Strategic Partnership for International Health Regulations (2005) and Health Security (SPH): workshop on prioritization, resource mapping and multisectoral partnership collaboration for the implementation of the national action plan for health security: April 23-26, 2018 - Freetown, Sierra Leone

1 Strategic Partnership for International Health Regulations (2005) and Health Security (SPH) Workshop on Prioritization, Resource Mapping and Multisectoral Partnership Collaboration for the Implementation of the National Action Plan for Health Security April 23-26, 2018 - Freetown, Sierra Leone 2 WHO/WHE/CPI/2019.19 © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution- NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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Printed in Switzerland 3 TABLE OF CONTENTS Executive Summary………………………………………………………………………………………………………….5 Background ……………………………………………………………………………………………………………………..8 Report on the Sessions …………………………………………………………………………………………………….9 Welcome and Opening Remarks…………………………………………………………………………………………10 Session 1 (Introductory Discussion).……………………………………………………………………………………11 Session 2 (National Perspective)…………………………………………………………………………………………14 Session 3 (Partner Support to Government)……………………………………………………………………….15 Session 4 (Prioritization of In-Country Activities)…………………………………………………………………16 Day 2………………………………………………………………………………………………………………………………18 Session 5 (Multisectoral Partnership Collaboration)……………………………………………………………18 Session 6 (Presentation of the Priority Areas)…………………………………………………………………….19 Session 7: Rescoring of the Activities………………………………………………………………………………….23 Session 8: Finalization and Analysis of the Scoring………………………………………………………………24 Day 3 ……………………………………………………………………………………………………………………………..26 Session 9: Presentation of the Resource Mapping Tool………………………………………………………26 Session 10: Group Work to Reorganize the Timelines…………………………………………………………29 Session 11: Documentary on International Health Regulations…………………………………………..29 Session 12: Presentation on SPH…………………………………………………………………………………………29 Results of the Meeting……………………………………………………………………………………………………29 Annex: List of Participants………………………………………………………………………………………………31 4 ABBREVIATIONS & ACRONYMS AAR After Action Reviews AMR Antimicrobial Resistance CPHRL Central Public Health Reference Laboratory DHMT District Health Management Team DPC Directorate of Disease Prevention and Control EOC Emergency Operations Center EVD Ebola Virus Disease FETP Field Epidemiology Training Program GHSA Global Health Security Agenda GPW Global Programme of Work IDSR Integrated Disease Surveillance and Response IHR International Health Regulations (2005) IPC Infection Prevention and Control JEE Joint External Evaluation MAFFS Ministry of Agriculture, Forestry and Food Security M&E Monitoring and Evaluation MEF Monitoring and Evaluation Framework MoHS Ministry of Health and Sanitation NAPHS National Action Plan for Health Security PHECP Public Health Emergency Contingency Plan REMAP Resource Mapping and Impact Analysis on Health Security Investment tool RRT Rapid Response Teams SPH Strategic Partnership for IHR and Health Security WHO World Health Organization 5 EXECUTIVE SUMMARY Sierra Leone in 2016 was among the first African nations to volunteer to undergo the Joint External Evaluation (JEE) of the country’s capacity to prevent, detect and rapidly respond to public health risks and threats. The JEE identified key areas for improvement including revision of public health laws and legislation, zoonotic disease prevention and response, strengthening surveillance at points of entry, antimicrobial resistance, detection and response, and development of a comprehensive multi-hazard National Public Health Emergency Preparedness and Response plan. Sierra Leone used the JEE recommendations to develop a National Action Plan for Health Security (NAPHS), covering 2018-2022, with an implementation cost of about $291 million. Seeking to accelerate implementation, Sierra Leone was the first country to request support from the WHO Strategic Partnership for IHR and Health Security (SPH) in activity prioritization, resource mapping and multisectoral partnership collaboration. WHO SPH responded by conducting a workshop in Freetown, Sierra Leone, 23-26 April 2018, bringing together national ministries and agencies, as well as partners and donors including FAO, US CDC, USAID, IOM, Public Health England, China CDC and GIZ. Workshop participants were placed in groups of five based on their technical areas of expertise and asked to score and prioritize health security activities in the NAPHS to be implemented in the first two years of the five-year NAPHS. The scoring of activities was based on 6 categories such as whether the activity is “low-hanging fruit”, whether there is a known advocate for the activity and whether there are existing technical and financial resources available to complete the activity. Some categories were worth more points than others in the scoring. A maximum score of 10 was possible for any activity that met all 6 criteria. The categories and their scores are illustrated in the table below. Low- hanging fruit (1 or No) Highest Priority (Yes or No) Known Advocate Activity Timing (Ongoing, 1st, or Follow-on activities) Resources Needed (High or Low) Existing or Potential Funding Source(s) YES YES YES Ongoing LOW YES 1 3 2 1 1 2 The exercise resulted in 107 activities with scores from 7 to 10 being prioritized for implementation in the first two years of the NAPHS. Real time surveillance had the biggest 6 budgeted amount of prioritized activities among the technical areas with $24,601,790.89. The graph below shows the technical 19 areas with their budgeted amounts of prioritized activities. The resource mapping and impact analysis on health security investment (REMAP) tool developed by WHO was then used to map the existing partner and donor health security activities in Sierra Leone. The mapping showed that 33 partners and donors in the country are supporting various technical areas. The mapping identified the number of partners and donors in each of the technical areas and demonstrated that National Laboratory System currently has 13 partners and donors, the highest number of all, followed by Emergency Response and Point of Entry, with nine each. The mapping identified technical areas without any partner or