National Action Plan For Health Security

Objectives

Sierra Leone’s 2018–2022 National Action Plan for Health Security seeks to make the country safe from the health and economic consequences of public-health hazards by building a health system able to prevent, detect and respond to threats through collaboration across all sectors. It is grounded in the International Health Regulations (2005), the Global Health Security Agenda and a One Health approach spanning human, animal, plant and environmental health.[1][2]

• Prevent and reduce the likelihood and consequences of outbreaks, other public-health hazards and events of national or international concern.[3][4]
• Build national capacity for early detection, laboratory confirmation, assessment, notification and effective response, including at ports, airports and land crossings.[5][6]
• Strengthen the legal, policy and financing basis for International Health Regulations implementation, including review of the Public Health Ordinance and related statutory and administrative provisions.[7][8]
• Advance priority capacities across antimicrobial resistance, zoonotic disease, food safety, biosafety and biosecurity, immunisation, laboratories, surveillance, reporting, workforce development, preparedness, emergency operations, risk communication, points of entry, chemical events and radiation emergencies.[9][10]
• Integrate human, animal and environmental surveillance and response through One Health mechanisms, including interoperable electronic real-time reporting systems targeted for all levels by 2022.[11][12]
• Develop all-hazards preparedness and response arrangements, supported by risk and resource mapping, emergency stockpiles, surge personnel, simulation exercises and disease-specific guidance.[13][14][15]
• Promote sustainable national health-security financing, strong leadership, transparency, community involvement, evidence-based action and mutual accountability.[3]

Implementation

Implementation is designed as a five-year, multisectoral programme delivered nationally, subnationally and through communities, with Ministry of Health and Sanitation leadership and active participation by agriculture, environment, security, finance, local government, research institutions, civil society, the private sector and development partners.[16][17]The plan uses Joint External Evaluation findings, stakeholder consultation, technical working groups, prioritised activities, costing and resource mapping to translate identified capacity gaps into operational actions.[1][7]

• Coordinate political and policy leadership through an Inter-Ministerial Committee co-chaired by the Chief Medical Officer and Chief Agricultural Officer, supported by a National Action Plan for Health Security or One Health Technical Committee and technical working groups.[18]
• Strengthen the International Health Regulations National Focal Point as a continuously operating national centre for event assessment, risk assessment, official communications, information sharing and notification to the World Health Organization and other countries’ focal points.[19]
• Implement district-level action through District Health Management Teams, Public Health Emergency Management Committees, District Disaster Management Committees and District One Health Coordination Committees.[20]
• Deliver core capacities through integrated surveillance, laboratory networks, workforce training, risk communication, emergency operations centre procedures, cross-border agreements, stockpiles and public-health preparedness plans.[16][21]
• Engage partners including the World Health Organization, Food and Agriculture Organization, United States Centers for Disease Control and Prevention, development agencies, academic institutions and non-governmental organisations in technical assistance, coordination, capacity building and resource mobilisation.[1][22]
• Monitor implementation through a harmonised 2018–2022 monitoring and evaluation plan defining indicators, baselines, targets, data sources, analytical methods, quality assessment, reporting responsibilities, performance reviews and use of findings.[20][23]
• Use annual International Health Regulations reporting, Joint External Evaluations, simulation exercises, after-action reviews and periodic reviews to support continuous improvement.[6][18]
• Cost implementation through a phased model, with the five-year estimate reported as approximately 291.1 million United States dollars, equivalent to 2.17 trillion Leones; detection receives the largest thematic allocation, and costs are expected to be heaviest in the first year.[24][25]
• Mobilise domestic and partner resources while addressing identified risks including financial constraints, delayed legislation, weak coordination, workforce shortages, procurement constraints and logistics limitations.[2]

Monitoring & Evaluation

The National Action Plan for Health Security (NAPHS) for 2018-2022 uses the 2016 Joint External Evaluation (JEE) as its principal baseline and applies a harmonised monitoring and evaluation system across International Health Regulations (IHR) capacities, One Health activities and national health-security priorities.[1][23]

• Use JEE assessments, self-evaluation, peer review, annual IHR reporting, simulation exercises and after-action reviews to assess capacity development and implementation progress.[6][18]
• Apply activity-level logical frameworks that identify responsible authorities, outputs, assumptions, schedules and indicators, and use periodic reviews to adjust implementation.[7]
• Maintain continuous monitoring, situational awareness and emergency communications through the National Operations Centre and the IHR National Focal Point.[19][20]
• Harmonise district, national and partner reporting through common indicators, data sources, analytical methods, data-quality processes, performance reviews and communication of findings.[20][23]
• Monitor surveillance through Integrated Disease Surveillance and Response, community-based and event-based surveillance, electronic reporting, zoonotic surveillance and interoperability between human and animal health systems.[11][12][26][27]
• Track operational targets including reporting completeness, timely outbreak detection and notification, response within 48 hours, laboratory results within seven days, surveillance reporting at points of entry, and real-time chemical and radiological reporting.[28][29][30][31]
• Review implementation through national and district coordination structures, including the Inter-Ministerial Committee, NAPHS or One Health Technical Committee, District Health Management Teams, Public Health Emergency Management Committees and District One Health Coordination Committees.[18][20]
• Promote accountability through transparent financial management, public availability of monitoring information, stakeholder participation, civil-society and media scrutiny, and Ministry of Finance audit and value-for-money functions.[32][2][17][33]

Detailed indicators are specified for several technical areas, including immunisation coverage, food-safety reporting, laboratory quality assurance, workforce training, emergency operations, risk communication and outbreak response.[34][35][36][13][37]However, some extracts do not provide complete indicator definitions, baselines, reporting calendars, evaluation methodologies or independent accountability procedures.[1][23]

Costing & Financing

The NAPHS was costed for 2018-2022 through a Government-led costing process that identified required goods and services, estimated prices and adjusted activities following review.[24]The estimated five-year implementation cost is 291,130,326 United States dollars, equivalent to 2,168,920,927,870 Leones.[24][38]

• Allocate the largest thematic share to detection, followed by prevention, other IHR hazards and points of entry, and response.[24]
• Prioritise high-priority activities estimated at approximately 50 million dollars during the first two years of implementation.[39]
• Weight planned expenditure towards the first implementation year, while allowing reprioritisation following stakeholder review.[25][9]
• Combine anticipated domestic financing with development-partner support, resource mapping and advocacy for sustainable health-security financing.[39][1][2]
• Increase domestic health allocations and seek to meet the Abuja commitment of allocating 15% to health, while recognising that government resources alone are insufficient for the plan.[2]
• Establish or strengthen dedicated budget lines for IHR implementation, public-health emergency management and risk communication.[40][41][17]
• Mobilise resources through Ministry of Finance, Ministry of Health and Sanitation, Ministry of Agriculture and Forestry, parliamentary budget approval, donor coordination and partner support.[17][18][42]

Costed activities cover legal reform, antimicrobial resistance, surveillance, laboratories, workforce development, emergency operations, stockpiling, risk communication, points of entry, chemical events and radiation emergencies.[9][10]Many technical workplans identify funding availability, logistics, procurement, human-resource constraints and funding gaps as implementation risks, but do not provide a consolidated financing-gap estimate or confirmed funding commitments.[2][43][44]