leadership and and in-country health partners whose cross- mapped all government agencies and partner disciplinary expertise was critical to the organizations who play a role in implementing successful preparation and action planning. health security activities. This widened the scope of participation in conducting the JEE This further embeds the One Health approach and in action planning. and integrated health security development in the planning process. The MoHS will take forward this partnership with all relevant 3.5 Strategic Partnership Planning stakeholders and existing frameworks (FAO, Workshop Scope Objectives OIE, Global Health Security Agenda, World Bank and other development agencies) to support In line with the WHO Strategic Planning the plan for expedited IHR implementation with Portal (SPP) framework, Sierra Leone fully transparency and accountability in external kept national and international partner investment, progress, and the delivery of organizations including UN agencies (WHO, action plan. Information from the monitoring FAO, OIE) informed of the preparations and and evaluation benchmarks will be openly progress during the development of the shared including on the WHO SPP platform. national action plan. This enabled international partners to support the preparatory activities and the planning workshop.

20 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 GOVERNMENT OF SIERRA LEONE

MINISTRIES, DEPARTMENTS AND AGENCIES (MDAs)

MOH • MAF • EPA • ONS

PARTNERS

Figure 6: Strategic partnerships for health security – Sierra Leone

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 21 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 JEE FINDINGS AND COMPONENTS OF THE NATIONAL ACTION PLAN 4 FOR HEALTH SECURITY

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 23 4.1 Findings of Joint External 4.2 Components of NAPHS Evaluation The NAPHS was developed based on all the The Joint External Evaluation team evaluated 19 core capacities/technical areas as shown all the 19 core capacities as per the International below. For each core capacity, objectives and Health Regulations (2005). Each core capacity appropriate activities to address the objectives has one or more indicators that were scored were developed with more focus on areas between 1 (lowest capacity) and 5 (maximum that had a poor score. The objectives were capacity). The figure below summarizes the formulated based on the JEE indicators. scores for the various core capacities.

Scores for the Joint External Evaluation JEE Technical Areas Linking Public Health and Security 4 1 National Legislation, Policy and Financing Real Time Surveillance 3.5 2 IHR Coordination, Communication and Advocacy Emergency Response Operations 3.3 3 Antimicrobial Resistance Immunization 3 4 Zoonotic Disease Risk Communication 2.8 4 Food Safety Reporting 2.5 6 Biosafety and Biosecurity Workforce Development 2.2 7 Immunization Radiation 2 8 National Laboratory System Chemical Events 2 9 Real Time Surveillance Food Safety 2 10 Reporting IHR Coordination, Communication 2 11 Workforce Development National Legisislation, Policy and Financing 2 12 Preparedness National Laboratory System 1.9 13 Emergency Response Operations Points of Entry 1.5 14 Linking Public Health and Security Authorities Medical Countermeasures 1.5 15 Medical Countermeasures and Personnel Deployment Biosafety and Biosecurity 1.5 16 Risk Communication Antimicrobial Resistance 1.3 Preparedness 1 17 Points of Entry Zoonotic Disease 1 18 Chemical Events 0 AVERAGE SCORE 5 19 Radiation Emergencies

Figure 7: JEE Average Score (Maximum 5) Figure 8: JEE Technical Areas

24 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 4.3 Costing of Activities and JEE process. Further work was then done to Summary of Cost Categorisation identify quantities of goods/services that would by JEE Thematic Areas be required, estimate the prices and adjust the proposed activities based on costing results. The Government of Sierra Leone with the The 5-year cost estimate developed during support of partners involved in the JEE process the planning exercise for implementing the convened a workshop to review and cost the Sierra Leone NAPHS is approximately US$ draft NAPHS. This workshop that was held on 291million. The costs of implementation are 7th – 10th November 2017 brought together heavier on the 1st year of the implementation key government agencies and stakeholders period with the costs almost evenly distributed as well as IHR and costing experts from over the rest of the 4 years. The costs are WHO Regional Office and the Headquarters. slightly skewed towards the earlier portion of The NAPHS contained the realistic activities the implementation period. required to attain the desired objectives as outlined in the recommendations of the

Thematic Area 2018 2019 2020 2021 2022 Total Usd Prevent 56,256,776,138 56,182,444,338 46,879,879,138 46,816,280,138 56,597,865,138 262,733,244,890 35,266,207 Detect 348,633,434,465 301,937,855,965 310,286,208,040 282,604,417,040 305,869,215,040 1,548,586,130,550 207,863,910 Respond 31,247,654,500 14,041,873,000 18,275,492,667 13,616,199,667 15,611,744,667 92,792,964,501 12,455,431 Other IHR Hazard 115,594,595,077 100,238,243,077 31,362,706,877 10,318,833,950 7,294,208,950 264,808,587,930 35,544,777 and POEs Total (Leones) 551,732,460,179 472,400,416,379 406,804,286,721 353,355,730,795 385,373,033,795 2,168,920,927,870 Total (Usd) 74,058,048 63,409,452 54,604,602 47,430,299 51,727,924 291,130,326 291,130,326

Table 3: Costs of NAPHS activities by year of implementation

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 25 4.4 Cost breakdown by technical area over years

Virtually all the technical areas have their costs of implementation of the NAPHS spread over the whole 5 years. The costs are skewed towards the earlier portion of the implementation period. This is subject to change after the broad based stakeholders meeting to prioritize the activities has been held.