donor support, including food safety, radiation emergencies, medical counter measures, national legislation, and linking public health and security. WHO concluded the workshop with a roundtable discussion between donors and key government decision makers to achieve alignment on the implementation of the prioritized activities. The process attracted new partnerships, funding, and technical support. When the resource mapping workshop showed some overlap in donor-funded projects, WHO encouraged donors to be more flexible in their earmarking of funds to achieve better $24,601,790.89 $12,789,085.65 $2,460,250.68 $1,552,831.12 $1,505,392.32 $1,500,735.25 $1,477,743.10 $1,063,554.04 $818,312.37 $672,662.96 $624,971.09 $440,569.14 $332,994.53 $125,246.09 $116,575.52 $92,896.88 $66,683.46 $59,191.67 $17,269.53 Real Time surveilance Immunization AMR Chemical Events PoE Zoonotic Disease National Laboratory System IHR Coordination Communication and Advocacy Biosafety and BioSecurity Emergency Response Operations Linking Public Health & Security Food Safety Radiation Emergencies Risk Communication Preparedness National Legislation, Policy and Financing Reporting Workforce Development Med Counter Measure 7 coordinated results. As a result, more than USD $50 million of new and reprogrammed funding was identified, both domestic and external, with domestic funding representing about 20% of the total. 8 BACKGROUND Sierra Leone has a long history of health emergencies resulting from recurrent disease outbreaks and natural disasters that affect human, animal, and environmental health. The unprecedented West Africa Ebola Virus Disease (EVD) outbreak in 2014–2015 affected more than 14,000 people in Sierra Leone and killed another 3,956. The country’s fragile health system suffered a severe shock and the epidemic took a heavy toll on the health workforce, with 221 deaths. The severity of the outbreak was exacerbated by limited investment in the country’s health system and a lack of access to affordable health services, as the health sector was largely dependent on external funding sources. Ebola is not the only threat in Sierra Leone. Maternal and child mortality rates are among the highest in the world. Communicable diseases such as cholera, yellow fever, Lassa fever (an endemic viral haemorrhagic fever), and rabies present significant public health threats. Flooding and landslides leave communities dangerously vulnerable to waterborne disease outbreaks and cholera. Zoonotic diseases also have a serious impact on human health. Numerous outbreaks have devastated livestock and caused significant losses in agricultural productivity and food security. To address the recurrent health threats, better planning, preparedness, and coordination are urgently needed. The same health threats in Sierra Leone affect many other countries. The EVD outbreak in West Africa revealed an alarming level of unpreparedness to manage health emergencies and disasters in other countries in the region. A 2015 independent review of the response to the EVD outbreak recommended changes in how countries evaluate public health capacities and emergency response capacities, as required by the International Health Regulations (IHR, 2005). Following the 2015 independent review, WHO developed the IHR Monitoring and Evaluation Framework for all WHO Member States, comprising four components, one mandatory and three voluntary. First, countries undertake a mandatory annual self-assessment of their IHR capacities and report the results to the World Health Assembly. Second, a multi-pronged external peer reviewed evaluation (a joint evaluation exercise, JEE), involving both domestic and international experts, is undertaken every 4-5 years to assess a country’s IHR capacities and its ability to prevent, detect, and rapidly respond to public health threats. This voluntary test helps countries identify the most critical gaps within their human and animal health systems and prioritize actions to improve preparedness and response capabilities. Since the 2016 launch of the JEE tool, 91 countries have volunteered and completed the assessment. In addition to the JEE, countries undertake simulation exercises to test their readiness to prevent, detect, and respond to a health emergency. Finally, after-action reviews (AAR) have 9 been instituted for countries to assess their response to an emergency, and to identify best practices, gaps, and lessons learned. Simulation exercises and AAR are voluntary elements of the WHO IHR Monitoring and Evaluation Framework, requested by the country and supported by the three levels of WHO. Sierra Leone was the sixth country in the African region to conduct a JEE in October 2016. Fourteen experts from 10 countries participated in the 5-day evaluation, together with more than 60 participants from government partner agencies. They assessed 19 technical areas to identify the most critical gaps within the country’s human and animal health systems. Several recommendations were developed, including: • Revise public health laws and legislation; • Create a budget line for IHR and ensure funding from domestic and international sources; • Strengthen the National IHR Focal Point and World Organisation for Animal Health functions; • Strengthen cross-border collaboration and surveillance; • Develop a “multi-hazard” National Public Health Emergency Preparedness and Response Plan, integrated with points of entry (air, land, sea) and contingency plans. In addition to taking on board these recommendations, Sierra Leone developed a multi-year National Action Plan for Health Security (NAPHS) to better prepare for and manage health security threats in a coordinated way. The Ministry of Health and Sanitation took the lead in the planning, including mapping all actors involved in implementing health security activities. In October 2017, the Ministry convened more than 75 in-country and international experts in a workshop to finalize and cost a 5-year action plan. As a next step, Sierra Leone was the first country to request that WHO convene a Prioritization and Resource Mapping (REMAP) workshop. The workshop in April 2018 focused on prioritizing activities and aligning ministries, programmes, partners, and donors. The aim was to align and agree on the first two years of NAPHS implementation. REPORT ON THE SESSIONS Day 1 - Monday, 23 April 2018 Objective of