Pandemic Influenza Strategic Plan (PISP)

Objectives

The 2020-2024 Pandemic Influenza Strategic Plan provides a national, whole-society and One Health framework to prevent, prepare for, respond to and recover from influenza pandemics, while strengthening readiness for other infectious-disease emergencies. It aims to minimise illness, deaths and socio-economic disruption; preserve critical public, private, health and social services; and support recovery and more resilient systems.[1][2][3]

• Strengthen an integrated human, animal and environmental health workforce, including recruitment, training, supervision, mentorship, retention and surge capacity, so influenza can be detected and managed at all levels by 2024.[4][5][6]
• Establish reliable logistics, supply-chain, warehousing, transport and cold-chain arrangements to maintain commodities and equipment nationally, in districts and locally, including supplies for a three-month response.[4][7][8]
• Develop integrated human and animal surveillance and laboratory systems, expand influenza sentinel surveillance across all 16 districts, improve diagnostic capacity and strengthen reporting to national and international influenza platforms.[4][9][10][11]
• Improve national, district and community coordination and communication to support risk communication, health education, community sensitisation, resource mobilisation and reduced duplication.[4][12][13]
• Ensure timely, safe and appropriate clinical care at home and in health facilities, supported by case definitions, screening, treatment guidance, medicines, infection prevention and control, and trained personnel.[4][14][15]
• Strengthen border management, prevention and immunisation readiness, including points-of-entry screening, electronic reporting, vaccine procurement and distribution procedures, cold-chain capacity, and preventive behaviours among 90% of the population by 2024.[4][16][17][18][19]
• Develop business-continuity plans across health services, government and essential businesses, targeting 90% coverage, alongside community resilience plans covering 75% of targeted communities by 2024.[4][20]

Implementation

Implementation uses a phased, risk-based operational model spanning prevention, preparedness, standby, initial and targeted response, stand-down and recovery. Actions may overlap or recur, with national and local risk and severity assessments guiding escalation, resource prioritisation and adaptation to Sierra Leone’s circumstances.[21][22][23][24][25]

• Coordinate delivery through the One Health Technical Working Group, led by the Director of Health Security and Emergencies, which has overall responsibility and accountability for the plan; assign each strategic priority to a named champion for implementation oversight and reporting.[26][27]
• Provide political and institutional stewardship through the Office of the President, Parliament, the Ministry of Health and Sanitation, the Office of National Security, the Ministry of Agriculture and Forestry, the Environmental Protection Agency and the Ministry of Finance.[28][29]
• Operate preparedness and response through national and district One Health structures, rapid response teams, the Public Health Emergency Operations Centre and district emergency operations arrangements, using an Incident Management System where activated.[30][31][32]
• Engage government ministries, district authorities, health and animal-health services, communities, civil society, private companies, non-governmental organisations, donors, United Nations agencies and neighbouring countries in preparedness, response and continuity planning.[2][28][33][34]
• Deliver high-level activities over five years through detailed plans, standard operating procedures, training, supportive supervision, mentorship, simulations, partner mapping and business-continuity workshops.[35][4][36][37]
• Maintain continuous surveillance, laboratory testing and risk assessment, including influenza-like illness and severe acute respiratory infection reporting, regular data review, national and international reporting through FluNet and FluID, and adaptive assessment of transmissibility, disease seriousness and wider impact.[38][39][25]
• Monitor performance through indicators and scorecards, including targets for workforce recruitment, surveillance reporting, sentinel-site coverage, infection prevention and control, public awareness, continuity planning and community resilience; conduct Joint External Evaluation processes, supervision, simulations and periodic plan review.[40][41][42][27][43][20]
• Mobilise domestic and partner resources through coordination mechanisms, parliamentary allocation and Ministry of Finance oversight; establish a domestic fund and annual government budget line of 1 million United States dollars by 2024 for rapid outbreak-response mobilisation, covering commodities, equipment, transport, labour and warehousing.[28][44][7]

Monitoring & Evaluation

The plan combines routine influenza surveillance, risk and severity assessment, performance monitoring, periodic review and multi-sector accountability. It assigns overall delivery accountability to the One Health Technical Working Group, led by the Director of Health Security and Emergencies, while the Ministry of Health and Sanitation stewards plan implementation, monitoring and evaluation.[26][28][27]