NAPHS Costing by Technical Areas in USD

Real Time Surveillance 143,007,414 Immunization 50,478,414 Antimicrobial Resistance 12,710,631 Chemical Events 12,345,096 Zoonotic Disease 9,470,723 Labaratory 8,646,852 Emergency Response Operations 6,336,419 Points of Entry (PoE) 4,954,607 Risk Communication 2,747,025 Biosafety and Biosecurity 2,567,806 Radiation Emergencies 2,072,383 IHR Coordination, Communication and Advocacy 1,935,078 Food Safety 1,128,503 Preparedness 986,219 Linking Public Health and Security Authorities 364,581 National Legislation, Policy and Financing 213,602 Medical Countermeasures and Personnel Deployment 177,085 Reporting 166,453 Workforce Development 131,479

20,000,000 40,000,000 60,000,000 80,000,000 100,000,000 120,000,000 140,000,000 160,000,000

Figure 9: NAPHS Costing by Technical Areas in USD

26 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 4.5. High Prioritized Activities

Item Amount (LE) Amount (USD) Medical Counter-measures and Personnel 132,630,000 17,270 National Legislation, policy and Financing 538,875,510 70,166 Reporting 560,129,000 72,933 Linking Public Health and Security 712,630,000 92,790 Preparedness 895,300,000 116,576 Radiation Emergencies 2,557,398,000 332,995 Food Safety 3,383,571,000 440,569 Emergency Response Operations 5,166,051,500 672,663 Bio safety and Bio security 6,124,939,000 797,518 Workforce development 6,265,592,000 815,832 Risk Communication 7,132,482,480 928,709 IHR Coordination 7,140,000,000 929,688 Laboratory 11,041,238,000 1,437,661 Zoonotic Diseases 11 525,646,690 1,500,735 Chemical Events 11,925,743,000 1,552,831 JEE Indicator PoE.1 12,177,678,166 1,585,635 Antimicrobial Resistance 19,083,684,592 2,484 855 Immunization 93,410,747,000 12,162,858 Real Time Surveillance 189,463,254 ,000 24,669,695 Total (USD) 389,237,589,938 50,681,978

Table 4: High Priorited Activities

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 27 4.6 Sierra Leone Health Security manage the flow of funds. For additional Naphs Financial Sustainability funding resources, MoHS and MAFS will advocacy for more budget allocations to their • Value-based investment may take time to respective ministries. MoHS and MAFS will realise and careful financial management is approach donors and development partners needed year to year for additional funding for this plan. • Estimating the certainty that domestic or donor resources are sustainable each investment year will allow the country to manage and mitigate 4.8 Platform For National Action Plan the risk 4.8.1 Linkage with existing plans • Long-term progress against the IHR requirements are more likely to be met using Sierra Leone already has a One Health long- term financial planning methods platform that involves collaborative efforts of multiple disciplines working locally, • The resource mapping exercise should be reiterated on a smaller scale and with a degree nationally, and globally to attain optimal of regularity to ensure appropriate adjustments health for people, animals, plants and our are made. environment. This platform was developed based on the following global strategies and policy frameworks: WHO International Health Regulations (IHR-2005), Global 4.7 Financing of National Action Health Security Agenda (GHSA), OIE (World Plan (Domestic, SPP and Further Organization for Animal Health), National Donor Engagements) Public Health Emergency Management Committee (NPHEMC). MoHS and MAF will use the NAPHS as an advocacy tool to mobilize resources Implementation of the NAPHS will utilize for both domestic and external sources. the existing coordination mechanisms The Government of Sierra Leone, through with multi sectoral collaboration with the the Ministry of Finance and economic different stakeholders to avoid duplication development, will play a lead role of of resources, while enhancing synergisms improving domestic revenues. An increase with the existing plans, programs and in government revenue will indirectly impact ongoing activities to maximize health gains. the capacity of the government to finance The ongoing World Bank Regional Disease health services. It is anticipated that a new Surveillance Strengthening Enhancement Health Financing strategy is able to collate (REDISSE) is one of the projects that will and develop a rigorous sector-wide budget, have synergic effects to the implementation resource map, and processes to better of NAPHS. Others include: Sierra Leone

