SIERRA LEONE ANNUAL REPORT A YEAR IN FOCUS 2018 Cover photo: WHO / S. Gborie Credits attributed towards the editorial management and publication of this report – Editorial contents: Saffea Gborie & WHO Technical Teams Publication design: LedCool Graphix, South Africa LIKE, FOLLOW + TWEET to us on social media whosierraleone @whosierraleone Photo: WHO/Saffea Gborie SIERRA LEONE ANNUAL REPORT A YEAR IN FOCUS 2018 YEAR IN FOCUS SIERRA LEONE ANNUAL REPORT 2018 Photo: WHO/Saffea Gborie 2 YEAR IN FOCUS SIERRA LEONE ANNUAL REPORT 2018 Contents INTRODUCTION • Executive Summary 5 ESSENTIAL HEALTH SERVICES • Immunization 9 • Surveillance 12 • Reproductive and child health 13 • Maternal death surveillance and response 14 • Emergency obstetric and newborn care 15 • Safe blood transfusion services 16 • Quality of care 17 • Nursing and midwifery 18 • Child and adolescent health 19 • Nutrition 21 • Malaria 24 • Neglected tropical diseases 25 • Tuberculosis 26 • HIV 28 • Noncommunicable diseases and mental health 31 - Tobacco use 31 - Diabetes 31 - Cancer 32 - Mental health 32 HEALTH SYSTEM STRENGTHENING • Health system strengthening 34 HEALTH SECURITY AND EMERGENCIES • Integrated disease surveillance and response 38 • Emergency Preparedness and response 41 • Infection prevention and control 42 • Laboratory system strengthening 43 • Public health and the environment 46 OPERATIONS • Making the organization work 50 • The nature of operations and support 51 • Staff association 52 ALLOCATIONS AND EXPENDITURES • Allocations and expenditures 55 3 YEAR IN FOCUS SIERRA LEONE ANNUAL REPORT 2018 Photo: WHO/Saffea Gborie 4 YEAR IN FOCUS SIERRA LEONE ANNUAL REPORT 2018 Executive Summary Throughout 2018 the World Health Organization data at the national level. This resulted in 853 Sierra Leone Country Office with the generous out of more than 1300 health facilities in the support of its donors including DFID, US-CDC, country with an average intra-district reporting USAID, GIZ, the World Bank and many others, rate of 99% by the end of the year, improving supported the Government of Sierra Leone significantly the effectiveness and performance through the Ministry of Health and Sanitation of surveillance activities. The aim is to complete (MoHS) and other line Ministries to implement the roll-out by the second quarter of 2019. This the priority health agenda in the country. Our means that disease surveillance activities will be support this year will continue to show immediate fully transformed to an electronic system in all impact on some of the health outcomes, whereas 1,300 public health facilities across Sierra Leone, other activities will have medium and long term making it the only country in the African region impact on the health system. with such progress on disease surveillance. This achievement will support the MOHS to ensure WHO assistance is diversified, and is targeting accurate and timely reporting of priority diseases priority programme areas in the MoHS National and health conditions in Sierra Leone. Health Sector Strategic Plan, ranging from high level strategic policy formulation, development of Major milestones were also achieved in guidelines and strategies, technical skills transfer improving reproductive, maternal, child, newborn through training and mentorship programmes, and adolescent health. Being a national health to logistics and operational support. This priority, WHO prioritized support to the Ministry varied support is aimed at enhancing a health in both capacity development at various levels system that is robust and capable of preventing, as well as the formulation and review of strategic detecting and responding to disease threats and policy documents that will help in improving health concerns, while at the same time effective the outcome of maternal and child health enough to improve access of the general service delivery. Improving the quality of the population to basic quality health services Maternal Death Surveillance and Response everywhere. (MDSR) programme resulted in streamlining it into community based surveillance and This year’s Annual Report: ‘A Year in Focus’ reporting of maternal deaths in four districts. highlights the major outcomes of this support while WHO supported the establishment of a Quality also stating some of the challenges and lessons of Care Programme, in the Ministry, following learned emanating from the sector in 2018. prioritization of the issue by the Government. Sierra Leone is now one of 10 countries 2018 saw remarkable progress in the health participating in the Global Network for Improving sector. Unlike 2017, when the country was struck Quality of Care for mothers, Newborn and by a devastating landslide, no major health Children. The Quality of Care Programme emergencies