Non-Communicable Diseases (NCDs) Policy

Objectives

Sierra Leone’s National Non-Communicable Disease (NCD) Policy seeks a country free from preventable illness and death from NCDs. Its mission is to improve health and wellbeing through cost-effective, evidence-based interventions and an enabling environment for quality NCD services at every level of care.[1]The policy aims to guide healthy development and wellbeing while accelerating reductions in preventable and premature NCD mortality.[1]

The policy responds to a substantial and diverse disease burden: NCDs and injuries accounted for 41% of deaths in 2016, with an estimated 29,700 deaths annually and a 30% probability of premature death from the principal NCDs.[2]It recognises chronic diseases as shaped by genetic, physiological, environmental and behavioural factors, and links them to poverty, catastrophic health expenditure and lost household income.[2]

• Strengthen leadership, governance and health-system capacity for NCD prevention and control.[3]
• Mobilise sustainable funding, partnerships and networks for NCD activities at all levels.[3]
• Promote healthy lifestyles and reduce tobacco use, harmful alcohol use, unhealthy diets, physical inactivity and air pollution, while addressing hypertension, overweight and obesity, hyperglycaemia and hyperlipidaemia.[4]
• Deliver prevention, screening, early detection, diagnosis, treatment, long-term management, rehabilitation and palliative care across the NCD continuum.[4]
• Establish monitoring, evaluation, research and surveillance systems that support evidence-based decisions and assess intervention effectiveness.[3]

Priority conditions include cardiovascular disease, cancers, chronic respiratory disease, diabetes, chronic kidney disease, epilepsy, sickle-cell disease, injuries, mental health conditions and alcohol-use disorders.[3][4]The policy also recognises haemoglobinopathies, neurological, digestive, sensory, skin and musculoskeletal conditions, alongside violence and other injuries, as relevant contributors to disease and disability.[2][5]

Action is organised into 10 intervention areas under three domains: Leadership and Governance, Health Promotion, and NCD Services.[3]The strategic orientation is people-centred, equitable and integrated, covering health promotion through to tertiary and palliative services and aligning NCD action with universal health coverage and the social determinants of health.[6]

The policy is intended to strengthen national attention to NCDs following the 2013–2017 NCD policy and strategic plan, in a setting where NCDs had received limited prominence within broader health policy and competed with communicable disease and reproductive, maternal, newborn, child and adolescent health priorities.[5]It aligns with Sustainable Development Goal commitments, the World Health Organization Framework Convention on Tobacco Control, relevant global NCD strategies, the Africa Health Strategy and Sierra Leone’s Medium-Term National Development Plan 2019–2023.[5][1][3]

Implementation

Implementation uses an integrated, multisectoral and phased model, recognising that NCD risk factors and determinants extend beyond the health sector and that scale-up must reflect local capacity and resources.[6][7]The approach combines practical, cost-effective interventions, including World Health Organization Best Buys, with a continuum of care spanning primary prevention, treatment, tertiary care and palliative care.[1]

• Integrate a basic NCD package into existing primary health-care services, particularly at Community Health Centre level, using the World Health Organization Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-Resource Settings.[7]
• Strengthen referral pathways from primary to secondary and tertiary facilities, with higher-level services managing advanced conditions.[7]
• Expand workforce capacity through training, continuing education, clinical guidance, standard operating procedures and standardised health-promotion materials.[4][7]
• Improve availability and affordability of essential medicines, diagnostics, equipment, supplies and tools across all levels of care.[4][7]
• Develop legislation and supportive policies on tobacco, drugs and alcohol, alongside wider measures in trade, agriculture, transport and urban planning.[8][3]

The Ministry of Health and Sanitation leads policy development, implementation and accountability through the Directorate of NCDs and Mental Health, established in 2017 and responsible for NCDs, mental health, physiotherapy and rehabilitation.[9][6]National coordination also involves the National NCD and Injuries Commission, technical working groups, district focal persons and District Health Management Teams.[7]The Commission and its technical working groups provide oversight and coordination for the policy, five-year strategic plan and implementation plans.[10]

District Health Management Teams are expected to disseminate the policy, prepare district operational plans, coordinate partners, integrate NCD actions into annual health and hospital plans, supervise service delivery, build provider capacity and develop community programmes.[11]They also provide district-level leadership for monitoring and evaluation and support the use of national indicators and milestones.[11][12]

Implementation involves government ministries and agencies, local councils, parliamentarians, development partners, civil society, academic and professional associations, the private sector, media, communities and individuals.[11][12]Non-health ministries are assigned roles in implementing cross-sectoral measures and enforcing relevant legislation, while local councils and parliamentarians contribute to financing, legislation, monitoring and evaluation.[11]Academic and professional bodies support research, curricula, pre-service education, technical assistance and provider regulation.[12]