• Maintain integrated human and animal surveillance and laboratory systems, including influenza sentinel surveillance, standard case definitions for influenza-like illness and severe acute respiratory infection, and reporting through FluNet, FluID and the Integrated Disease Surveillance and Response system.[38][39][9][11]
• Expand sentinel surveillance to public and private regional and district hospitals across all 16 districts, supported by specimen transport, data tools, trained personnel, supervision and laboratory feedback.[45][41][11]
• Monitor the timeliness and completeness of surveillance reporting, laboratory performance, staff training, supply-chain gaps, availability of preparedness stockpiles, points-of-entry readiness, infection prevention and control, and implementation of business continuity plans.[46][44][7][8][16][20]
• Track specified results targets, including recruitment of at least 90% of current volunteer staff to the government payroll, 80% reporting of quality surveillance data by 2024, infection prevention and control functionality in all health facilities by 2023, preventive-behaviour awareness among 90% of the population by 2024, and business continuity plans for 90% of health and essential services and businesses.[45][47][41][42][6][20]
• Use quarterly supportive supervision and surveillance reviews, monthly district supervision, periodic laboratory assessments, six-monthly scorecards, simulation exercises, Joint External Evaluation processes and annual plan-progress reviews to identify weaknesses and improve implementation.[48][40][41][36][9][10]
• Conduct continuous national and subnational risk and severity assessments, monitoring transmissibility, disease seriousness, service impacts, workforce pressures, antiviral sensitivity and effects on public and private services to guide response measures.[24][25]
• Maintain accountability through named priority champions reporting to the One Health Technical Working Group, animal-health monitoring led by the Ministry of Agriculture and Forestry, and Ministry of Finance audit and efficiency monitoring of raised resources.[28][27]
• Submit mandatory annual International Health Regulations implementation reports to the World Health Assembly and World Health Organization Executive Board, complemented by voluntary Joint External Evaluations every four to five years.[49]

The plan identifies data sources for several indicators, including approved government budgets, inventories, training reports, population surveys, supervisory visits, laboratory assessments and Integrated Disease Surveillance and Response data.[44][7][8][11][12][16]Detailed indicator definitions, reporting schedules, evaluation methodology and a consolidated accountability matrix are not fully specified in the supplied material.[27][50][51][52]

Costing & Financing

The strategic plan itself is not costed, and the operational activities document is also explicitly uncosted, although some activities overlap with the costed National Action Plan for Health Security.[26][48]The plan nevertheless establishes a domestic outbreak-response funding target and identifies substantial resource needs across preparedness, response and recovery.[7][8]

• Establish a domestic fund of 1 million United States dollars for rapid mobilisation when a pandemic threat is declared, covering commodities, equipment, transport, human labour costs and warehousing.[45][7]
• Provide a yearly government budget allocation of 1 million United States dollars for outbreak response by 2024, monitored through the approved government budget.[7]
• Integrate financial-needs estimates into annual fiscal planning through engagement with the Ministry of Finance and establish a government budget line for pandemic preparedness and response.[7]
• Mobilise domestic resources through Parliament, the Ministry of Finance, the Ministry of Agriculture and Forestry and cross-sector coordination mechanisms, while using partners to support health, animal-health and emergency-response capacities.[28][12]
• Use the National Action Plan for Health Security, costed at 291 million United States dollars, as a related financing framework for national health-security investment.[53]
• Address delayed access to contingency financing, including the Regional Disease Surveillance Systems Enhancement contingency mechanism and the REDISSE Zero Dollar Fund, which are reported as difficult or slow to access for frontline emergency needs.[54][24]
• Prioritise funding for workforce recruitment and retention, emergency kits, vaccines, antivirals, personal protective equipment, laboratory reagents and consumables, cold chains, warehousing, transport, fuel, communications, training, isolation capacity, water, sanitation, electricity and business continuity measures.[46][36][37][55][9]

Domestic financing is constrained by a heavy reliance on external support: approximately 90% of health-emergency support is provided by international partners.[56]Total health expenditure is approximately 95 United States dollars per person, with out-of-pocket payments contributing 76%, government 16% and donors 13%; health spending represents 10% of government expenditure, below the 15% Abuja Declaration target.[57]The material identifies operational gaps in timely financing, supplies, fuel, logistics, equipment and frontline capacity, but does not provide a consolidated pandemic budget, quantified funding gap, detailed financing commitments or costed activity schedule.[54][30][35]

Economic planning should account for expected demand exceeding national availability of vaccines, antiviral medicines, hospital beds, ventilators and other supplies, alongside potential disruption to trade, travel, workplaces and movement of essential goods.[58][59]No quantified economic assumptions for these effects are specified.[59][21]