occurred in 2018. Therefore, all addresses issues impacting on quality service available resources could be directed to efforts delivery in public health facilities. aimed at strengthening vital health services and core capacity development at different levels of Strengthening health systems in countries, to the Ministry of Health and Sanitation. improve health outcomes, is a major agenda item for WHO. In 2018 the Country Office Improved national capacity for effective disease supported strategic leadership and management surveillance is a major priority for both WHO training for health authorities in all the districts and the MoHS and this is demonstrated by the in Sierra Leone, strengthening the capacity of investments made to revitalize and strengthen the District Health Management Teams (DHMT) Integrated Disease Surveillance and Response to deliver quality services to the population. (IDSR) in Sierra Leone. This includes the use Further, 97 MoHS officials with governance, of information technology for improved disease leadership and managerial responsibilities at surveillance, reporting and data management. the district hospitals and DHMTs were trained in By December 2018, all public health facilities line with the MoHS District Health Management in 10 of Sierra Leone’s 14 health districts had Strengthening Strategy which was developed in rolled-out e-IDSR to report disease surveillance 2016. 5 YEAR IN FOCUS SIERRA LEONE ANNUAL REPORT 2018 Immunization occupies a centre stage in health Treatment for MDR TB patients saw a significant service delivery. To ensure access to vaccination improvement with an increased bed capacity, in services in Sierra Leone, WHO continued 2018, 126 MDR–TB cases were detected and to support the MoHS to implement the third enrolled into care, representing a 23% increment generation Comprehensive Multi Year Plan compared to the performance in 2017. (CMYP) which guides immunization services in the country for the next few years. The The prevalence of HIV has remained stable at support provided translated into improvement 1.5% since 2008. Estimates for 2018 showed in the country’s immunization coverage, and Sierra Leone is continuing to make progress introduction of two new vaccines (measles towards the 90 90 90 fast track targets. During second dose and Inactivated Polio Vaccine or the year, WHO provided technical support IPV) into the country’s routine immunization in program review, planning, training and programme. implementation. In 2019, WHO will continue to work with the Global Fund, UNAIDS, UNICEF Despite this progress, a proportion of children and other partners to support the development remain unimmunized and ongoing effort to and implementation of health sector HIV increase coverage is needed. Dropout using acceleration plan in addition to other ongoing Bacille Calmette–Guérin (BCG)–MCV1 was support. 0.8%, using Penta 1–Penta 3 was 4%, and using Penta 1–MCV1 was 9.6%. support for polio Through the leadership of the MoHS and close surveillance in four districts using the Auto- partnership with WHO, combined with the Visual Acute Flaccid Paralysis Detection and collaboration with other partners, progress and Reporting (AVADAR) led to the reporting of 132 gains made towards improving health outcomes alerts and 33 true acute flaccid paralysis (AFP) in Sierra Leone, were made possible. Joint cases investigated, thus positively influencing the projects, where the UN works as one, such as national surveillance performance indicators, with the Saving Lives Project that is supported by the a non-polio AFP rate of 3.6/100 000 and stool UKaid, contributed significantly in making impact adequacy of 83.3%. on the lives of the people that need services the most especially women and children. The TB burden remains high in Sierra Leone. In 2018, only 75% of the estimated national WHO is grateful to its donors, including DFID, annual burden of new TB cases (23 000) were US-CDC, USAID, GIZ, the World Bank and many diagnosed and put on treatment. Further, an others, for the generous and valuable support estimated 430 patients developed multidrug that enabled us to support the work of the MoHS. resistant TB (MDR–TB) among known cases in 2018. 6 Photo: WHO/Saffea Gborie ESSENTIAL HEALTH SERVICES Photo: WHO/Saffea Gborie YEAR IN FOCUS SIERRA LEONE ANNUAL REPORT 2018 Immunization Immunization remains one of the priority public The IPV is expected to contribute to the complete health programme owing to its high impact and eradication and containment of all wild, vaccine- cost effectiveness in the prevention and control related and Sabin polio viruses such that no child of vaccine preventable diseases (VPDs). The ever again suffers from paralytic poliomyelitis. overall goal is to provide equitable