Operating Plan

March 2017

Draft 0.1.1

ContentsForeword...............................................................................................................................................2

Acknowledgements...............................................................................................................................2

Country Context....................................................................................................................................2

Public Health Context............................................................................................................................2

Health Outcomes...............................................................................................................................2

Legislative and policy context............................................................................................................3

Healthcare Provision..........................................................................................................................3

Public Health Infrastructure..............................................................................................................4

The Sierra Leone NPHA..........................................................................................................................5

Moving Forward................................................................................................................................5

Development Methodology...............................................................................................................5

Vision.................................................................................................................................................5

Mission..............................................................................................................................................5

Functions of the Agency....................................................................................................................5

Goals of the NPHA.............................................................................................................................6

Development of the NPHA................................................................................................................6

Staffing and structure........................................................................................................................8

Costing framework............................................................................................................................9

Operational Plans................................................................................................................................10

Public Health Surveillance...............................................................................................................10

Public Health Laboratory Services...................................................................................................13

Public Health Emergency Operations..............................................................................................16

Public Health Workforce Development...........................................................................................18

Public Health Research....................................................................................................................20

Health Promotion............................................................................................................................22

Office of the Director.......................................................................................................................24

Monitoring and Evaluation framework................................................................................................25

2

Foreword

Acknowledgements

Country ContextSierra Leone is located on the western coast of Africa, bordered by Guinea to the north and northeast, Liberia to the south and southeast, and the Atlantic Ocean to the west. Sierra Leone has a total area of 71,740 km2

It is divided into the Northern, Southern and Eastern provinces, and the Western Area, which includes the capital city of Freetown. The regions are divided into fourteen (14) districts, which are sub-divided into 152 chiefdoms, governed by local paramount chiefs. For district-level health governance, the Western Area Rural and Western Area Urban districts combine to comprise the Western Area Health district; the remaining twelve (12) health districts correspond to the national districts. There are thirteen (13) health districts.

Figure 1: Sierra Leone and its districts

Public Health Context

Health OutcomesHealth outcomes in Sierra Leone are poor, with a life expectancy of 50 years at birth and under-five mortality and maternal mortality rates that are among the highest in the world.

Public Health in Sierra Leone must be viewed within the broad historical context of poverty and a high illiteracy rate (43 percent). Sierra Leone is recovering from multiple disasters: the civil war (1990–2002); the cholera epidemic (2012); and the EVD outbreak (2014-present). The country was deemed to have “not attained the minimum International Health Regulations core capacities by 2012”. Nevertheless, prior to the EVD outbreak in mid-2014, Sierra Leone had made substantial

3

progress towards a number of the Millennium Development Goal targets in the health and nutrition sectors, including a reduction in child and maternal mortality and improving coverage with a range of critical interventions such as family planning, skilled birth attendance, and immunization. The recent National Nutrition Survey (2014) also demonstrated major improvements in nutrition levels.

Legislative and policy contextSierra Leone’s Public Health Ordinance of 1960 defines the powers of the state to regulate areas concerned with the public health such as sanitation, housing, infectious disease control and food safety. While there have been numerous amendments to the Public Health Ordinance 1960, the most recent being the inclusion of Ebola in the “notified disease” category in 2014, the ordinance is currently being reviewed to reflect current and historical developments and contemporary public health needs.

Framed alongside commitments articulated in the national development plans, the National Health Strategic Plan 2010–2015, Free Health Care 2010, the Basic Package of Essential Health Services 2010, and the National Health Compact 2011 provide overall guidance for health system strengthening and for improving the health status of the population. Health policies, programmes and coordinating structures, such as the Health Sector Coordinating Committee chaired by the Minister of Health and Sanitation, do exist, galvanizing cooperation among health, environment and development partners in the country. Sierra Leone, as a signatory of the International Health Regulations, has recently undertaken a self-assessment and been the focus of a Joint External evaluation to assess country capacity to prevent, detect, and respond to public health threats.

Healthcare Provision The health workforce is concentrated in the capital Freetown, where 50 percent of all health professionals work, serving just 16 percent of the population. There is a critical general shortage of health professionals (0.3 physicians per 10,000 people), and wage bill constraints limit public sector employment (despite a vacancy rate among health professionals of 54 percent). Despite efforts to improve the availability of services, including a network of nearly 1,200 Peripheral Health Units, and efforts to improve access – such as the Free Care Act, which reduces financial access barriers for pregnant women, lactating mothers, and children under five – gaps persist in the quality of care. Not least, the ability of health information systems to inform decision making is limited by the timeliness, completeness and quality of data.

Ebola has impacted significantly on the public health system of Sierra Leone. Health workers suffered disproportionate mortality during the EVD outbreak, owing to increased instances of exposure. The World Health Organisation (2015) estimates a ratio of 1444,000 people per trained doctor in the country. Concurrently, there has been noted reduction in health centre utilisation, institutional deliveries and childhood immunisation and treatment for malaria.

Capacity has also been diverted away from existing public health priorities such as immunisation and prevention of possible outbreaks of vaccine-preventable diseases (particularly measles). There has been a noted surge in malaria cases and deaths, acute malnutrition, and maternal/new-born deaths due to home deliveries. Concerted efforts to restore and scale up essential health services in line with the Basic Package of Essential Health Services will be a major challenge. Importantly, the outbreak underpins the need to have strong social capital, to engage communities in the planning

4

and delivery of health services, and to integrate risk communication and social mobilization into health system strengthening.

