National Action Plan For Health Security

Objectives

Sierra Leone’s National Action Plan for Health Security (NAPHS) 2018–2022 is the country’s five-year framework for achieving and sustaining the core capacities of the International Health Regulations (IHR) 2005 and strengthening national and global health security.[1]Its vision is a country protected from the health and economic consequences of public health hazards, while its mission is to enable a health system that prevents, detects and responds to threats through collaboration across all sectors.[2]

The plan is grounded in the 2016 Joint External Evaluation (JEE), risk profiling, resource mapping and stakeholder review, and applies a One Health approach across human, animal and environmental health.[3][4]It seeks to prevent outbreaks and other hazards, improve early detection and effective response, foster cross-sector partnerships, establish sustainable health-security financing and address weaknesses identified across 19 JEE technical areas.[3][5]

• Strengthen legislation, policy and administrative arrangements for IHR implementation, including review of the Public Health Ordinance, establishment of an IHR financing budget line and reinforcement of the IHR National Focal Point.[6][7]
• Prevent priority threats through antimicrobial resistance surveillance and stewardship, infection prevention and control, zoonotic disease surveillance, food safety, biosafety and biosecurity, and immunisation.[8][9][10][11]
• Improve detection through integrated real-time surveillance, electronic Integrated Disease Surveillance and Response, community-based and event-based surveillance, interoperable human and animal health reporting, laboratory systems and specimen referral networks.[12][13][14]
• Strengthen response through an all-hazards preparedness and response plan, Emergency Operations Centre capacity, emergency stockpiles, surge personnel, case-management guidance, risk communication and medical countermeasure deployment.[15][16][17][18]
• Enhance preparedness at points of entry and for chemical, radiation and nuclear hazards, including 24-hour port health services at four points of entry, contingency plans, chemical surveillance and radiation emergency arrangements.[19][20][21][22]
• Target priority hazards identified through national risk profiling, led by Lassa fever, followed by floods, wind storms, avian influenza and anthrax.[4]

Implementation

Implementation is designed as a multisectoral, nationally led One Health programme delivered from 2018 to 2022, with high-priority activities concentrated in the first two years.[3][2]The Ministry of Health and Sanitation provides overall stewardship, implementation management, stakeholder coordination, monitoring and evaluation, resource mobilisation, policy guidance and performance review.[23]The Ministry of Agriculture and Forestry co-leads animal health and One Health actions, while the Environmental Protection Agency leads key environmental and chemical-management responsibilities.[24][25]

Governance links high-level political direction with technical coordination and district delivery. The Office of the President coordinates ministries and national emergency response, while Parliament reviews legislation and approves the health budget.[23]The Inter-Ministerial Committee is the highest decision-making body, and the National Multi-Agency Coordination Committee, comprising coordination and technical committees co-chaired by the Chief Medical Officer and Chief Agricultural Officer, provides leadership, policy guidance and technical oversight.[26]The IHR National Focal Point supports planning and monitoring, coordinates information sharing and reports through these structures.[26]

• Coordinate delivery through the Ministry of Health and Sanitation, Ministry of Agriculture and Forestry, Environmental Protection Agency, Office of National Security, local councils, security services, regulatory authorities, civil society, academic institutions, private-sector actors and development partners.[5][27][28]
• Use national, district and community structures, including District Health Management Teams, District Public Health Emergency Management Committees, District Disaster Management Committees and District One Health Coordination Committees.[29]
• Link activities to existing programmes and strategies, including the One Health Platform, the National Health Sector Strategic Plan, the National Health Sector Recovery Plan, the Regional Disease Surveillance Systems Enhancement project and national laboratory, antimicrobial resistance and infection prevention plans.[30][7][31]
• Translate strategic actions into costed lower-level activities with responsible institutions, output indicators, implementation assumptions and schedules through logical frameworks.[27]
• Use technical working groups, joint planning, data sharing, training, supportive supervision, simulation exercises, after-action reviews, stakeholder workshops and public communication to operationalise activities.[27][32][33]
• Engage the World Health Organization, Food and Agriculture Organization, World Organisation for Animal Health, United States Centers for Disease Control and Prevention, international agencies, bilateral partners and donors for technical assistance, implementation support, evaluation and fundraising.[34][29]

Monitoring combines the IHR Monitoring and Evaluation Framework, annual reporting, JEE assessments, simulation exercises and after-action reviews.[35]The plan also provides for an inclusive monitoring and evaluation system with indicators, baselines, targets, data-quality assessment, performance reviews, transparent reporting and feedback to subnational stakeholders.[36][37][38]Key operational targets include reporting potential public health emergencies of international concern to international organisations within 24 hours, interoperable real-time surveillance by 2022, and sustained measles second-dose coverage of at least 95%.[32][12][39]

