Pandemic Influenza Strategic Plan (PISP)

Objectives

The Pandemic Influenza Strategic Plan provides a national, whole-society and One Health framework for Sierra Leone’s preparedness, response and recovery over a five-year period ending in 2024. It aims to reduce influenza-related morbidity and mortality, limit disruption to essential health, social, economic and infrastructure services, and support rapid recovery and longer-term resilience.[1][2][3]The intended vision is that Sierra Leone and its partners emerge from a pandemic with minimal disease and socio-economic impacts, maintain critical public and private services, and apply lessons from the response to strengthen future preparedness.[4]

• Strengthen a sufficient, competent and integrated workforce able to detect, investigate, report and manage influenza cases at all levels, including through recruitment of at least 90% of current volunteer staff to the government payroll, workforce development, supervision and mentorship.[5][6][7]
• Establish reliable supply-chain, logistics, stockpiling, warehousing, transport and cold-chain arrangements so that response commodities and equipment are available nationally, district-wide and locally during an outbreak.[8][9][10]
• Develop integrated human and animal surveillance and laboratory systems, improve reporting platforms and laboratory capacity, and establish influenza sentinel surveillance across all 16 districts.[11][12][13]
• Strengthen coordination, leadership, risk communication, health education and community engagement so that the public receives timely, trusted information and can adopt protective behaviours during changing pandemic conditions.[14][13][15]
• Provide safe, timely clinical management and infection prevention and control, including treatment guidance, triage, case definitions, screening, trained staff, essential medicines and capacity for severe cases at home or in health facilities.[16][17]
• Improve border management at Points of Entry in line with International Health Regulations standards through screening, detection, staff training, infrastructure, equipment, electronic reporting and cross-border collaboration.[18][19]
• Promote prevention through vaccination preparedness, non-pharmaceutical measures, public behaviour change and district One Health structures that reduce animal-to-human transmission.[20][21][22]
• Maintain essential services and strengthen resilience through business continuity plans, targeting coverage of 90% of health and other essential services and businesses and resilience plans for 75% of communities by 2024.[2][23][24]

Implementation

Implementation is organised through eight strategic priorities and phased preparedness, alert, response, transition and stand-down arrangements, using risk assessment and surveillance evidence to tailor interventions by location and severity.[25][26]Delivery relies on national, district, facility and community structures and requires collaboration among government, One Health partners, development partners, civil society, businesses, essential-service providers and communities.[27][3][28]

• Coordinate overall delivery through the One Health Technical Working Group, led by the Director of Health Security and Emergencies, which holds overarching responsibility and accountability for the plan; assign a Champion and supporting personnel to each strategic priority.[2][28]
• Use the Ministry of Health and Sanitation for stewardship, implementation monitoring and health-system delivery; use the Ministry of Agriculture and Forestry for animal-health implementation and monitoring; and use the Ministry of Finance for domestic resource mobilisation and monitoring of resource efficiency.[20]
• Operate through the Emergency Operations Centre and the Department of Health Security and Emergencies, including weekly cross-sectoral surveillance meetings, the International Health Regulations National Focal Point function and coordination arrangements under the National Action Plan for Health Security.[29]
• Engage the Office of the President, Parliament, the Office of National Security, regulatory bodies, district councils, United Nations agencies, donors, non-governmental organisations and private-sector organisations in political leadership, legislation, emergency coordination, resource allocation, continuity planning and practical support.[20][28][30]
• Deliver operational activities through standard operating procedures, clinical protocols, competency-based training, simulation exercises, supportive supervision, mentorship, procurement and supply distribution, laboratory strengthening, electronic reporting, risk communication and community sensitisation.[11][31][32]
• Maintain surveillance through Integrated Disease Surveillance and Response reporting, sentinel monitoring of influenza-like illness and severe acute respiratory infection, laboratory testing, human and animal health reporting, and submission of relevant data to FluNet and FluID.[33][34][12]
• Measure progress through strategic-priority indicators with specified data sources, baselines and targets, supplemented by Joint External Evaluation, World Health Organization checklists, simulation exercises and six-monthly scorecards.[35][36]Key targets include 80% quality-data reporting from public, faith-based and private facilities by 2024, reference-laboratory feedback within seven days of sample submission, and 90% population awareness and practice of recommended preventive behaviours.[35][26]
• Review progress annually and update the plan regularly as legislation, evidence and best practice evolve; review the wider plan every five years and incorporate business-continuity updates.[37][3]
• Mobilise a rapidly accessible domestic outbreak-response fund of 1 million United States dollars for commodities, equipment, transport, human labour and warehousing when a pandemic threat is declared, with a corresponding annual government budget-line target by 2024.[9]The supplied material does not provide a comprehensive plan budget, detailed activity costs, confirmed funding sources or quantified overall funding gap.[31][9]

Monitoring & Evaluation

The plan establishes a multi-level monitoring, surveillance and accountability approach combining continuous risk assessment, integrated human and animal surveillance, laboratory systems, operational reviews and performance targets. It also identifies several gaps in reporting quality, surveillance coverage, monitoring tools and formal evaluation arrangements.[38][36][39]