Public Health InfrastructureHistorically public health programs in Sierra Leone could be characterized as being fragmented and siloed which led to competition for limited resources. However, in the post-Ebola environment, Sierra Leone has made substantial progress in its upgrading public health systems through donor funded programs that have supported:

Updating the Integrated Disease Surveillance and Response System Updating the surveillance system to incorporate event-based, syndromic, and indicators Creating, equipping, and training rapid response teams Updating Preparedness and Response Plan Upgrading, equipping of public health laboratory and training laboratory personnel Establishing, equipping, training, and operationalizing the Emergency Operations Center…

Despite these advancements, the November 2016 Joint External Evaluation found that Sierra Leone had multiple deficits in its compliance with the International Health Regulations, notably

Updating public health laws and legislation Formulation of a multi-hazard National Public Health emergency preparedness and response

plan that address ports of entry and integrates cross border collaboration Accelerated the implementation of a One Health approach Develop strategies and plans for antimicrobial resistance, detection, and mitigation Establish a comprehensive national biosafety and biosecurity system for both human and

animal health sectors Scale up the FETP program to cover intermediate and advanced courses for the national and

district level, including veterinary and laboratory staff Develop strategic plan, guidelines & SOPs to facilitate capacity building for laboratory,

syndromic surveillance & response to chemical hazards

One measure that Sierra Leone has embarked upon to address these deficits is the adoption of a One Health approach to those public health issues that would benefit from taking a multisectoral approach to planning, prevention, preparedness, and response. Although links between ministries (particularly MOHS and the Ministry of Fisheries, Agriculture, Forestry and Food Security (MAFFS) and EPA have improved in recent years, now Sierra Leone will institutionalize and operationalize these linkages in order to leverage the country’s combined expertise on human, animal and environment health.

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The Sierra Leone NPHA

Moving ForwardWithout a dedicated focus on the public health infrastructure, systems and personnel in the country, efforts in Sierra Leone will continue to fall short of realising its development goals.

Within this context, the GoSL is committed to developing an effective and resilient NPHA, for the health of the people of Sierra Leone.

Development Methodology The development of a Sierra Leone NPHA has been ongoing since 2014, despite significant interruption during the Ebola outbreak. In November 2016, the working group was reconvened, comprising representatives of CDC USA and China, Public Health England, GoSL, WHO and NGOs/ implementing partners. Terms of Reference (TOR) for the working group can be found in annex 1. This led to the development of a strategic plan, identifying the functions and model that the agency will adopt. These are outlined below.

Goals and strategic objectives were derived from identified functions and from these, activities were identified and costed, with key stakeholders engaged to inform specific costs. Following consultation, the draft operating plan 2017-20 will be validated and finally endorsed following a wider stakeholder meeting with national and international partners.

A sustained focus will be placed on the training, recruitment, and motivation of adequate numbers of the right skill mix of professionals to work in the NPHA. Attracting sufficient human and financial resources will be critical in ensuring that the agency is able to deliver on its goal of being the principle source of public health advice in Sierra Leone.

Vision The vision of the Sierra Leone NPHA is:

“A Healthy Sierra Leone through evidence based leadership in Public Health”.

MissionThe mission of the Sierra Leone NPHA is:

“To secure the health of Sierra Leone, as the trusted source of Public Health information, guidance and leadership”.

Functions of the Agency The NPHA will incorporate and consolidate a number of core public health functions, currently dispersed across the MoHS and other parts of GoSL :

Public Health National Reference Laboratory Public Health Surveillance activities Public Health Emergency Operations Health Promotion

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Human Resources for Public Health Public Health Research

Goals of the NPHAStrategic and operational planning for the NPH is guided by the following goals, linked to the functions above.

A functional integrated public health surveillance system that provides timely evidence for public health action (prevention, detection and response).

An effective public health reference laboratory, linked to surveillance and capable of supporting ongoing improvements.

A health system that is able to effectively prepare for and respond to public health emergencies

A sustainable workforce, capacitated and skilled to meet the public health needs of Sierra Leone.

A strong and coordinated public health research capacity that informs policy and public health programs.

Effective prevention of disease, through effective public health advocacy, education, services and policy development

7

Development of the NPHA

Figure 2: Phasing in of the NPHA functions and operations

The NPHA will develop incrementally, acquiring additional functions and staffing over time. The agency will be focussed in the first instance on integrating the National Public Health Laboratory, Surveillance and Response functions, along with workforce development, research and health promotion, to support public health functions existing across GoSL ministries. As the organisation matures and developments within extant functions are conducive, the agency will incrementally absorb all core public health functions within Sierra Leone, with a view to potentially moving to develop greater delegated authority.

8

Staffing and structure

Staffing plans will be developed following assessment of functions currently located across GoSL. Staff engaged in relevant public health functions will be collocated within the Agency. The director will be supported by two deputies, one with respective responsibilities for technical functions and operations of the Agency.

Figure 3: Proposed Structure of the NPHA

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Costing frameworkThe operating plan priorities are based on the core functions identified in the NPHA Strategic Plan:

For each strategic goal, detailed strategic objectives, activities and costings have been developed and are presented in the attached spreadsheets. The summary may be seen below:

Function Year 1 Year 2 Year 3 Total Budget Funding source

Shortfall Comment

1 45833 95789 76390 218,012 0 ? 218,0122 60,981 129,530 89,924 280,435 0 ? 280,4353 31905 58147 39584 129,636 0 ? 129,6364 159,122 4199 0 163,321 0 ? 163,3215 294,860 270,860 270,860 836,580 0 ? 836,5806 30,860 24,660 24,660 80,180 0 ? 80,180Table 1: Outline costings for the NPHA Functional Areas

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Operational Plans

Public Health Surveillance

Goal

A functioning, integrated public health surveillance system that provides timely evidence for public health action (prevention, detection and response) across GoSL.

BackgroundThe NPHA will integrate the range of public health surveillance functions currently undertaken across the MoHS and other parts of GoSL.Public health surveillance is the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice. Effective Public Health relies on having community, district and national infrastructure, communications and information technology, and linkages to the health care system to rapidly identify disease outbreaks. It also requires effective collaboration and data sharing within the health sector and between other sectors such as the agricultural and environmental sectors.