The estimated five-year cost is approximately US dollars 291 million, equivalent to 2,168,920,927,870 Leones, with the largest investment assigned to detection activities and the highest expenditure in the first year.[40]Financial sustainability depends on increased domestic health allocations, predictable development-partner support, regular resource mapping, improved donor coordination and stronger budget execution.[41][42]The plan assumes progress towards the Abuja commitment of allocating 15% of gross domestic product to health, while recognising that government resources alone will not meet implementation needs.[42]

Monitoring & Evaluation

The National Action Plan for Health Security uses a comprehensive monitoring, evaluation and accountability approach to track progress towards the International Health Regulations (IHR) 2005 core capacities through 2022. It combines routine surveillance, Joint External Evaluation (JEE) scoring, implementation output indicators, performance reviews, simulation exercises, after-action reviews and stakeholder-led accountability.[35][43][36][38]

• Use the World Health Organization IHR Monitoring and Evaluation Framework, including mandatory annual reporting and voluntary simulation exercises, after-action reviews and Joint External Evaluations.[35][43]
• Monitor National Action Plan for Health Security implementation through the IHR National Focal Point, with annual reporting of IHR core-capacity status to the World Health Organization and regular district reporting to national structures.[31][44][29]
• Apply a monitoring and evaluation framework covering indicators, baselines, targets, data sources, data-quality assessment, analysis, performance reviews, communication and use of findings for corrective action, resource allocation and financial disbursement.[36][37][38]
• Conduct periodic reviews and make monitoring and evaluation benchmarks available through the World Health Organization Strategic Planning Portal to promote transparency and accountability.[27][45]
• Track implementation through logical frameworks that specify responsible institutions, output indicators, assumptions and schedules for individual activities.[27]
• Review the national strategic plan annually under IHR National Focal Point guidance and prepare broader strategic plans every four to five years informed by JEE recommendations, IHR capacities and health-security events.[26]

Surveillance is a central implementation and monitoring mechanism. Revised Integrated Disease Surveillance and Response monitors 47 priority diseases through weekly or monthly reporting, supported by electronic reporting through the District Health Information System 2.[46]Reporting completeness reached 97% by September 2017.[46]Performance measures include outbreak detection, notification within 24 hours, response within 48 hours and laboratory results within seven days.[46]

• Strengthen interoperable human, animal and environmental surveillance systems, including electronic zoonotic reporting, electronic Integrated Disease Surveillance and Response, community-based surveillance, event-based surveillance and syndromic surveillance.[12][13][47][48]
• Monitor antimicrobial resistance, healthcare-associated infections, food safety, chemical events, radiation hazards, immunisation, laboratories, points of entry and emergency operations through technical-area indicators and implementation outputs.[8][10][19][49][50][51]
• Use JEE indicators and periodic assessments to identify gaps, document scores, prioritise improvement actions and track movement towards higher capacity levels.[4][2][40]
• Maintain public accountability through National Multi-Agency Coordination Committee oversight, Ministry of Health and Sanitation performance reviews, Ministry of Finance value-for-money audits, civil-society scrutiny and media reporting.[23][24][34][26]

Many technical implementation tables define activity outputs, but do not consistently specify consolidated indicator definitions, reporting frequencies, baselines, outcome targets or independent evaluation methods.[36][37][38]

Costing & Financing

The five-year estimated implementation cost for the National Action Plan for Health Security is approximately 291 million United States dollars, equivalent to 2,168,920,927,870 Leones, for 2018–2022.[40]Costs are concentrated in the first year and then broadly distributed across the remaining four years.[40][41]

• Allocate the largest thematic share to Detect activities, followed by Prevent activities, other IHR hazards and points of entry, and Respond activities.[40]
• Prioritise high-priority actions during the first two implementation years, which were estimated at approximately 50 million United States dollars.[52]
• Use detailed activity costing, quantities and prices, cost categorisation by JEE area, resource mapping, risk appraisal and annual financial management to inform implementation.[53][22][40][41]
• Mobilise domestic funding, development-partner support and additional donor resources, using the Strategic Partnership Portal to align contributions with identified needs and gaps.[41][42]
• Strengthen Ministry of Health and Sanitation and Ministry of Finance collaboration, financial management, budget execution, fiduciary oversight, transparency, value for money and monitoring of donor aid.[41][42]
• Establish or advocate for budget lines for IHR implementation, public health emergencies, Emergency Operations Centre operations and risk communication.[6][7][54][55][23][56]

Financial sustainability depends on increased government health allocations, continued or increased development-partner commitments, more predictable and harmonised funding, and regular resource mapping.[41][42]The plan assumes government health spending will reach the Abuja commitment of 15% of gross domestic product over the following five years, while recognising that government commitments alone will be insufficient.[42]

Costed technical actions include surveillance systems, laboratories, antimicrobial resistance, animal health, food safety, biosafety and biosecurity, workforce development, all-hazards preparedness, stockpiling, Emergency Operations Centre functions, points of entry, risk communication, chemical safety and radiation preparedness.[40][57][58][51][59][60]Many activity tables provide local-currency estimates but do not name the currency, identify financing sources or quantify aggregate funding gaps.[57][58][56][61]