the meeting • Prioritization of NAPHS activities • Multisectoral collaboration; • Resource mapping to support NAPHS implementation Summary of the meeting 10 Day one: ➢ Opening remarks by Dr. Amara Jambai of the Ministry of Health and Sanitation (MoHS), partner organisations and ministerial representatives for Sierra Leone ➢ Working groups review and recommend key priority actions within the costed NAPHS ➢ Mapping of sub-activity synergies to existing national plans Day two: ➢ Introduction to multisectoral partnership collaboration framework ➢ Identification of relevant multisectoral actors for each priority activity ➢ Scoring of priority activities by weighted aggregate approach Day three: ➢ Introduction to financing preparedness for sustainable health security implementation ➢ Identification of potential partners and resources according to priority score ➢ Activity costs mapped according to priority score Welcome and Opening Remarks The meeting started at exactly 9:30 am with an individual prayer followed by introduction of almost 61 participants present. Participants included personnel from the various ministries and agencies such as Ministry of Health and Sanitation, the Ministry of Food and Agriculture, etc. and local and international partners such as MAFA, LCAA, EPA-SL, DPC/MoHS, NDSP/MoHS, PHNECO, SLRCS, PBSL/MoHS, LAB/MoHS, RSLAF/Medical, ONS, Njala University, W A/Rural/MoHS, Airport/MoHS, AFDB, US-CDC, China CDC, GIZ, PHE, WB, PREDICT/UCD, Breakthrough Action, FAO, IOM, and WHO, the World Bank and IOM. WHO, the ministries and partners were given the opportunity to give their welcome addresses. Partner Opening Remarks All partners present at the start of the meeting were allowed to give their opening remarks. They all expressed their gratitude to be invited to be part of the meeting to support the prioritization of activities and to map all available resources to support Sierra Leone in IHR and Health Security. They all expressed their appreciation to WHO for taking a leadership role in this very important health activity and pledged their support to actualize all the efforts successfully. Partners involved in the opening remarks were CDC, FAO, China CDC and the Ministry of Food and Agriculture. Opening Remarks by Dr. Jambai (MoHS) Dr. Jambai welcomed all participants to the meeting and thanked them for their support in mapping the resources available in the country to enable the prioritization of activities. He said there is the need to prioritize at least a one- year plan by working closely with the partners. 11 He made it known to participants that, if they are able to come together and pool their resources, they can move forward in terms of health security. He said responsibilities should be given to the technical people who are capable and can work hard for better results. He admonished partners to stop injecting money into areas where there are no results and to redirect their investment into other technical areas where there will be better results. He advised all the participants to work very hard with the little available resources to achieve much in terms of results. He further admonished Sierra Leone nationals to utilize the human resources of partners and not always think about monetary investment. He expressed his appreciation to all participants, especially WHO, for making the meeting possible and opened the meeting. Session 1: Introductory Discussion Dr. Charles Njuguna (WHO) The representative of the WHO Country Office in Sierra Leone made known to participants that there is a very strong partnership in Sierra Leone that is of great help. The JEE helped identify gaps in each of the 19 technical areas and he admonished all to work hard to sustain the green areas and also to improve all the yellow and red areas. In terms of monitoring, Sierra Leone is doing well in annual reporting and WHO will provide the country with the tools to monitor progress. A M&E framework to conduct simulation exercises is also being implemented and Sierra Leone conducted exercises for Lassa fever and yellow fever. The JEE will be conducted again in the next four years to measure the level of improvement in the country’s capacity in terms of health security and IHR. Sierra Leone is the first country to conduct the resource mapping for the IHR and prioritize its five-year action plan to move ahead in a One Health approach. 12 He promised WHO’s continued support to the government of Sierra Leone in advocacy and resource mobilization. Dr. T. T. Samba (MoHS) Sierra Leone is a signatory to the IHR (2005) and in 2015, WHO recommended a change from a system of self– assessment to the JEE with national action planning. This was in order to emphasize transparency and mutual accountability in the international community, which are essential in implementing IHR and the global health security agenda (GHSA) collectively. Based on that, the JEE process was initiated in Sierra Leone and completed with support from external examiners and WHO. This provided an objective basis for the development of a national action plan for strengthening the country’s capacity to contribute to global health security. Dr. Samba said partners have been committed and supported Sierra Leone through funding, infrastructure, technical capacity building, equipment and technical assistance. He enumerated all the processes they have gone through as a country in term of health security: Sensitization & advocacy – June 2016 Internal self-assessment 10th – 14th Sep 2016 JEE 31st Oct – 4th Nov 2016: ▪ Peer review of internal self-assessment conducted ▪ Consensus achieved on status of implementation and prevailing strengths and challenges ▪ Country scores per indicator established ▪ Priority areas for improvement per technical area identified Final JEE report published in February 2017 Post JEE national action planning Sept 2017 – NAPHS prepared Workshop to identify national priorities and develop a draft five-year NAPHS 17th – 20th Oct 2017 • Identification of objectives, strategies, activities and M & E framework • Drafting of the NAPHS Secretariat retreat to consolidate the draft five-year NAPHS: 24th – 27th Oct 2017 13 Draft NAPHS shared with internal and external stakeholders 2nd Nov 2017 NAPHS Costing – from Nov 2017 He expressed his appreciation to WHO, partners, donors and all who have been involved in all these processes leading