Each level of the system, from the community to national, will have the capacity appropriate to its level to collect and analyse surveillance data, and mount a response if an outbreak is identified. The national level will provide support to subnational levels in surveillance and response, as well as conducting combined data analysis and providing regular feedback to subnational levels. The NPHA will work to promote integration of surveillance data across multiple sectors and to use the data to forecast or prevent public health events. Working with partners, it will build a robust surveillance data that can be collated, analysed and used to predict and prevent outbreaks or other public health events and drive public health action.

A multi-faceted strategy is required to ensure that epidemic-prone conditions can be detected, confirmed, and addressed early. This requires that the Ministry of Health and Sanitation, SLNPHA and supportive partners focus its efforts to implement the procedures necessary for a prompt response, ultimately limiting the spread and impact of disease when an outbreak occurs. In keeping with the Sierra Leonean Presidential Recovery Plan, this will require building IDSR and multi-sectoral early warning systems from the community up through the national level of the surveillance system. Once in place, these systems will ensure that the local health infrastructure is prepared to recognize epidemic-prone diseases and other public events when they occur.

11

Activity Tasks Outcome measure Costed Items Estimated costs

USDFunding Source

17 18 19Critical Individuals / Organization

to be involved/synergiesComments

a) Support training of 100 staff per district (1400) on IDSR annually, for 3 years, printing of training manuals, DSA and transport refund (participants and facilitators), hall rental, coordination, stationery support,

15605

b) Support supervision from national to district: DSA, and transport for 28 national level supervisors, stationery support, printing of supervision protocols, coordination

7112

1.1.2Develop an inventory for relevant sectors

Comprehensive inventory developed

Prepare and install a database. Prepare a data collection tool. Collect data on relevant sectors. Update information annually.

a) Refreshment for 10 tehnocrats to develop coordination organogram. Validation meeting for 50 people: DSA and transport refund (participants and facilitators), hall rental, coordination, stationery support

4403

b) Support coordination meetings. 40 people, to include refresment

800

a) Workshop to decide on cross sectoral surveillance activities (50 people) (from Human health, agriculture, environmental, fisheries, tourism , ONS) DSA and transport refund (participants and facilitators), hall rental, coordination, stationery support.

3603

b) Train 50 sector Staff on integrated surveillance across sectors: DSA and transport refund (participants and facilitators), hall rental, coordination, stationery support

3603

c) Support working group of 15 technocrats to prepare and print reporting tools on integrated surveillance across sectors

180

a) conduct a needs assessment across sectors. Prepare and print needs assessment tools DSA and transport for data

b) Provide logistics for integrated surveillance activities (computers, printers, etc)

c) Provide linkage between sectors and NPHA data poola) payment for installation of database, national plus district levelsb) Train 38 staff on data management: 2 staff from NPHA, 4 surveillance, 4 labs, 28 district staff. printing of training manuals, DSA and transport refund (participants and facilitators), hall rental, coordination, stationery support,

10896

SO 1.1: Integrate and strengthen surveillance activities from across GoSL

1.1.5

Develop reporting and information

sharing mechanism

1.1.1Implement the

Integrated Disease

Surveillance and response strategy

(IDSR)

Ability to detect and respond to outbreaks

Ablity to detect and respond to outbreaks

1.1.3

Develop a coordination

mechanism for inter-sectoral co-

ordination

Co-ordination mechanism is

developed

Improved integration of surveillance

activities

1.1.6

Strengthen the management of

integrated surveillance data

Reporting and information sharing

mechanism developed

1.1.4

Conduct integrated

surveillance activities

Table 1: Surveillance Activities

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Activity Tasks Outcome measure Costed Items Estimated costs USD

Funding Source

17 18 19Critical Individuals / Organization to be involved/synergies

Comments

1.2.1

Support participation in IHR meetings at the international level

SL is able to address current IHR initiatives2 staff annually: (Air fare, DSA, Visas) 10000

a) Training workshop for 40 port health staff (4 each from Kambia, Bombali, Koinadugu, Kono, Kailahul, Pujehel, Port Loko, Western Area), 4 facilitators, 4 support staff Hall rental, food (50 people), coordination costs, DSA and transport reimbursement

3931

b) Conduct an assessment of all crossing points. Prepare and print assessment tools. Fuel for data collection (8 districts), DSA for data collectors (two per district (16 total). Refreshments for data management staff (10 staff for 5 days), stationary support, printing and dissemination of assessment report.

c) Provide logistics for port health stations. (cost tbc)

a) Training for 30 policy makers for 2 days. Printing of training manuals, DSA and transport refund (participants and facilitators), hall rental, coordination, stationery support,

5546

b) Support dissemination of surveillance briefings to policy makers

1000

1.2.4

Support programming in the context of healthcare delivery

Availability of technical programs for effective disease prevention and control

Refreshment for 10 technical staff to review surveillance information and propose feasible programmes. Twice yearly

100

1.2.5Strengthen health management

Improved management of health service at all levels

Train national and district staff on health management using surveillance information (28 district and 12 national staff). Repeated annually across programmes

4098

1.3.1

Review and upgrade surveillance protocols and guidelines

Availability of standard protocols and guidelines for surveillance

2 workshops for 40 participants (28 DHMTs plus 12 national) 5 facilitators, 5 support staff : Hall rental, food (50 people), coordination costs, 10 drivers (14 district, 6 national), DSA and transport reimbursement

6096

a) Annual DQA field visits (DSA and transport for enumerators (28 for 5 days), prepare and print DQA tool.

