By Kemo Cham
If an epidemic of any disease were to erupt today, Sierra Leone has all what it takes to contain it, at least on paper.
The country’s health authorities say all what is needed is contained in the National Action Plan for Health Security (NAPHS), which was launched last week. The document outlines how the country will respond to emergencies, both in terms of expertise and resources needed, and facilitate its achievement of universal health coverage.
The five-year plan outlines activities that will be carried out in the medium term (2019- 2022) to accelerate attainment of Health Security and significantly contribute to the regional and global health security agenda as stipulated under the International Health Regulations 2005.
The NAPHS, developed with the support of partners in the health sector - World Health Organization (WHO), United States Centers for Diseases Control and Prevent (CDC), and the United States Agency for International Development (USAID) - is Sierra Leone’s response to what experts say is a growing trend of epidemics globally.
Sierra Leone has already had quite an experience of this, from Cholera to Lassa Fever to Ebola, all of which have had devastating impact.
Sierra Leone has experienced at least four cholera outbreaks since 1970. The latest outbreaks of the bacterial disease were in 2012 and 2013. The 2012 outbreak is so far the largest on record; it claimed 392 lives.
The Ministry of Health and Sanitation (MoHS) said the 2012 outbreak met the country ill prepared to respond.
“And when Ebola came, the picture was the same,” said Dr Amara Jambai, Chief Medical Officer in the MoHS.
The West African Ebola epidemic (2014 -2016), which began in Guinea and spread to Liberia and then Sierra Leone, remains the largest ever outbreak of the viral hemorrhagic fever disease in the world, according to WHO.
While in the case of Cholera Sierra Leone had minimal expertise to diagnose and it, with Ebola there was virtually no knowledge about the virus. And there was not a single laboratory facility equipped enough to detect it.
In all three neighbouring Mano River Basin countries, the Health ministries were so ill equipped that the response efforts were taken away from them and independent units were established. In Sierra Leone it was the National Ebola Response Center (NERC), which was subsequently transformed to the Emergency Operations Center (EOC), which today oversees all health emergencies. The EOC will be implementing the NAPHS, under the coordination of the newly created Directorate of Health Security and Emergencies.
The NAPHS was developed based on recommendations of the 2016 Joint External Evaluation (JEE) which is a voluntary, collaborative and multi-sector process recommended by the World Health Assembly (WHA) in the aftermath of the West African EVD outbreak. The JEE was meant to evaluate Sierra Leone’s capacity to prevent, detect and rapidly respond to public health events. The process gave an opportunity to national authorities and partners to identify the most critical gaps within the country’s human, animal and environmental health sectors which were prioritized for enhanced preparedness and response capacity development.
The end of the epidemic, Sierra Leone has embarked on a lot of reforms in the health sector as part of its health system strengthening. And all the reforms are aligned with the NAPHS.
Among the nearly 4000 people who died from that epidemic, about 300 were healthcare workers. Those needed to be replaced. Some efforts is being done in that direction.
The EOC has been replicated in all 16 districts across the country, and attached to each is a rapid response team, made up of trained surveillance officers. Surveillance is a major focal point in the NAPHS. And while Community Engagement was the buzz word during the Ebola response, now the focus is community mobilization.
A standard Infection Prevention Control system has also been put in place. Trainings have been conducted to provide key expertise, from lab specialists to epidemiologists. Lab technicians are trained to diagnose many pathogens. And today, Sierra Leone boasts of 22 epidemiologists.
Dr Jambai said with the experience gathered from the Ebola response, the country has created a cohort of experts so that in terms of human resources there is enough people to handle any health emergency.
“The dawn has come by where we are better prepared. We can make things work,” he said at a prelaunch press conference.
“We still have a long way to go, but we are trying,” he added.
Enthusiasm for surveillance
The launch of the NAPHS is also part of Sierra Leone’s efforts to fulfill its international obligations towards the global health security agenda, as set out by the WHA.
According to WHO, Sierra Leone became the 7th country in Africa and 11th in the world to prepare and launch this document. In West Africa, only Liberia and Nigeria are part of this list.
The Global Health Security agenda is tied to the phenomenon known as One Health, which is an approach that pursues the health of human beings by taking into account the health of animals - zoonotic diseases.
Ebola and Lassa Fever are both examples of zoonotic diseases, meaning they can be transmitted from animals to humans.
In the last two years, two major scientific discoveries in Sierra Leone have highlighted the significance of this concept of One Health to the country. In December 2018, scientists discovered the deadly Marburg virus in fruit bats in three of the country’s five regions. Five months earlier, another group of researchers had discovered a new strain of the Ebola virus in the northern Bombali district.
A recent risk profiling conducted by the MoHS and its partners identified 10 diseases and conditions, environmental and other threats as potential risks for emergency concerns in Sierra Leone. And in the NAPHS, up to 15 priority diseases are listed. But officials say the focus will be on the ones with the capacity to cause outbreaks, especially the Viral Hemorrhagic Fevers, notably Ebola, Lassa Fever and Marburg.
Dr Alpha Wurie, Minister of Health and Sanitation, said amidst rapid urbanization, Sierra Leone has also had to contend with environmental degradation which posses health risks due to water borne diseases. Dr Wurie also cited the growing trend of animal bites related diseases like rabies, as well as cross border infections of disease like Measles, Rubela and Yellow Fever as causes for concern.
“Such situations require labs that can do diagnosis almost immediately,” he told journalists, stressing that the ministry of health cannot protect the population without collaboration with sister ministries and departments, like the Environment, Lands and Agriculture.
Sierra Leone launched its One Health platform in March 2019.
The sensitization aspect of the NAPHS will let the people learn how to handle animals when they fall sick, said the Minister.
But all of this is what's on paper - What the country is capable of doing, if the resources are available. A whopping US$291million is needed to fully implement the whole plan.
The MoHS has identified and isolated the high priority activities to be implemented in the first two years, which cost an estimated US$50 million.
Dr Evans Liyosi, WHO Country Representative, said the NAPHS presented some of the best programmes for Sierra Leone and that all it needs are commitment from the government and its partners to realize it.
“What is most critical moving forward would be a very strong collaboration and demonstrated commitment by the government and all partners in making sure that the required resources are made available for the full implementation of this well formulated action plan that would help to save lives and promote socio-economic development in this country,” he said in the joint statement issued to coincide with launch of the document.
© 2019 Politico Online