28 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 National health sector strategic plan 2017 to By engaging multiple sectors, partners can 2021 and the National Health Sector Recovery leverage knowledge, expertise, reach, and Plan (2015 – 2020), resources, benefiting from their combined and varied strengths as they work toward the 4.8.2 Interplay between Relevant Sectors shared goal of securing Sierra Leone’s Public Health security health capacity. The Government of Sierra Leone will make deliberate efforts to collaborate with various The public health problems of the NAPHS are stakeholder groups: government sectors, complex, and in many cases, a single health UN agencies, international organizations, issue may be influenced by interrelated social, partners, civil society, and private sector environmental, and economic factors that (e.g., health, environment, economy) to jointly can best be addressed with a holistic, multi- achieve the desired purpose of the NAPHS sectoral approach. implementation.

01 02

Political Political Stability Commitment

NATIONAL ACTION PLAN ENABLERS

Transitioning Macroeconomic back into the Agenda for Stability and Figure 10: Prosperity Plan Sustainable National Action Economic Growth Plan Other 03 04 Enablers

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 2934 330 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 4.9 Contribution to Health System An effective health care system will contribute Strengthening and UHC 2030 to attainment of Universal Health Coverage (UHC) by ensuring that people have access Implementation of the NAPHS will make to the health care they need without suffering significant investments in the different health financial hardship. It also helps drive better systems blocks; Leadership and governance, health and development outcomes. Service delivery, Human resources for health, Health financing, Medical products and health This approach is key to ending extreme technologies, Health information systems and poverty and increasing equity and shared research, Health security and emergencies, prosperity. It is also an essential part of the Community engagement and health promotion Sustainable Development Goals (SDGs): SDG there by contributing to building a robust, 3 includes a target to “achieve universal resilient and responsive health system for health coverage (UHC), including financial risk Sierra Leone. These plans form the foundation protection, access to quality essential health for better health security, preventing deaths, care services, and access to safe, effective, tackling diseases, strengthening the health quality, and affordable essential medicines system and improving the health and well- and vaccines for all.” SDG 1, with the goal to being of the population. end poverty in all its forms everywhere, is also in peril without UHC, as hundreds of millions of people are impoverished by healthcare costs every year.

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 31 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 5 DELIVERY OF THE ACTION PLAN

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 33 5.1 Roles and Responsibilities Some stakeholders will be depended upon to of Key Stakeholders provide support either technical, financial or the intangibles such as community support. Various stakeholders will be active for the Overall, the NAPHS requires all the actors to duration of the implementation of the NAPHS. work concurrently so that the targets are met The roles will vary from providing leadership across the board while monitoring progress to carrying out the activities themselves. towards the achievement of goals set.

The roles and responsibilities of the various entities that will be involved in the implementation include the following:

OFFICE OF THE PRESIDENT PARLIAMENT LINE MINISTRIES OTHER Ministry of Health and Sanitation O­ce of National Security - ONS Ministry of Agriculture and Forestry Military and Ministry of Defence Ministry of Finance Paramount chiefs & Councillors Ministry of Internal Aairs Pharmacy Regulatory Board Ministry of Local Government and Rural Development Sierra Leone Standards bureau Ministry of Technical and Higher Education Environment Protection Agency – EPA Ministry of Information and Communication Medical & Dental Council and Nurses Board Ministry of Marine Resources Ministry of Transport and Aviation Ministry of Social Welfare, Gender and Children’s Aairs WHO, OIE, FAO, other UN Agencies, CDC, Ministry of Foreign Aairs National and International Agencies Academic Institutions Civil Society The Media

Table 5: Roles and Responsibilities of Key Stakeholders

34 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 5.2 Coordination Mechanisms partners will further ensure the actualization and Framework for Delivery of NAPHS. The coordination mechanisms and of Action Plan framework for delivery of the national action plan for health security 2018-2022 is designed The implementation of the NAPHS will be to further strengthen existing coordinating delivered through the various fora with a strong structures such as inter-ministerial council country ownership, commitment and political and one-health coordinating committees. The will. In addition, a continuous engagement of figure 11 highlights the inter-relationships in stakeholders, collaboration and support from coordinating structures at the national level.