8260

Printing and dissemenation of DQA report 1000

b) Quarterly review of routine data. Refreshment for 20 stakeholders per quarter

400

a) Refreshment for 5 technocrats to develop and validate integrated M&E indicators

25

b) Support to the conduct of annual integrated M&E. (external consultants/ evaluators)a) Support preparation and production of advocacy and resource mobilisation tools, using surveillance information. (Annual workshop for 40 participants for 3 days) printing of training manuals, DSA and transport refund (participants and facilitators), hall rental, coordination, stationery support,

9579

b) support advocacy and resource mobilisation drives

C) twice annual roundtable conference- refreshments for 40 people, hall rental, fuel, stationery support

9579

Increased financing for health service

delivery

1.2.3Support policy

formulation and regulation

1.3.4

Support advocacy and mobilization of resources for

effective healthcare

delivery

Tools developed and M&E completed

1.3.2

Conduct periodic data

harmonization and quality audits

Deliver timely, relevant and high quality evidence to inform public health action

SO 1.3: Undertake ongoing, multi-partner evaluation of surveillance systems to address data quality, relevance, timeliness and use in order to inform investment and ongoing improvement

Conduct integrated

monitoring and evaluation.

1.3.3

Strengthen the implementation of

port health

Effective prevention of cross border hazards

1.2.2

Improved data quality

Availability of Surveillance Policy

Table 2: Surveillance Activities (Continued)

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Public Health Laboratory Services

Goal

An effective public health reference laboratory, linked to surveillance and capable of supporting ongoing improvements.

BackgroundPublic Health Laboratories operate as a first line of defence to protect the public against diseases and other health hazards. Working in collaboration with other arms of the nation’s public health system, public health laboratories provide clinical diagnostic testing, disease surveillance, environmental and radiological testing, emergency response support, applied research, laboratory training and other essential services to the communities they serve. Public health laboratory scientists are highly educated specialists with knowledge of one or more scientific disciplines, advanced skills in laboratory practice and the ability to apply this expertise to the solution of complex problems affecting human health.

The Agency will include the National Public Health Reference Laboratory, capacitated to test for, and aid in the diagnosis of usual, unusual and emerging pathogens; chemicals and other contaminants and pollutants. The national reference laboratory will confirm atypical laboratory test results, verify results of other laboratory tests and test epidemiologically significant specimens with potential public health implications.

In addition, the National Public Health Reference laboratory will provide reference diagnostic testing to laboratories not fully capacitated to identify disease agents of public health significance and ensure quality control/quality assurance for laboratory procedures.

Through linkages with the national surveillance and response functions within the Agency, the laboratory will support investigations of public health problems, hazards, and emergencies.

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Activity Tasks Outcomes Costed items Estimated costs USD

Funding Source

17 18 19Critical Individuals / Organization to be

involvedComments

a) Refreshment for 10 technocrats to prepare needs

50

b) Print 100 copies of the needs assessment tool

200

c) Data collection (DSA And transport for 2 data collectors in 14 districts for 4 days (112

6048

d) Refreshment for 10 data management staff for 5 days

250

e) Print and disseminate 200 comprehensive lab

400

a) 1 consultant for 1 month 8000b) Lab infrastucture development planning workshop for 40 people. Hall rental, food (50 people), coordination costs,

2591

1.1.3 Mobilise resources to implement infrastructure development plan

resources are available to implement development plan

Support launch of development plan (refreshment for 200 people. Printing of invitations, hall rental, decoration of hall,

1803

a) Train 4 maintainance staff per district, provision of

56000

b) Provide equipment

1.1.5 Conduct periodic review and ongoing development of laboratory infrastructure

Production of laboratory review and upgrade plan

1 Consultant for 2 weeks and report

4000

a) Procure 50 computers and printers to support laboratory b) Install database for reporting pathogens promptly. Train 100 diagnostic service personell on reporting of

8303

1.2.2Build capacity to test epidemiologically significant specimens, with potential public health implications.

Capacity to test epidemiologically significant specimens

Train 50 diagnostic staff on laboratory techniques DSA, hall rental, refreshment, transport

4353

a) Train district EOC staff on investigation of public helath incidents. (70 staff- 5 per

5933b) Support simulation exercises in each district (28 exercises, twice annually, per district)Two days per session: Refreshment, hall rental (DSA for facilitators) 19684

SO 1.1: Function As an Accredited Public Health reference Laboratory

SO1.2: Develop and Assess tools for the testing of pathogens of Public Health Interest

1.1.1 Conduct a comprehensive laboratory infrastructure needs assessment

A comprehensive Laboratory needs Assessment is produced

Improved capacity to investigate hazards and emergencies

1.1.2 Develop a costed laboratory infrastructure development plan

A costed laboratory infrastructure development plan is produced

1.1.4 Develop and implement a facility maintenance mechanism

Regular maintainence of facility

1.2.1Strengthen laboratory reporting mechanisms for

usual, unusual and emerging pathogens Improved reporting of pathogens

1.2.3 Support investigation of public health issues, hazards and emergencies

Table 3: Laboratory Activities

15

Activity Tasks Outcomes Costed items Estimated costs USD

Funding Source

17 18 19Critical Individuals / Organization to be

involvedComments

1.3.1 Develop an inventory of diagnostic facilities Inventory DevelopedPrepare and install a database. Prepare a data collection tool. Collect data on relevant sectors.