up to the NAPHS prioritization and resource mapping activities. He then charged all participants to work hard to make this successful. Ludy Suryantoro (Team Leader, Strategic Partnership for IHR and Health Security (SPH) Ludy Suryantoro of WHO headquarters said that IHR (2005) Article 44.2 is the provision for facilitation of technical cooperation and logistical support to States Parties to mobilize financial resources and support developing countries in building, strengthening and maintaining their capacities. He gave the objective of the meeting as: Prioritization of activities Multisectoral collaboration Resource mapping to support implementation of activities by countries He said WHO is mandated to enhance strategic partnerships and increase countries’ capacities through accountability, transparency and sustainability. He made it known to participants that, in building health security beyond Ebola, everybody has a role to play such as: • Countries will commit to providing national leadership & sustained support and resources • WHO will commit to an active coordinating, convening and monitoring role • Partners will commit to working closely and actively with WHO and each other to share relevant information and make their technical and funding contributions as complementary, synergistic and coordinated as possible with other initiatives. He admonished all to work very hard for the next 3 days to be able to achieve all the objectives of the meeting, because WHO is supporting countries to move forward with NAPHS to attract investments from both international and domestic financing. Key points • Evidence is power – increase the evidence base on financing for health security 14 • Mainstreaming and integrating – embed financing needs for improved capacities into respective sectors, systems and macro-fiscal discussions • Prioritize – system strengthening interventions and investments Session 2: National perspective on country priority for health security including strengthening national capacities for IHR (2005) Dr. Samba (MoHS) Dr. Samba enumerated all the major progress made by Sierra Leone in the capacity to detect, investigate and report. Establishment of EOC Sierra Leone has improved coordination of response. A priority has been the strengthening of institutional capacity for emergency response operations. The country now has a good human capacity under the Emergency Operations Center (EOC). Human Resource for Directorate of Disease Prevention and Control (DPC) activities There is improvement under the Field Epidemiology Training Program (FETP) from Basic/Frontline to intermediate. Training of Rapid Response Teams (RRT) on the national and district levels still needs improvement Improved Gaps Major Gaps FETP Animal Health HR CBS Funding for health Emergencies CFF has been funding the MoHS contingency fund, REDISSE CERC Priority: Funding for emergencies that is commensurate Policies, Laws and Regulations 1. Public health ordinance undergoing revision Priority: Complete the modernization Laboratory capacity 15 Central Public Health Reference Laboratory (CPHRL) Refurbished Other labs established at Jui, Kenema, Connaught Capacity building on a fairly large scale Priority: Further strengthen lab services to support Directorate of Disease Prevention and Control (DPC) (MoHS and Ministry of Agriculture, Forestry and Food Security (MAFFS) activities IPC- Infection prevention and control 1. Isolation capacity greatly enhanced 2. Continuous improvements made, frequent structured supervisions 3. Health workers now much better protected 4. Priority exercise has been carried out 5. Simulations planned and carried out 6. Risk assessment carried out 7. Priority: Strengthened capacity for response Preparedness 1. Status of preparedness has improved greatly 2. Much still to be done 3. Priority: all hazards plan, a system for stockpiling of supplies, a comprehensive risk and resource mapping of priority public health hazards Chemical and radionuclear hazards, Points of Entry 1. Enact Draft National Chemicals Management Act 2017 2. Develop a comprehensive radioactive waste management policy 3. Develop strategic plan for port health Session 3: Partner Support to Government All the donors and partners present were given the opportunity to inform the audience about their interventions and support to Sierra Leone. The following are some of their presentations: FAO The representative of FAO informed participants that they are currently working with MAFFS to build their capacity and the competencies needed at the ministry. FAO is supporting 4 main technical areas 1. Zoonotic diseases 2. Biosafety and biosecurity Labs 3. National Laboratory System 16 4. Food safety UK Aid UK Aid provided support in response to the Ebola outbreak in the country and refurbished 3 laboratories and trained 5 health staffs to operate the labs. They will provide other support in human capacity building, monitoring and surveillance CDC The representative of CDC described support for emergency response and strengthening of the country health system. Surveillance: Revitalization of the integrated disease surveillance and response (IDSR) and improvement of the electronic surveillance system. They are also supporting the following: 1. Workforce development 2. National Laboratory System They are currently developing a curriculum for the IPC training program. They are also strengthening the capacity of the laboratory system, supporting the simulation exercise on emergency response. China CDC Supported the Ebola fight, supporting the laboratories in detection. Improved skills of hospital workers in data collection and analysis. Going forward, they will provide education on public health and surveillance. GIZ Supporting human resources for health, with 2 international experts to train students on public health in 2 universities. They are also providing support for cross border activities and cholera prevention. GIZ, moving forward, will work with the MoHs on health financing and support real time surveillance, including giving out tablets to collect and report data. Universities The universities have played a major role under the One Health program. The universities have also been involved in research. They have collected samples of pig for Ebola analysis. They have also taken samples of dogs and analysed for rabies. IOM Health border mobility