Community delivery includes integrating NCD education into reproductive, maternal, newborn, child and adolescent health, nutrition and communicable-disease activities, while developing broader education strategies and materials.[13]The policy also envisages stronger links between district providers and traditional healers, drug peddlers and low-level pharmacies; the assessment cited found that community health workers had not yet incorporated NCDs into their scope of work.[13]

Monitoring and evaluation are to be embedded in routine health-management information and surveillance systems, supported by research, periodic performance reviews, regular monitoring visits and annual review meetings.[4][7][12]The monitoring frameworks attached to the five-year NCD strategic plan and implementation plans cover leadership and governance, health promotion and NCD services.[10]Surveillance strengthening includes the national cancer registry and Connaught stroke register, although both were reported to have limited geographic coverage.[13]

Resource mobilisation relies on domestic funding, donors, development-partner assistance and private-sector contributions, supported by evidence-based advocacy using analysed and packaged NCD data.[11][12]Financing, staffing and implementing-partner capacity remain constrained, and the supplied material provides no quantified budget, allocation, costed funding gap or financing target.[9][4]

Monitoring & Evaluation

Monitoring and evaluation are intended to track implementation, service coverage, disease burden and intervention impact within a government-led accountability structure. The Ministry of Health and Sanitation, through the Non-Communicable Diseases and Mental Health Directorate, leads policy development, implementation and accountability, supported by the National NCD and Injuries Commission, technical working groups, district focal persons and District Health Management Teams.[6][7][10]

• Establish a functional monitoring and evaluation framework covering policy implementation, achievement of the policy goal and objectives, and the full continuum from prevention to palliative care.[13][4][12]
• Integrate non-communicable disease prevention, control, surveillance and service data into routine health-management information systems, including District Health Information System reporting.[13][4]
• Conduct regular monitoring visits, periodic performance reviews and annual review meetings, using monitoring and evaluation frameworks attached to the five-year strategic plan and its implementation plans.[13][7][12][10]
• Strengthen research and surveillance, including maintenance of a national repository of non-communicable disease research and expansion of limited-coverage systems such as the national cancer registry and Connaught stroke register.[13][7]
• Use population risk-factor surveys, disability data, facility assessments and treatment-continuum measures to guide planning and identify gaps in screening, diagnosis, treatment and disease control. The 2009 STEP-wise approach to Surveillance survey found that 70–75% of the population had one or two risk factors and 27.0% had three or more.[5][9][13]
• Develop and use national indicators and milestones through district-level leadership by District Health Management Teams, while the NCD and Injuries Commission and technical working groups oversee and coordinate implementation plans.[11][12][10]
• Promote accountability through participation by government agencies, local councils, parliamentarians, private-sector actors, communities and individuals in monitoring, evaluation and policy review.[6][11][12]

Available evidence highlights substantial service and treatment gaps that monitoring should address. In the 2017 assessment, diabetes, cardiovascular, chronic respiratory, cervical cancer and basic surgical services were available in 11%, 20%, 15%, 3% and 59% of facilities respectively, while advanced diagnostics were available in 25% of 54 hospitals.[9][13]In a cited Bo District study, screening, diagnosis, treatment and control among people over 40 with known raised fasting blood glucose or hypertension remained limited.[13]The excerpts do not provide a complete indicator set, numerical targets, standard reporting timetable beyond annual reviews, detailed evaluation methodology, surveillance protocol or formal accountability sanctions.[8][3][4][12][10]

Costing & Financing

The policy seeks sustainable and progressively increased financing for non-communicable disease prevention and control, using a phased implementation approach that can adapt to local capacity and available resources.[14][3][7]It identifies a weak, underfunded coordination, implementation and monitoring framework, alongside limited initiatives, funding and implementing partners, as major constraints.[9][13][6]

• Mobilise domestic and external resources through government leadership, evidence-based advocacy, analysis and packaging of non-communicable disease data, and collaboration with donors and other stakeholders.[6][4][11]
• Secure funding at national and district levels, including advocacy with district councils, local councils and parliamentarians on financing and budget allocation.[11]
• Use technical and financial assistance from development partners and contributions from private-sector actors to supplement government financing.[11][12]
• Provide adequate human resources and financing for the Non-Communicable Diseases and Mental Health Directorate, workforce development, service delivery, essential medicines, diagnostics, equipment, supplies and implementation tools across all levels of care.[4][7]
• Prioritise cost-effective, evidence-based interventions, including World Health Organization Best Buys and the Package of Essential Noncommunicable Disease Interventions for Primary Health Care in Low-Resource Settings.[2][1][7]

The World Bank and World Health Organization contributed technical and financial support to policy development.[8][14]The policy rationale notes that World Health Organization Best Buys could save an estimated 9,700 lives in Sierra Leone by 2025, but this is an estimated health impact rather than a monetary costing.[2]The excerpts do not specify a total budget, monetary allocation, expenditure estimate, quantified funding gap, financing share, costing methodology or detailed economic assumptions.[8][6][3][4][11]