5000

1.3.2 Undertake annual inventory updates Inventory updated Collect data on relevant sectors. a) conduct a needs assessment across sectors. Prepare and print needs assessment tools DSA and transport for data b) Provide logistics for integrated surveillance activities (computers, printers, c) Provide linkage between sectors and NPHA data pool

1.3.4Support the review of existing diagnostic servics policy Diagnostic services policy is reviewed

a) refreshment for 15 technical staff. 10 sessions 250

1.3.5Support the production of draft revised diagnostic services policy Revised draft policy is produced

Printing of 500 copies of revised diagnostic services policy 1000

1.3.6 Finalise revised laboratory policy Policy is finalisedValidation workshop for 50 people: Hall rental, food (50 people), coordination costs, DSA

2140

1.3.7 Ensure implementation of diagnostic services policy Policy is implemented Support annual field visits for 14 technocrats (DSA, transport)

1512

1.3.8Develop the capacity of diagnostic workforce

Improved capacity of the diagnostic workforce

Training of 50 staff annually, for 5 days : Hall rental, food (50 people), coordination costs, DSA

21765

a) Refreshment for working group meetings of 20 technical staff for 5 sessions

500

b) Print and disseminate 200 copies of standard protocols

400

Refreshment for 15 technical staff to prepare comprehensive list of equipment and costed plan for laboratories for 5

375

b) Procurement of laboratory a) Prepare and print 200 copies of the supervision and performance monitoring checklist for supervision,

400

b) DSA and transport for 42 monitors , supervisors and

11340

c) Specialised support and printing costs for 100 copies of

500

a) Refreshment for 10 tehnocrats to develop

50

b) Validation meeting for 50 people: DSA and transport refund (participants and facilitators), hall rental,

3353

1.3.13 Conduct regular coordination meetings between laboratories Meetings are held regularly

Support coordination meetings. 6 meetings, 40 people, to include refresment

1200

1.3.14Review and upgrade coordination mechanism, as required

Coordination mechanisms reviewed and updated

Laboratory managers, meetings, stationary

1200

SO1.4: Undertake Public Health research

SO 1.3: Develop wider diagnostic capacity within Sierra Leone through ongoing quality assurance and training

1.3.3 Develop a mechanism for information sharing Mechanism is developed

1.3.11

Strengthen the supervision, performance monitoring and quality audit of laboratories

Improved performance of diagnostic services

1.3.9

Develop and implement standard protocols for storing, collecting, labeling, transporting, and

delivering diagnostic samples

Improved management of diagnostic samples

1.3.10

Ensure adequate equipment of laboratories Diagnostic services are adequately equipped

1.3.12

Develop a diagnostic services coordination mechanism

Diagnostic coordination mechanism is developed

Table 4: Laboratory Activities (continued)

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Public Health Emergency Operations

Goal

A health system that is able to effectively prepare for and respond to Public Health Emergencies

Background

The International Health Regulations (IHR 2005) request that States Parties develop, strengthen and maintain their capacity to respond promptly and effectively to public health risks and public health emergencies of international concern. The emergency Operating Centre facilitates the assembly of Public health emergency management personnel, to coordinate operational information and resources for strategic management of public health events and emergencies.

Emergency response, and the management of an Emergency Operations Center (EOC), is closely linked to surveillance, routine outbreak response, and follow-up. Routine outbreak response and follow-up provides practice and linkages that support effective response during a major outbreak.

At the national level, the NPHA will have the capacity to respond to outbreaks, including conducting investigations and recommending interventions. Routine outbreaks provide practice runs for larger responses.

17

Activity Tasks Outcome measure Costed Items Estimated Costs

Funding Source

17 18 19Critical Individuals / Organization to be involved

Comment

3.1.1 Support and maintain the operation of the EOC and EPRR multi team meetings

Meetings are regularly held and attended NPHA to attend meetings0

Support the functioning of National Public Health Emergency Management Committee (PHEMCs) in all districts.

Meetings are regularly held and attended NPHA to attend meetings0

3.1.2 Support the functioning of Public Health Emergency Management Committees (PHEMCs) in all districts. Meetings are regularly held and attended

NPHA staff to attend (Fuel and DSA to attend periodically)

3024

Combine with EOC orientation- WHO has resource to support

3.1.3Develop an effective mechanism to respond to recommendations from PHEMCs (co-ordinate, investigate, manage, respond, evaluate)

Improved response to Public Health Emergencies

Create email links between agency and PHEMECs in districts. Provide top up cards for contact 0

Alusein pushing for District focal

a)Meeting of 50 people (DSA, transport, hall hire , refreshments, coordinationa nd stationary support). 28 from districts 12 from national plus facilitators and drivers

3249

b) Validation meeting 0 WHOa)Meeting of 50 people (DSA, transport, hall hire , refreshments, coordinationa nd stationary support). 28 from districts 12 from national plus facilitators and drivers

3249

b) Validation meeting 0 CMO office

a)Meeting of 50 people (DSA, transport, hall hire , refreshments, coordinationa nd stationary support). 28 from districts 12 from national plus facilitators and drivers

3249

b) Validation meeting 0 SAS Kargboa)Meeting of 50 people (DSA, transport, hall hire , refreshments, coordinationa nd stationary support). 28 from districts 12 from national plus facilitators and drivers

3249

b) Validation meeting 0 CMO Officea)Meeting of 50 people (DSA, transport, hall hire , refreshments, coordinationa nd stationary support). 28 from districts 12 from national plus facilitators and drivers

3249

b) Validation meeting 0

3.3.1

support the conduct of risk assessments for emergency situations (pandemic flu, cholera, extreme weather events, EVD, etc.)

comprehensive risk assessment is available

a) Orientation training for 100 staff every year for 3 years on risk assessment for emergency situations. 8 facilitators (4 sessions) DSA, Transport, refreshments

29712 Who, RRTs,

3.3.2Support development of national emergency preparedness plan

National emergency management plan is available

Allocate technical staff to the process. Build capacity of 10 NPHA staff in emergency planning (Bring in a facilitator)