management is the program being executed by IOM. They are operating by mapping areas prone to transmission of disease and strengthening the activities of the District Health Management Team (DHMT). Cross border posts have been established in some border towns. They have also provided clean drinking water for the people of the border towns. Session 4: Prioritization of in-country activities to strengthen IHR and health security Participants were grouped into five teams to work together to prioritize activities of the 19 technical areas in the NAPHS. Dr. Njuguna explained that the reason for conducting 17 this prioritization exercise to enable the country to implement most of its activities within the next two years. He called for stronger partnerships and coordination and information sharing. Below are the prioritization criteria: Low- hanging fruit (1 or No) Highest Priority (Yes or No) Known Advocate Activity Timing (Ongoing, 1st, or Follow-on activities) Resources Needed (High or Low) Existing or Potential Funding Source(s) YES YES YES Ongoing LOW YES 1 3 2 1 1 2 The above criteria gave a total score of 10 for any activity that had a positive score in all categories. After prioritization and scoring of all the 155 activities outlined in the National Action Plan on Health Security (NAPHS) costing tool, 107 prioritized activities with scores from seven to 10 were analysed. Among the 19 technical areas, real time surveillance had the biggest budgeted amount of prioritized activities with $24,601,790.89. The graph below shows the technical areas with their budgeted amounts of prioritized activities. Below are the five groups with their responsibilities and their assigned technical areas $24,601,790.89 $12,789,085.65 $2,460,250.68 $1,552,831.12 $1,505,392.32 $1,500,735.25 $1,477,743.10 $1,063,554.04 $818,312.37 $672,662.96 $624,971.09 $440,569.14 $332,994.53 $125,246.09 $116,575.52 $92,896.88 $66,683.46 $59,191.67 $17,269.53 Real Time surveilance Immunization AMR Chemical Events PoE Zoonotic Disease National Laboratory System IHR Coordination Communication and Advocacy Biosafety and BioSecurity Emergency Response Operations Linking Public Health & Security Food Safety Radiation Emergencies Risk Communication Preparedness National Legislation, Policy and Financing Reporting Workforce Development Med Counter Measure 18 Group 1 was led by Dr. Jalloh – MAFFS (Presenter), Wilson Gachari – WHO (Moderator) and MoHS representative as rapporteur and were assigned the following technical areas • National Legislation, Policy and Financing • IHR Coordination, Communication and Advocacy • Immunization Group 2 Marcus Eder PHE (Moderator), Doris Harding – MoHS (Presenter) and representative from MAFFS as rapporteur and were assigned the following technical areas • National Laboratory System • Anti-microbial Resistance (AMR) • Biosafety and Biosecurity Group 3 – Representative from CDC (Moderator), Roland Conteh - MoHS (Presenter) and representative from Ministry of Lands, Country Planning & Environment as rapporteur and were assigned the following technical areas • Zoonotic Disease • Real Time Surveillance • Reporting • Workforce Development Group 4 - Led by Dr. Moosa - MoHS (Presenter), Robert Musoke - WHO (Moderator) and partners as rapporteur and were assigned the following technical areas • Preparedness • Emergency Operations Centres • Linking Public Health & Security Authorities • Medical Countermeasures and Personnel Deployment • Risk Communication Group 5 - Led by Dr. Sillah – MoHS (Presenter), representative from IOM (Moderator) and some of the partners as rapporteur and were assigned the following technical areas • Point of Entries (PoEs) • Chemical Events • Radiation Emergencies • Food Safety Day 2 Session 5: Multisectoral Partnership Collaboration It was explained to participants the meaning, benefits and the outcomes of Multisectoral Partnership Collaboration for countries, partners and donors with regards to IHR and health security. 19 Session 6: Presentation of the Priority Areas The data on the prioritization was analysed in a more meaningful way to be able to identify the greater priority activities out of the 155 activities of the 19 technical areas. In the analysis, Group 2 presentations The group first presented on the antimicrobial resistance (AMR) and the following were the first activities that were rated highly based on the scoring: AMR Raise awareness on AMR 6 AMR Integration of AMR plan into the NLSP 5 AMR Review and update national HCAI plan 5 AMR Establish surveillance system of HCAI in 25 government hospitals 5 AMR Support, monitor and evaluate infection prevention and control programs in collaboration with national IPC Unit and stakeholders 5 AMR Establish occupational health program for health workers 5 AMR Strengthen national and community linkages/partnership for IPC in human, animal, and agricultural sectors 5 AMR Review and update treatment guidelines to include appropriate antibiotic use 5 AMR To establish treatment and testing algorithm inclusive of antibiotic use 5 AMR Develop regulation for antibiotic use in animals, agriculture and fisheries 5 AMR Monitor prescription and consumption patterns in both human and animals 5 AMR Establish antimicrobial stewardship committees at health facilities level 5 AMR Update the National Medicines Policy to include use of antimicrobial agents 5 20 The second presentation by group 2 was on biosafety and biosecurity Biosafety and BioSecurity Review and update the National Laboratory Strategic Plan 2016-2020 to include biosecurity and to integrate biosafety for animal and environmental health laboratories 6 Biosafety and BioSecurity Establish a national One Health biosafety committee including chair 5 Biosafety and BioSecurity Establish integrated waste management protocol including decommissioning protocol for all biological agents and equipment. 