On #WorldChildrensDay, Minister of Health in Sierra Leone, Dr Austin Demby, discusses the country’s intense focus on child survival and health, using the life stages approach to health service delivery, and its advocacy among countries in the African region to ramp up efforts.
Freetown ‒ Between 2014 and 2016, the highly infectious Ebola Virus Disease (EVD) outbreak in Sierra Leone and neighboring countries claimed the lives of over 4000 men, women and children in the country. At the time, the surveillance system, which was partially rolled out in 2003 by the Ministry of Health and Sanitation (MoHS), was weak and rudimentary. The need to strengthen IDSR to ensure prompt detection and response to epidemic-prone diseases was urgent.
Revitalization and transformation efforts by the MoHS commenced with adaptation of updated Integrated Disease Surveillance and Response (IDSR) guidelines and the creation of tailored national guidelines to align with regional and global frameworks. To ensure effective data management, public health experts carefully defined the flow of information, system operations, case definitions, reporting frequency, and channels of information dissemination.
In close cooperation with other partners, like African Field Epidemiology Network (AFENET), eHealth Africa, and the US Centers for Disease Control, and with funding from donors, World Health Organization (WHO) provided technical and financial support for the adaption of IDSR technical guidelines. The WHO-led training and supportive supervision, and provision of IDSR tools for case reporting and investigation, were instrumental in rolling out the IDSR strategy to all health facilities. IDSR focal points from health facilities and District Health Management Teams (DHMTs) were trained on all priority diseases.
WHO also supported the development and operationalization of an electronic IDSR reporting platform (eIDSR), which enabled the Ministry of Health and Sanitation to establish a functional public health surveillance system in Sierra Leone. That enhanced the national capacity to effectively prevent, detect and respond to public health events and emergencies.
Rapid Response Teams were also formed and trained to investigate and respond to disease outbreak alerts in all districts. Together with the Health Ministry, WHO conducts monitoring activities, including periodic supportive supervision and data quality assessments.
Currently, the epidemic intelligence system in Sierra Leone has evolved from its pre-EVD paper-based approach to the current modern electronic integrated disease surveillance and response system that can efficiently detect and trigger the response to a disease outbreak or event.
The rate of reporting has shown a significant improvement, starting from about 60% in 2015, rising to an average of 98% for both completeness and timeliness in 2023. Additionally, successful cross-border collaboration and coordination have been established with neighbouring Liberia and Guinea. This has significantly improved sharing of information and experiences.
Freetown ‒ On November 5, 2021, an oil tanker explosion in Sierra Leone’s capital Freetown resulted in at least 100 deaths and left hundreds of people seriously injured with burns. The government, through the Ministry of Health and Sanitation (MoHS), immediately called an emergency meeting of the National Public Health Emergency Management Committee (PHEMC), during which partners were informed about the incident and the initial steps taken to address the situation.
To enable a coordinated and efficient response, the PHEMC activated the Emergency Operation Centre (EOC) and escalated the incident response to level two. This activation allowed for enhanced coordination, communication and resource mobilization, enabling an effective response to the public health event.
Despite these measures, it became evident that the scale of the situation exceeded the country’s existing capacity for trauma/burns management. The overwhelming nature of the crisis exposed the limitations in fully addressing the growing demands and complexities. Additional support and resources were required to bolster response efforts.
WHO conducted a Rapid Risk Assessment and an independent grading, quickly accessing financial resources through the Central Fund for Emergencies (CFE) to expedite initiation of emergency response interventions.
WHO provided six tons of critically needed case management commodities and supplies within 24 hours of notification and deployed a specialist emergency medical team (EMT) comprising an orthopedic/trauma surgeon, anesthesiologist, visceral surgeon, and several specialist nurses. In addition to supplementing the work of local experts, visiting specialists also provided training to help strengthen local staff capacity.
This transfer of knowledge empowered local staff to efficiently assist victims, in conjunction with the Emergency Medical Team. This played a pivotal role in substantially increasing the survival rates of severely injured people being treated in hospitals.
Implementing Incident management principles as outlined in the Emergency Response Framework, such as timely assessment and event grading, facilitated timely deployment of critical resources. Further swift response was facilitated by a roster approach to deployment of Emergency Medical Teams and other experts.
The 2014 - 2016 Ebola Virus Disease (EVD) outbreak was devastating for Sierra Leone. The outbreak claimed the lives of up to 4 000 men, women and also wrecked huge social and economic impacts on the country. However, lessons learned and best practices from that emergency left the country better positioned and with a resilient health system that is now able to effectively prevent, detect and respond to emergencies such as the COVID-19 pandemic.
Watch how the country successfully managed the COVID-19 pandemic using experiences from the Ebola outbreak
In early July, more than 197,000 children aged between 6 months and 15 years were vaccinated against measles in a targeted immunization campaign in Koinadugu district in northern Sierra Leone.
Reaching some of the country’s most remote areas, the campaign was conducted by the Ministry of Health and Sanitation with support from the World Health Organization, UNICEF Sierra Leone, UK Department for International Development, the World Bank and other health partners following confirmed cases of the disease among children in two far apart communities in that district.