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©MINISTRY OF HEALTH AND SANITATION Any part of this document may be freely quoted, reproduced or translated in full or in part, provided the source is acknowledged. It may not be sold or used for commercial purposes or for profit. 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