5 Biosafety and BioSecurity Appoint and train One Health biosafety and biosecurity officers in all human, animal and environmental laboratories 5 Biosafety and BioSecurity Build One Health technical capacity for biosafety and biosecurity (at relevant laboratory sites) 5 The third presentation by group 2 was on National Laboratory System National Laboratory System Develop an integrated syndromic and laboratory- based POCT algorithm 6 National Laboratory System Build the testing capacity for environmental health laboratories to test for water and food safety 5 National Laboratory System Improve communication for timely reporting of laboratory results 4.5 National Laboratory System Improve the capacity for bacteriological testing culture and ASTs for Human health 4.5 National Laboratory System Establish a network of specimen transportation at all levels - national and international 4.5 National Laboratory System Establish a tracking system for specimen referral and transportation 4.5 National Laboratory System Establish sustainable commodities supplies system 4.5 Questions/Suggestions 1. The group complained that the human laboratory should be separated from the animal laboratory in the scoring because they felt the human laboratory is much important than the animal and that has made them score low under National Laboratory System. 2. Another participant wanted an explanation to the comment that the “human laboratory is much important than the animal” and the response was that, if a dog bites any person, that person will be taken to the lab and not the dog. 21 3. The group further complained that, due to the importance of this activity “Establish a network of specimen transportation at all levels - national and international” they should have had a rating of 6 had it not been for the animal factor. 4. The group requested the animal and human activities with regards to the National Laboratory System be split to ensure high rates for most of the National Laboratory System activities. ----------------------------------------------------------------------------------------------------------------------- Group 3 presentations They explained in detail how they arrived at a consensus. Question: It was raised by one of the participants that, the group did not take into consideration the environmental component when making a decision on “Strengthen Community-based surveillance system in the context of “One Health program”. Other people advocated for the strengthening of the area of environment and animals. The group requested to reconvene to consider their choices again to ensure the right answer. Group 4 presentations The group first presented on Preparedness and the following were the first activities rated highly based on the scoring: 12-Preparedness Develop a One Health compliant all hazards plan 6 12-Preparedness Establish comprehensive risk and resource mapping of priority public health hazards 6 The group presented on Emergency Response Operations and and the following were the first activities rated highly based on the scoring: 13. Emergency Response Operations Develop a costed strategic plan for EOC that should be review and tested annually. 6 13. Emergency Response Operations Capacity building for surge personnel 5 The group presented on Risk Communication and the following were the first activities rated highly based on the scoring: 16-Risk Communication Finalize the EOC communications strategic plan. 5 16-Risk Communication Sustain regular communications with partners 5 22 16-Risk Communication Develop messaging and materials for risk communication 5 16-Risk Communication Create a dedicated budget line for addressing risk communications response in MoHS & MAFFS 5 Questions/Suggestions 1. Under preparedness, a participant raised the concern of why simulations were not part of the high priority activities and the response was, “It is under the emergency response.” Group 5 presentations The group first presented on the PoE, the following were the first activities that were rated highly based on the scoring: 17-PoE Develop Strategic plan for Port Health 5 17-PoE Develop framework, SOPs, guidelines and tools for border health 5 17-PoE Cross border engagement for information sharing, joint outbreak response and planning 5 17-PoE Develop a national public health emergency contingency plan (PHECP) for emergencies at PoEs 5 The group first presented on Chemical Events, the following were the first activities rated highly based on the scoring: 18-Chemical Events Promote programs to develop chemicals- management instruments (national profiles, national implementation plans, national emergency preparedness and response plans). 5 18-Chemical Events Develop communication framework for pollution and chemicals management 5 18-Chemical Events Enact Draft National Chemicals Management Act 2017 5 18-Chemical Events Enact Draft regulations for the management of toxic and hazardous substance 5 18-Chemical Events Develop/adopt chemical standards in air, water, waste water, sediment/sludge, plant and human specimen, soil, exhaust fumes and products 5 23 18-Chemical Events Develop and enact national chemical standards regulations for all environmental media 5 18-Chemical Events Enactment of electronic waste management regulation 5 Questions/Suggestions 1. “Develop/review policy for port health services” was not one of the high priority activities and some of the participants were of the view that, considering its importance, it should be reconsidered to be prioritized as a high priority activity. 2. A participant asked if the group is aware of the use of chemicals by companies and farmers for spraying their farm produce. Response – Most of the companies and farmers do not follow the environmental impact assessment process of handling chemicals. 3. A participant asked if there are linkages between chemical control and laboratory services. Response- There is a link between labs and chemical control but the policy needs to be strengthened and enforced. 4. The group informed participants that, the bill to “Develop a comprehensive Radioactive waste management policy, regulations, plan and guidelines” is before parliament to be passed. Session 7: Rescoring of the Activities The scoring of activities under each of the criteria was reconsidered based on participant reactions and comments following the first presentations. According to them, the initial scoring criteria assigned low scores to some high priority activities, therefore making them low priority activities. Based on their request, the scoring criteria was changed as shown below: Low- hanging fruit (1 or No) Highest Priority (Yes or No) Known Advocate Activity Timing (Ongoing, 1st, or Follow-on activities) Resources Needed (High or Low) Existing or Potential Funding Source(s) YES YES YES Ongoing LOW YES 1 3 2 1 1 2 The new scores were then presented to participants to ensure their understanding and their agreement. Some of the comments that came up during and after the presentation were: 1. The National Laboratory System group wanted activities which had both human and animal component to be split up to attract a fair and representative score. 