1893 WHO, PHE, CDC

3.3.3 Support development of district emergency preparedness plans

district emergency management plans are available

Dispatch technical staff (Fuel and DSA) 14 districts for 3 meetings

2268 WHO, PHE, CDC

3.3.4Mobilise resources to implement emergency response plans

Adequate resources are available to respond to emergencies

Support advocacy meetings (top up/ phone lines, refreshments 300 TMT

3.4.5Establish and maintain a roster of personnel with the technical expertise to respond to potential public health emergencies

Roster of trained personel is available a) develop database. Upgrade periodically 500

Redisse funding Ministry

3.4.6 Support advocacy and community sensitisation for emergency response

effective engagement of communities for emergency response

dispatch staff to work with districts (DSA and fuel)

6048

Unicef

3.4.2Support periodic simulation exercises for all response teams (PHEMC, RRT, etc.) Simulation exercise(s) are conducted Dispatching staff

WHO, PHE, CDC

SO3.3: Develop EPRR capacity at the local and national level

3.2.4

Review and upgrade financial management policy

Review and upgrade safe and dignified burial policy

3.2.5 Review and upgrade hazard pay policy

SO 3.4: Strengthen capacity to respond to public health emergencies at national and district levels

3.2.3

SO 3.1: Ensure the functioning of EPRR Infrastructure at the local and national level, including an effective EOC

SO 3.2: Develop policy and governance for EPRR at the local and national level

3.2.1 Review and upgrade surveillance policy Policy is revised

Policy is revised

Policy is revised

Policy is revised

3.2.6 Review and upgrade transport management policy Policy is revised

Table 5: EPRR Activities

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Public Health Workforce DevelopmentGoal

A sustainable workforce, capacitated and skilled to meet the public health needs of Sierra Leone.

BackgroundA strong public health system requires workers with training in a wide range of fields, including epidemiology, laboratory sciences, health policy, health communications, information technology, and management. It is the NPHA's responsibility to help develop a public health workforce that is adequate for national needs, both for the NPHA itself and to support the broader public health infrastructure.

This responsibility might include monitoring the workforce in terms of existing capacity and unmet needs, providing training and continuing education for NPHA employees or other public health professionals (for example, in laboratory techniques or epidemiology), advocating for strong public health departments in universities, forming partnerships with universities and other places where public health training is conducted, and defining licensure requirements for public health professionals.

Retention of skilled public health workers is also important. Public health work may pay less than work in the private sector, and skilled workers in low-resource countries may seek opportunities in higher resource countries. The NPHA will play a role in helping to provide fulfilling opportunities for public health practitioners and other incentives for remaining in the public health workforce. The mix of activities related to workforce will focus on training that is practical and provides specific skills in public health.

19

Activity Tasks Outcome Costed Items

Estimated Costs

Funding Source

17 18 19Critical Individuals / Organization to be involved

4.1.1 Conduct a comprehensive Public Health workforce needs assessment

Comprehensive public health workforce needs assessment is conducted

Consultant for 3 months 24000

4.1.2Develop a comprehensive human resource plan for public health (roles, skill mix, location, impact of migration and age re future trends)

A PH human resource plan is produced

Workshop (Meeting of 50 people (DSA, transport, hall hire , refreshments, coordinationa nd stationary support))

3199

a) Consultancy for 6 months 52000

b) advocacy politicians and TMTs (cost free)

0

4.1.4 Mobilise resources to support the HRM plan Resources to support the HRM plan are mobilised

Advocacy with politicians etc (cost free)

0

4.1.5 Develop ethical standards for the public health workforce

Ethical standards are produced refreshment for 15 technical staff x 6 times

225

a) Meeting of 50 people (DSA, transport, hall hire , refreshments, coordinationa nd stationary support). 28 from districts 12 from national plus facilitators and drivers

3199

b) Validation meeting 3199

4.2.2 Produce revised version of the public health workforce strategy

Revised policy is produced Print and distribute 200 copies of the revised policy

1000

4.2.3Ensure that the public health workforce is included in wider discussions regarding Human Resources for Health (HRH).

Public health workforce is included in wider discussions regarding Human Resources for Health (HRH)

Host technical meetings with HRH dierctorate and Top Management team

0

4.3.1 Conduct comprehensive needs assessment of public health training institutions

A public health training institution Needs Assessment is produced

consultancy for 3 months 24000

4.3.2Develop a plan for the upgrading of training institutions

A plan for upgrading research institutions is produced

Consultancy for 3 months 24000

4.3.3Develop standard curricula and accreditation processes for PH training institutions

standard curricula and accreditation processes for PH training institutions are produced

Consultancy for 3 months 24000

4.3.4 Mobilise resources to implement the institutional improvement plan

resources to implement the institution plan are mobilised

Advocacy meetings with politicians, TMT

0

4.4.1 Sponsor training opportunities to improve scientific and technical skills of public health staff.

Training opportunities to improve scientific and technical skills of public health staff are sponsored

National level Training of trainers for NPHA and directorate staff (train 20 people )

300

4.4.2

Provide, or facilitate, training courses and workshops for laboratory staff in private and public sectors to continually upgrade the knowledge and skills essential for providing quality services in medical, environmental, and public health laboratories

Training opportunities to improve scientific and technical skills of public health staff are sponsored

Training institutions, courses, funds, mentors

4.4.3Provide continuing education in management and leadership development for those in administrative positions

continuing education in management and leadership development for those in administrative positions is available

quarterly training for 10 technical staff per district across sectors

4.4.4 Participate in training of international scientists International scientists are trained Support 2 staff per year

Review existing strategy on public health workforce

SO 4.2: Co-ordinate a multi-partner workforce development strategy to proactively meet public health workforce needs

SO 4.1: Undertake ongoing assessment of the public health workforce needs, to include evaluation of current training provision

4.1.3 Develop short and long term training courses

SO 4.3: Support and advocate for partner institutions to ensure that appropriately trained and experienced staff are available in sufficient numbers to meet public health needs

Deliver specialist training in core areas of public health need

Existing policy is reviewed

short and long term training courses are developed

4.2.1

Table 6: PH Workforce Activities

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Public Health Research

GoalA strong and coordinated public health research capacity that informs policy and public health programmes

BackgroundConducting research is a critical public health function and is important for the credibility of a public health agency.