• Conduct continuous national risk and severity assessment using transmissibility, disease seriousness and impact, updating findings as virological, epidemiological and clinical evidence develops to guide decisions, communication and response measures.[40][38]
• Maintain integrated One Health surveillance across human, animal and environmental interfaces, supported by community-based and cross-border surveillance, the Integrated Disease Surveillance and Response system, electronic reporting platforms and weekly district reporting.[41][42][12]
• Strengthen influenza sentinel surveillance, currently involving four sites in Western Area Urban, and establish sentinel capacity in public and private hospitals across all 16 districts.[33][13]
• Improve laboratory confirmation, specimen transport, quality assurance, reporting and feedback, including a target for reference-laboratory feedback to surveillance services and referring districts within seven days of sample submission.[43][35]
• Report influenza surveillance data through FluNet and FluID, alongside regular laboratory and epidemiological analysis; the plan identifies incomplete, delayed and inconsistent weekly reporting and weak record keeping as constraints to address.[33][34]
• Track implementation through indicators linked to the eight strategic priorities, with intended data sources, baselines and measurable targets set out in Annex Seven.[36]
• Monitor core targets including 90% population awareness and practice of preventive behaviours, 90% business-continuity plan coverage among health, essential-service and business entities, 75% community resilience-plan coverage, and 80% quality-data reporting from public, faith-based and private health facilities by 2024.[44][2][35]
• Assess workforce performance through recruitment, attrition and training indicators, including targets to recruit 90% of current volunteers to the government payroll, reduce attrition by 50%, and train all healthcare workers in influenza detection, investigation and reporting.[6][7]
• Review infection prevention and control through national and district checklists, supervisory visits, monitoring surveys and planned impact assessment of adapted influenza protocols.[31][16][17]
• Review surveillance data weekly through the Emergency Operations Centre, conduct quarterly supervision and sentinel review meetings, use a six-monthly pandemic-plan scorecard, and review overall progress annually against key performance indicators.[29][43][35][3]
• Hold the One Health Technical Working Group, led by the Director of Health Security and Emergencies, ultimately accountable for plan delivery; assign Champions for each strategic priority to oversee implementation and report to the Working Group.[2][28]

The plan also assigns monitoring and evaluation responsibilities to the Ministry of Health and Sanitation for the overall pandemic plan, the Ministry of Agriculture and Forestry for animal-health components, and the Ministry of Finance for efficiency and use of mobilised resources.[20]International Health Regulations implementation is supported by annual reporting to the World Health Assembly and World Health Organization Executive Board, with voluntary Joint External Evaluations every four to five years.[45]

Although numerous indicators, data sources and review activities are specified, the supplied material does not present one consolidated reporting calendar, independent evaluation framework or comprehensive reporting matrix.[31][36][43]

Costing & Financing

Financing provisions combine a proposed domestic emergency fund, annual government budget-line objectives, existing health-security investments and resource-mobilisation responsibilities, but the Pandemic Influenza Strategic Plan is not comprehensively costed.[9][3]

• Establish a rapidly mobilisable domestic fund of 1 million United States dollars for commodities, equipment, transport, human labour costs and warehousing when a pandemic threat is declared.[9]
• Secure a government budget line with a yearly allocation of 1 million United States dollars for outbreak response by 2024, supported by financial-needs estimates submitted through the annual fiscal-planning cycle.[9]
• Use the Ministry of Finance to mobilise domestic resources, prepare the annual fiscal budget, regulate its execution and monitor the efficiency and utilisation of resources.[20][30]
• Mobilise resources through district One Health coordination structures and through the One Health Inter-Ministerial Committee, while Parliament supports resource allocation and legislation.[23][46][20]
• Draw on the costed National Action Plan for Health Security, valued at 291 million US dollars, and align later costing of operational activities with clarified supply and resource requirements under that plan.[41][3]
• Recognise reliance on external support: approximately 90% of health-emergency support is reported to come from international partners, while World Bank funding supported development of the pandemic plan and associated workshops.[47][37]
• Address resource needs for staffing, training, medicines and vaccines, personal protective equipment, laboratory reagents, cold chain, transport, warehousing, facilities, utilities, border infrastructure, communications and business-continuity arrangements.[8][31][32]
• Address constraints including slow access to emergency funding, delayed disbursement to frontline facilities, inadequate contingency financing, and shortages of support for fuel, logistics, equipment and supplies.[47][48][38]

Health expenditure is reported at approximately 95 United States dollars per person, with 10% of total government expenditure allocated to health against a 15% Abuja Declaration target; the source also reports major reliance on out-of-pocket payments and donor contributions.[49]Reported allocation for International Health Regulations implementation is 11%, while the plan seeks increased spending towards the 15% Abuja commitment.[50]

No overall pandemic-plan budget, activity-level cost breakdown, financing timetable, quantified funding gap or economic assumptions are specified beyond the identified funds, allocations and related health-security costing.[3][9][31]