2. Participants were satisfied with the new score for “Develop a national public health Emergency Contingency Plan (PHECP) for emergencies” at PoE because 24 that activity is a high priority. The score was 8 under the new criteria compared to the first score of 4. 3. Under surveillance, the group wanted a review of the score of “Establish mechanism for collaboration and coordination between human and animal health sector in the context of One Health” which had high scores in both the old and new scoring criteria. To them it was not a high priority activity. 4. The group wanted to look at the activities again and finalize the scoring at their group levels, having understood the process of scoring. Session 8: Finalization and Analysis of the Scoring All the groups worked together again to brainstorm on the new scoring criteria and confirm and finalize their scoring on each of their activities. They all worked for the next 45 minutes with the exception of group 2 which had a problem with the scoring of all activities under the National Laboratory System that had both human and animal components. Analysis of the activity scoring Analysis of the 107 activities with scores 7-10 show that AMR has the highest number of activities in that score range while food security, medical counter measures and linking public health and security had the least number of activities in the score range of 7 to 10. Of the 107 activities that scored between 7 and 10, only 15 of them scored a 10. Thirty- seven of the activities had a score of 9, 25 activities had a score of 8 and 30 activities scored a 7. The table below shows the technical areas with the least budgeted amounts in the NAPHS costing tool among prioritized activities with scores 7-10: Food Safety 440569.1406 Radiation Emergencies 332994.5313 Risk Communication 125246.0938 Preparedness 116575.5208 National Legislation, Policy and Financing 92896.875 Reporting 66683.46354 Workforce Development 59191.66667 Med Counter Measure 17269.53125 Figure 1: The number of activities per technical area for each of the 107 activities with 7-10 point scores 25 Figure 2: The scores for the 107 prioritized activities with scores 7-10 Figure 3: The budgeted amount by technical area for the activities with scores of 7 to 10 1 1 1 2 2 2 3 3 4 5 6 6 7 7 8 8 9 15 17 0 5 10 15 20 14-Linking Public Health & Security 5-Food Safety 15-Med Counter Measure 13. Emergency Response Operations National Legislation, Policy and Financing 12-Preparedness 19-Radiation Emergencies 11-Workforce Development Zoonotic Disease Real Time surveilance Reporting 16-Risk Communication IHR Coordination Communication and Advocacy 18-Chemical Events 17-PoE Immunization Biosafety and BioSecurity National Laboratory System AMR The first 107 Activities with 10-7 point scores technical area 30 25 37 15 0 20 40 60 80 100 120 Values for each score The first 107 priority activities with scors 7-10 10 9 8 7 26 Day 3 The third day was for the resource mapping and began with a presentation on financing preparedness for sustainable health security. It focused on: 1. Introduction of financing preparedness and guidance 2. Conceptual understanding For five-year financing preparedness, the following are the key steps: 1. Identify activities and the resources 2. Prioritization of activities Session 9: Presentation of the Resource Mapping Tool Bismarck Adusei and Glenn Lolong of WHO presented the resource mapping tool to participants and explained the importance of the tool in mapping all the available resources in the country. The tool was designed for accountability and transparency for the investments by donors and partners in the country. It also helps identify areas that have substantial resources and areas that have minimum or no investment. This can provide guidance to partners and donors on where to invest for better results. Participants were positive about the tool because of its mapping and analysis capabilities through the dashboard interface. $24,601,790.89 $12,789,085.65 $2,460,250.68 $1,552,831.12 $1,505,392.32 $1,500,735.25 $1,477,743.10 $1,063,554.04 $818,312.37 $672,662.96 $624,971.09 $440,569.14 $332,994.53 $125,246.09 $116,575.52 $92,896.88 $66,683.46 $59,191.67 $17,269.53 Real Time surveilance Immunization AMR Chemical Events PoE Zoonotic Disease National Laboratory System IHR Coordination Communication and Advocacy Biosafety and BioSecurity Emergency Response Operations Linking Public Health & Security Food Safety Radiation Emergencies Risk Communication Preparedness National Legislation, Policy and Financing Reporting Workforce Development Med Counter Measure 27 Participants returned to their initial groups to map out all the available resources in the country with the resource mapping tool. Analysis of the data by the tool revealed that there are currently 33 partners and donors in the country supporting various technical areas. Further analysis helped to identify the number of partners and donors in each of the technical areas and showed that National Laboratory Systems currently has 13 partners and donors, the highest number of all. The next highest is Emergency Response and Point of Entry, 9 each. The analysis also identified other technical areas without any partner or donor support. Those include food safety, radiation emergencies, medical counter measures, national legislation and linking public health and security. Technical Areas Donors and Partners AMR US - CDC USAID Biosafety and Biosecurity Canada US - CDC USAID Chemical Events European Commission GEF (Global Environment Facility) MLF (Multi-Lateral Fund) Coordination USAID Immunization European Commission GAVI Rotary International US - CDC Laboratory Canada Aid China CDC Chinese Government DFID DoD DTRA European Union Global Fund JICA UK AID UNICEF US - CDC USAID World Bank Points of Entry CDC DFID 28 GIZ Italy MBTF MPTF MRU US - CDC USAID Preparedness DFID Italy Switzerland UK AID USAID Reporting USAID Response DFID Italy Luxembourg Development Cooperation MDTF (UNDP Multi-Donor Trust Fund) Netherlands Norad Switzerland UK AID USAID Risk Communication