The Agency will establish a research agenda that includes operational and original research leading to findings of national and international importance. Research will be undertaken collaboratively, with national and international partners, enhancing the quantity and types of data collected and the relevance of the work. The NPHA will have sufficient resources to carry out its research agenda, by conducting the work itself and by supporting other partners who have specialized expertise, links to populations of concern, etc. Priorities reflecting the JEE suggest that cross-sectoral collaboration on research should be included to be able forecast, model, or prevent outbreaks

The recent Ebola outbreak demonstrated the capacity of Sierra Leone to provide leadership in the development of a research agenda to address important questions regarding prevention and treatment of the disease as well as a better understanding of the long-term health consequences in survivors. This research agenda is important not only to the people of Sierra Leone, but also this region of Africa, as well as the rest of the world. The development of research capacity will help to inform public health policy and practice, generate hypotheses and questions for further research and serve as a basis to demonstrate capacity in seeking external research funding.

With health care delivery a more immediate need for the Ministry of Health and Sanitation, a comprehensive, long-term approach to funding research is needed, especially as current research efforts are funded through research partners in response to the Ebola epidemic. Raising the potential for both internal and external funding is dependent upon the demonstration of research accomplishments through near-term publications and the presentation of a research agenda responsive to the needs of Sierra Leone and of interest to potential future partners.

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Activity Tasks Outcomes Costed items estimated costs

17 18 19Critical Individuals / Organization to be

involvedComment

5.1.1Support relevant institutions to initiate or participate in research

Institutions are able to participate in research

train 20 researchers across instritutions in research methodologies and techniques annually- 3 week course

46200

5.1.2

Ensure availability of resources (e.g. Databases, information technology) to facilitate research resources are in place

Provide logistic support to NPHA and other relevant institutions for research (Computers, statistical packages etc)

a) Support 10 research proposals annually ($5000 per project)

50000

b) foster exchange programs with internal and external research institutions (exchange visits/ hosting)

Host institutions to provide

a)3 month consultancy to develop an evauluation mechanism on the impact of PH research

24000

b) Conduct evaluations of PH efforts

5.2.1Recommend and advocate relevant public health

issues for inclusion into institutions' research agendas

Nationally relevant PH issues are included in research agendas

5.2.3Create and maintain linkages with leading research institutions

Links are formed and maintained Research institutions, bursaries, training programmes

a) Monthly email newsletter 0b) development of a website

5.4.2Promote the active use of research evidence used in designing and supporting policy in the field of public health

Evidence is considered and included in policies

Train NPHA staff on translation of research findings into policy (annual 3 day workshop for 40 persons annually)

10791

5.4.3Increase the capacity of policy makers for effective use of health information

policy makers are better able to effectively use PH evidence

Advocacy meetings with policy makers and TMT- minister and CMO quarterly (20 policy makers per quarter)

2272

5.4.4

Build capacity for translation of research findings into usable information

Research is included in policy and decision making

Train NPHA staff on translation of research findings into policy (annual 3 day workshop for 12 persons annually with 3 facilitators)

2025

a) Newsletter/ research briefsCreate access to publications (LICENCES to PH database)b) Support NPHA staff to participate in research meetings (Bimonthly meetings at NPHA for 15 persons)

450

SO 5.1: Strengthened National Capacity to initiate or participate in epidemiological and public Health Research

5.4.1 Support the dissemination of research findings to public health colleagues

5.1.4

Evaluate the development, implementation, and impact of public health research efforts

Research findings are disseminated

The development, implementation and impact of of public health research effors

are evaluated

SO5.4: Solutions to health problems are identified and the feasibility of new technologies assessed

5.1.3

Support public health staff to engage in public health research

5.4.5

Create opportunities for utilisation of best practice from other agencies

SO 5.3: Solutions to health problems are identified and the feasibility of new technologies assessed

Public Health staff are engaged in PH research

Best practice is implemented

SO 5.2: An agenda for research based on population need and key actors is produced

Table 7: Research Activities

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Health Promotion

Goal

Effective prevention of disease, through effective public health advocacy, education, services and policy development.

Background

Sierra Leone, as with other countries in West Africa, finds itself entering an epidemiologic transition. Whilst infectious disease remains the largest contributor to morbidity and mortality, Non-Communicable Diseases (NCDs), including mental illness, are of considerable concern. Under-nutrition remains a chronic issue for many in Sierra Leone, but over nutrition, leading to diseases such as diabetes, heart disease and stroke, is a significant and growing concern. Cancer has recently been declared a public health emergency.

Non-communicable disease risk factors are modifiable; however, people may lack the knowledge, resources and agency to do so without support.

In turn, rates of infectious disease can be reduced markedly through education and appropriate policies, particularly with regards to Water and Sanitation for health and environmental management. However, these may require significant investment and advocacy to ensure that infrastructure is effective in preventing and mitigating outbreaks of disease.

Ebola highlighted the impact of communication and collaboration in controlling the spread and impact of disease. The recent Joint External Evaluation (JEE), assessing compliance with the International Health Regulations (IHR) made a number of recommendations for developing cross sectoral co-operation and consolidation of effort to address the risks of emerging infections, zoonoses and Anti-Microbial Resistance (AMR).

As the trusted source of public health guidance and leadership in the country, the Agency has a key role in supporting and co-ordinating efforts to prevent and reduce the impact of disease, undertaking and supporting research to inform health promotion activities, advocating for and enabling the formation of evidence informed policies and providing recommendations to relevant programs and partners to promote the public’s health.