OFFICE OF THE PRESIDENT

NATIONAL INTER MULTI-AGENCY MINISTERIAL CO-ORDINATING COMMITTEE (NMCC) NATIONAL FOCAL POINT Figure 11: National Inter-ministerial Coordinating Committees structure

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 35 5.3 Inter-Ministerial Committee for The DMO will oversee, and be responsible implementation of NAPHS for coordinating and updating relevant MDAs and other stakeholders through existing fora. The Inter-Ministerial Committee is the highest The DMO will ensure strong collaboration, decision-making body responsible for policy effective information sharing and coordination formulation and coordination oversight with relevant MDAS in the districts. In addition, and decision-making. The Committee will the district structures will share information present to cabinet and the Presidency and regularly and report on the implementation of secure high- level strategic decisions as and NAPHS with national structures. when necessary - on issues of NAPHS, IHR, including emergencies and public health 5.5 Monitoring and Evaluation threats. of the Plan 5.4 District level implementation Monitoring and evaluation is an of NAPHS essential component for the successful implementation of any program. The NAPHS The district health management teams (DHMT) will be monitored and evaluated through a are pivotal in implementation of various comprehensive Monitoring and Evaluation national health policies and strategies, and the plan that will cover all thematic areas of the implementation of NAPHS will leverage on the health security. The plan also includes a existing coordinating structures at the district comprehensive framework that addresses level including: the Public Health Emergency indicator selection, related data sources, and Management Committee (PHEMC) which is analysis and synthesis practices, including under the leadership of the DMO; the District quality assessment, performance reviews, Disaster Management Committee which communication, and utilization. The plan will requires strong participation of the DMO also serve as the mechanism for districts and as a member; and the District One- Health national reporting, and aligning partners at Coordination Committee which DMO chairs districts and national levels around a common and DAO co-chairs. approach to country support, and reporting requirements.

36 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 List of Contributors The Government and People of Sierra Leone acknowledge the contributions made by the following individuals during the preparation of this publication.

Government of Sierra Leone Government of Sierra Leone Amara Jambai MoHS Mohammed B. Jalloh MoHS Sorie Kamara MAF Musa Bockarie MoHS Thomas T Samba MoHS Roland Conteh MoHS Amadu Tejan Jalloh MAF Samba Kamara MoHS Gack Jalloh MAF Zein Sama MoHS Amara Leno MAF P Daniel NPHA Abdul Rahman Conteh MAF Wilshire Johnson PBSL/MoHS Alie D. Jalloh EPA Agnes k. Dumbuya LABS./MoHS Hamidu D. Mansaray EPA Fay Chaloba LABS./MoHS Lovetta Joanah EPA Fatmata R.D. Jalloh LABS./MoHS Ansumana Sillah MoHS Doris Harding LABS./MoHS Alfredo J Moösa MoHS Ahmed J. Samba LABS./MoHS Alie H. Wurie MoHS Dorcas Wanjohi LABS./MoHS James Squire MoHS Rebecca B. Neale NDSP/MoHS Anthony Foday MoHS Kumba M. Kamara SLCAA Charles Ngombu MoHS Doris K. Sonda SLCAA Dauda Kamara MoHS Patrick K. Lansana PHNEOC-MoHS Edward Kamara MoHS Rubiatu Nicol SLRCS Festus.U. Amara MoHS Mohamed Boie Jalloh RSLAF/Medical Florence Max-Mcarthy MoHS Mohamed P. Jalloh ONS Harold Thomas MoHS John K. Sesay ONS Christiana Fortune MoHS Sabiatu Bakar ONS

James Akpablie MoHS Roland Suluku Njala University Manso S. Kargbo MoHS

NAPHS EXECUTIVE SUMMARY | 2018 - 2022 37 Partners & Stakeholders Partners & Stakeholders Alex Chimbaru WHO Michael Mahar US-CDC Charles Njuguna WHO Ansu Kamara US-CDC Shikanga O-Tipo WHO Nyabengi Tito Tipo FAO Anderson Latt WHO Tesfai Tseggai FAO Anna Maruta WHO Momoh .F.Lavahun FAO Claudette Amuzu WHO Garba Maina Ahmed FAO Jonathan Green WHO Dorothy Peprah USAID Robert Musoke WHO Marcus Eder PHE Stanley Muoghalu WHO Ian Rufus PHE Steve Sesay WHO Duraman Conteh GIZ Tobin Ekaete WHO Sandy Jasama AfDB Victor Caulker WHO Tao Shen China CDC Wilson Gachari WHO Jinsong Li China CDC Immaculate Nabukenya WHO Isata Wurie APHL Victor Tugumizemu WHO Joseph M. Sembo IOM Ludy Suryantoro WHO HQ Sanusi Savage IOM Glenn Lolong WHO HQ Dayo Bismarck Adusei WHO Consultant S. Walters e-Health Paul Verboom WHO Consultant James Bangura PREDICT Tushar Singh US-CDC Mukeh Fahnbulleh P&R Regan Hartman US-CDC Tina Dickenson Breakthrough Action Gladys Anyo US-CDC James S. Fofanah Breakthrough Action David H. Jimmy US-CDC

38 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 NAPHS EXECUTIVE SUMMARY | 2018 - 2022 4539 40 NAPHS EXECUTIVE SUMMARY | 2018 - 2022