GIZ USAID Surveillance AfDB China CDC DFID MPTF US - CDC USAID WHO World Bank Workforce Development UK AID US - CDC USAID World Bank Zoonotic USAID 29 Session 10: Group Work to Reorganize the Timelines of Priority Activities Participants returned to their groups to look at their high priority activities and match them with the implementation timelines in their costed plan to ensure those activities are implemented within two years. Session 11: Documentary on International Health Regulations A documentary on the importance of IHR (2005) was shown to participants. This was shown for participants to be aware of the reasons for countries, partners and donors to come together to ensure all countries are able to comply. Session 12: Presentation on the Strategic Partnership for IHR and Health Security Ludy Suryantoro and Glenn Lolong of WHO headquarters made a presentation on SPH so participants can better understand the features and benefits. The components were displayed and explained. All the resources available through the online Strategic Partnership Portal such as an inventory of partners and donors for each of the technical areas for each country was shown to participants. Results of the meeting WHO concluded the workshop with a roundtable discussion between donors and key government decision makers, which resulted in elimination of bottlenecks and better alignment among all stakeholders for the implementation of the prioritized activities. Led by WHO, the REMAP process attracted new partnerships, funding, and technical support. When the resource mapping workshop showed some overlap in donor-funded projects, WHO encouraged donors to be more flexible in their earmarking of funds to achieve better coordinated results. As a result, more than USD $50 million of new and reprogrammed funding was identified, both domestic and external, with domestic funding representing about 20% of the total. The collective approach undertaken by the Ministry of Health created an environment of partnership and dialogue. Partners worked together to ensure better coordination and reduce earmarking. The Government agreed to provide an update on progress to WHO every three months. Sierra Leone’s resource mapping leads into the NAPHS implementation phase. Stronger national leadership and ownership of health security, improved donor coordination, and mapping of provincial activities and investments by donors resulted from the workshop. The achievement of broad support for implementation of prioritized activities better equips Sierra Leone to prevent, detect, and respond to health emergencies. The work undertaken by Sierra 30 Leone illustrates how an at-risk country can take the steps necessary to better prepare for a health emergency in a coordinated fashion, along with domestic and international partners. 31 ANNEX: List of Participants NO. NAME ORGANISZATION EMAIL ADDRESS TELEPHONE NO. PARTNER’s 1 Jinsong Li China CDC songpia@163.com 232 7743 6158 2 Joseph .M. Sembo - Kabia IOM Jsembo-kabia@IOM.int 088 118 877 3 Dr. Charles Njuguna WHO njugunach@who.int 079 244 453 4 Victor Caulker WHO Caulkerv@who.int 078 409 634 5 Dr. Claudette Amuza WHO amuza@who.int 076 607 891 6 P Daniel NPHA Pdaniel8@emory.odn 7 Alex Carter WHO alexcaterisc@gmail.com +447857810039 8 Anderson Latt WHO lattand@who.int 232 79 244 552 9 Alex Chimbaru WHO chrimbaru@who.int 079 911 353 10 Michael Machar US-CDC Kul1@cdc.gov 11 Bismarack Adusi WHO adusibismarack@gmail.com 0244 995 963 12 Marcus Eder PHE marcus.eder@phe.gov.uk 078 906 362 13 Ansu Kamara US-CDC Kse8@cdc.gov 099 905 557 14 Dr. G. Aoryo US-CDC NoQ3@cdc.gov 099 905 577 15 David .H. Jimmy US-CDC Kre5@cdc.gov 099 905 550 16 Dorcas .W. Wanjohi W/Bank wanjohidorcas@gmail.com 078 342 364 17 Glenn Lalong WHO/HQ lalongg@who.int 18 Tushar Singh US-CDC TSINGH@CDC.GOV 099 905 904 19 Garba Maina Ahmed FAO Garba.Ahmed@fao.org 030 388 847 20 Robert Musoko WHO musoker@who.int 078 071 112 21 Anna Mamta WHO mamtaa@who.int 076 501 417 22 Steve Sesay WHO sesays@who.int 076 501 417 23 Jonathan Green WHO greenj@who.int 078 606 190 24 James Bangura PREDICT/UCD banguraj@gmail.com 076 803 272 25 Duraman Conteh GIZ dumnacosul@giz 076 455 118 26 Sandy Jasama AFDB S.jambaci@afdb.org 079 287 076 27 Tina Dickenson Breakthrough Action tina@jhuccpsl.org 077 354 146 28 Dr. .M.F. Lavahun FAO Momohfonigay.lavahun@fao.org 076 979 859 29 James .S. Fofanah Breakthrough Action james@juccptsl.org 076 874 824 30 Anderson Glsdat WHO 31 Dayo .S. Walters eHealth GoSL PARTICIPANTS - National 32 Kumba .M. Kamara SLCAA kkamara@slcaa.net 076 661 332 33 Doris .K. Sonda SLCAA clsada@slcaa.net 078 640 961 34 Dr. Guduss Jalloh MAFFA stenliseit@yahoo.com 076 601 845 35 Dr. Amara Leno MAFFS/Livestock lenoamara87@yahoo.com 078254 574 36 Rev. Dr. T.T. Samba MOHS ttsamba@yahoo.com 076 602 162 37 Dr. Amara Jambai MOHS amarajambai@yahoo.com 076 603386 38 Alie .D. Jalloh EPA-SL adk76202@yahoo.com 076 696 170 32 39 Hamidu .D. Mansaray EPA-SL mansarayhamidu@yahoo.com 078 957 654 41 Festus .U. Amara DPC/MOHS festusamara76@yahoo.com 076 682998 41 Roland Conteh NDSP/MOHS rmconteh09@gmail.com 076 612 812 42 Samba Kamara DPC/MOHS kulikakamara@gmail.com 079 020 164 43 Musa Bockarie NDSP/MOHS musabockarie@yahoo.com 078 352 960 44 Patrick .K. Lanssana PHNECO Patlanss12@gmail.com 076 518 682 45 Rubiatu Nicol SLRCS rubynicol-2008yahoo.com 076 813190 46 Manso .S. Kargbo MOHS mansowonbor@gmail.com 076 780 376 47 W. Johnson PBSL/MOHS rejshor@phmacyboard.gov.sl 076 602 091 48 Florence Max- Macarthy DPC/MOHS auntyflo@gmail.com 076 681 835 49 Doris Harding LAB./MOHS dorisharding@yahoo.com 078 432 873 50 Mohamed Boie Jalloh RSLAF/Medical mboie1537@gmail.com 076 803 370 51 Mohamed.P. Jalloh ONS mpjalloh@ONS.com 078 351 639 52 John.K. Sesay ONS sesayjk@gmail.com 076 109 526 53 Dr. A.J. Moosa DPC/MOHS DRAJmooSA6@gmail.com 076 670 095 54 Fay Chaloba LABS./MOHS rfaycecilia@yahoo.com 078 757 603 55 Rebecca .B. Neale NDSP/MOHS beckynealej2015@gmail.com 079 658 694 56 Dr. Alie. H. Wurie MOHS wuriealieh@yahoo.com 079 771 946 57 Fatmata.R.D. Jalloh LABS./MOHS fatmatabin@outlook.com 076 647 534 GoSL – PROVINCE/DISTRICT PARTICIPANT’s 58 Roland Suluku Njala University nyasulukuroland2710@gmail.com 076 775 899 59 Abdul Rahman Conteh MAFFS 076 740 125 60 Dr. James Squire W A/Rural/MOHS jmsquire@yahoo.com 079 840 189 61 Christiana Fortune Airport/MOHS ramtuli@yahoo.com 078 403 189