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Activity Tasks Outcomes Costed ItemsEstimated

costsFunding Source 17 18 19

Critical Individuals / Organization to be

involvedComment

a) Training for NPHA staff in strategic planning. Annual two day training workshop

7348

b) Dispatch NPHA staff to participate in strategic planning at national level (5 staff monthly)

420

6.1.2 Mobilise the resources to implement the health improvement strategic plan

The resources to implement the health improvement strategic plan are mobilised

advocacy meetings with politicians, TMT and external partners

0

a) biweekly technical discussion meetings with 10 health service managers and stakeholders on health promotion

1300

b) participate in development of health promotion package

1200

6.1.4Develop a comprehensive community engagement package for health improvement

A comprehensive community sensitization package for health improvement is produced

Host technical discussion meetings with health service managers and stakeholders on community engagement

1200

a) engage Health service managers, PH experts, community educators, local and religious leaders, civil society groups

1200

b) Print and diseminate leaflets and information resources 5000

c) Refreshment for bimonthly information dissemination sessions for 50 participants

1500

6.2.1 Create opportunities for access to international public health policies and strategies and policies

International public health policies and strategies are accessed

Computers, subscriptions, data manager, funding

6.2.2Build capacity to develop plans for implementing international public health policies and strategies

Capacity to develop plans for implementing international public health policies and strategies is developed

Annual workshop for PH experts, service leads (28 from district, 12 national for 2 days, 3 facilitators)

5346

6.2.3 Mobilise resources to implement international public health policies

resources to implement international public health policies are mobilised Politicians, TMTs, briefings 0

6.3.1

Establish and maintain partnerships for improvementof healthy environments

Partnerships for improvement of healthyenvironments are established andmaintained

Environmental and public health leads, business and community leaders, civil society groups, NGOs

6.3.2

Develop and enforce policy to promote healthyworkplaces and institutions (schools, colleges, etc)

Policy to promote healthy workplaces adinstitutions is developed and enforced

Politicians, TMTs, Environmental and public health leads, business and community leaders, civil society groups, NGOs, workshops

6.3.3Build capacity for effective monitoring of living andworking environments

Capacity for effective monitoring of livingand working enviroments is developed

Environmental health officers, service leads, partners, workshops, logistics

6.4.1Build capacity for effective monitoring and evaluation

Capacity for effective monitoring and evaluation is developed

Capacity for effective monitoring and evaluation is developed Annual workshop for 40 staff)

5346

6.4.2 Undertake regular monitoring and evaluation of health outcomes and determinants

Regular monitoring and evaluation of health determinants and outcomes is undertaken

Service leads, training institutions, partners, workshops,

6.4.3Produce and disseminate M&E reports

M&E Reports are created and diseminated

Trained staff, stationary, logistics 1000

6.1.3

6.1.5

Develop and strengthen effective mechanisms to create and maintain supportive environments for health improvement

Develop and strengthen effective mechanisms to create and maintain supportive environments for health improvement

Develop a framework for adoption and implementation of international public health policies and strategies

A health improvement strategic plan is developed

A comprehensive advocacy tool for health promotion is developed

Partnerships for health promotion are created and maintained

Develop and implement a national health improvement strategy

Support the development of a health improvement strategic plan

Support the development of a comprehensive advocacy tool for health promotion

Create and maintain partnerships for health promotion

6.1.1

Table 8: Health Promotion Activities

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Office of the Director

The NPHA identifies and defines population health problems and maintains active surveillance of diseases through epidemiologic and laboratory investigations, data collection, analysis, and distribution; conducts operational research aimed at effective disease prevention and control; develops and implements a program to sustain a strong national workforce in disease prevention and control; and conducts a national program for improving the performance of public health reference laboratories. It serves as the Ministry of Health and Sanitation’s lead public health agency in developing and implementing programs addressing the Nation’s public health demands.

This ambitious role will be overseen by an office of the Director of the NPHA. Whilst not a Public Health function, the management, oversight and strategic direction of the Director and his/her team is crucial in ensuring that the Agency delivers on its desired public health outcomes.

Its functions will be to:

1. Manage and direct the operations of people, places, and things 2. Guide the development of Agency goals and objectives3. Provide leadership, coordination, and assessment of administrative management activities4. Provide leadership for related to disease prevention and control and public health reference

laboratory5. Provide overall direction and coordination to the epidemiologic and surveillance activities

including response to health emergencies6. Cooperate with the districts and facilities providing overall direction to, and coordination of,

the functional areas7. Advise the Chief Medical Officer in the Ministry of Health and Sanitation on policy matters8. Coordinate and assure coordination with the appropriate MoHS staff offices on

administrative and program matters9. Provide liaison with other governmental agencies, international organizations including the

World Health Organization, learning institutions, and other outside groups

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Monitoring and Evaluation frameworkTimely and reliable monitoring and evaluation (M&E) is important for improving performance and achieving results. An effective M&E system will ensure informed decision-making and support accountability.

NPHA will conduct M&E activities to monitor progress, assess its impact, and highlight the agency’s accomplishments and achievements. NPHA’s M&E activities will include:

Routine monitoring of inputs, outputs and outcomes to provide NPHA management and key stakeholders with early indications of progress.

Periodic reviews to assess progress and identify challenges and lessons learned in implementing the NPHA’s operational plan.

Evaluations to systematically and objectively assess progress towards the NPHA’s desired outcomes. Conducting such evaluations could provide accountability and demonstrate the agency’s impact.

To minimize reporting burden, NPHA will emphasise the use of indicators already being collected by the routine health information system, complemented by the collection of additional data through surveys, research and evaluations.

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