In November 2019, a health care associated Lassa Fever infection in Tonkolili District led to the onset of cases of the disease and death including healthcare workers. The event occurred when two patients presented at the Masanga Hospital with fever and other complications and were treated for their conditions but subsequently died. The cause of their deaths proved to be Lassa Fever, which later spread to three other people including healthcare workers with one additional death.

The Ministry of Health and Sanitation (MoHS) with the support of its partners including the World Health Organization (WHO), US-CDC, DFID then responded to that event by instituting public health interventions to prevent further escalation of cases. These included case management, training for frontline health workers, enhanced surveillance, contact monitoring, risk communication, as well as follow up technical and operational actions undertaken that eventually facilitated containment of the disease.

The MoHS with technical assistance from WHO through funding from the DFID Saving Lives Programme, recently concluded a structured review and assessment of the response to the November event to document the lessons from the technical and operational response actions. These lessons including the strengths, weaknesses, successes, opportunities and challenges that were identified from the review will inform future response plans and actions to improve response to public health events and emergencies.

The evaluation process known as After-Action Review (AAR), is a requirement under the International Health Regulations (IHR 2005) Monitoring and Evaluation Framework. Importantly also, AAR is in line with the Sierra Leone National Emergency Response Plan and the Learning from Incidents and Emergencies Guidance. A small-scale AAR was undertaken at the district level during which the Tonkolili District Health Management Team assessed their Incident Management System and the performances of the technical pillars which were activated during the response at the onset of the cases.

After Action Reviews are a structured process which supports reflective learning and gives participants the opportunity to evaluate their prior individual and the collective performances through insightful practice. The Review is evidence based and linked to the concept of learning from experience.

Lassa fever is endemic in Sierra Leone with sporadic onset of cases . The disease ia an acute viral haemorrhagic illness, transmitted to humans through contact with food or household items contaminated by infected rats (Mastomys natalensis). Human-to-Human transmission can occur in healthcare settings in the absence of adequate infection prevention control measures or where such measures are not strictly followed.

Major symptoms of the disease in humans include fever, headache, sore throat, general body weakness (and bleeding), though these signs may also present for other illnesses. Early detection and prompt treatment can prevent loss of lives.

Several areas of best practice were identified during the AAR process which demonstrate the capacity of the Ministry of Health and Sanitation and partners at national and district levels to respond to and manage a public health event. However, several areas requiring improvement were also identified and documented.