Sierra Leone: Score Justification Summary

2026

1.1 Antimicrobial resistance (AMR)

1.1.1 AMR surveillance, detection and reporting

1.1.1a National plan for AMR priority pathogens

Score: 100

There is a national antimicrobial (AMR) plan for the surveillance, detection and reporting of AMR pathogens in Sierra Leone. The "National Strategic Plan for Combating Antimicrobial Resistance 2018-2022" was released by the Government of Sierra Leone. The plan has been prepared by a collaborative effort of the Ministry of Health and Sanitation, Ministry of Agriculture, Forestry and Food Security, and the Environmental Protection Agency. The plan has six main objective: 1. establish AMR governance structures, 2. improve AMR awareness raising and education, 3. strengthen laboratory surveillance, 4. reduce incidence of infectious, 5. optimize antimicrobial use in all sectors, 6. ensure sustainable investment for research and development. The plan also identifies strategic steps to strengthen detection of AMR pathogens. Under the third strategic objective, the plan identifies the need for a "coordinated mechanism for AMR reporting" which will be used to "share information employing the one health approach". The plan text is available in the World Health Organisation (WHO) library of national action plans. ¹ The WHO library does not list an updated plan ² nor does the website of the The Ministry of Health and Sanitation (MoHS) of Sierra Leone. ³

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 50

There is publicly available evidence that Sierra Leone’s laboratory system can test for some but not all priority AMR pathogens. Sierra Leone has laboratory capacity to test for tuberculosis (including drug-resistant tuberculosis). ⁴ The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, confirms that Sierra Leone maintains two reference laboratories, the Central Public Health Reference Laboratory (CPHRL) and the Central Veterinary Laboratory (CVL), as well as multiple laboratories spread across the country including performing antimicrobial susceptibility testing (AST) (p. 38). The JEE also reports that Sierra Leone has “three laboratories with minimum capacities to detect, isolate and identify AMR pathogens” (p. 22). ⁵ In 2024, “WHO Sierra Leone has facilitated the procurement laboratory equipment and reagents, renovation of three laboratory sites, and provided capacity building for laboratory staff” in order to combat AMR in the country; at the conclusion of the program, "Sierra Leone will boast three bacteriology laboratories capable of testing and confirming diseases such as acute watery diarrhea, bacterial meningitis, and other bacterial infectious.” ⁶ Neither the National Health Laboratory Strategic Plan 2016-2020 ⁷ nor the National Health Sector Strategic Plan 2017-2021 ⁸ address testing for priority AMR pathogens. The websites of the Ministry of Health and Sanitation (MOHS) ⁹ and the National Public Health Agency (NPHA) ¹⁰ do not contain further information about AMR testing capabilities in Sierra Leone.

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no publicly-available evidence of detection or surveillance activities (e.g. in soil, waterways, etc.) for antimicrobial residues or antimicrobial resistance (AMR) organisms by the government in Sierra Leone. The Environment Protection Agency Sierra Leone (EPA-SL) is the designated government environmental agency of Sierra Leone, established by the Environmental Protection Agency Act of 2022. ¹¹ The website and the EPA Transformation Strategy 2024-20301, the current strategic plan of the EPA-SL do not mention any detection and surveillance activities for antimicrobial residues or AMR organisms. ¹² The 2nd Joint External Evaluation report for Sierra Leone, which was completed from 27 February to 3 March 2023 ¹³ and the National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation ¹⁴ do not mention any of the required surveillance or detection activities. The National Strategic Plan for Combating Antimicrobial Resistance 2018-2022 of Sierra Leone identifies the need for surveillance for AMR in the environment sector under intervention 4.3 of strategic objective 3. ¹⁵ The 2nd JEE mentions a national AMR surveillance strategy plan (2021–2025), but that pan is not available from the World Health Organization’s Library of AMR national action plans ¹⁶ or the website of the Ministry of Health and Sanitation (MoHS). ¹⁷ The website of the Ministry of Agriculture and Forestry does not provide any evidence of environmental surveillance for antimicrobial residues or AMR organisms. ¹⁸

1.1.2 Antimicrobial control

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

There is national legislation in place requiring prescriptions for antibiotic use in humans, but there is evidence of gaps in enforcement. The Pharmacy and Drugs Act, 2001 of Sierra Leone, as per articles 23, 24 and 25 of Section IV states that antibiotics as provided under the Class A Part I classification can not be sold without a valid written prescription from a medical practitioner. ¹⁹ However, as per the 2nd Joint External Evaluation report for Sierra Leone, which was completed in February-March 2023, indicates that there is no evidence that pharmacies, particularly private pharmacies, adhere to those guidelines and that there is no evidence of testing and control for substandard or counterfeit antibiotics. ²⁰ The "National Strategic Plan for Combating Antimicrobial Resistance 2018-2022" notes that antibiotics are available for human use without prescription. ²¹

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 0

There is no publicly available evidence of national legislation or regulation in place requiring prescriptions for the use of antibiotics in animals. According to the 2nd Joint External Evaluation report for Sierra Leone, which was completed February-March 2023, there is no evidence for the need for a prescription to use antibiotics in animals and no evidence that antimicrobial pesticides are controlled. ²² The lack of the necessity for a prescription for the use of antibiotics in animals is noted in the "National Strategic Plan for Combating Antimicrobial Resistance 2018-2022". ²³ The National Health Sector Strategic Plan 2021-2025 also does not mention antibiotic usage regulation for animals. ²⁴ There is no further evidence provided by the websites of the Ministry of Health and Sanitation ²⁵, and the Ministry of Agriculture and Forestry ²⁶. Lastly, the website of the Pharmacy Board of Sierra Leone also does not provide any further evidence on the matter.

1.2 Zoonotic disease

1.2.1 National planning for zoonotic diseases/pathogens

1.2.1a Laws/plans on zoonotic disease

Score: 100

There is public evidence of a national strategy document on zoonotic disease in Sierra Leone.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023 ²⁷, states that Zoonotic diseases are covered under Sierra Leone’s National Strategic Plan ²⁸ and One Health Governance Manual ²⁹.

The “Strategic Plan 2023-2026” of the National Public Health Agency includes zoonotic diseases under the Infection Prevention and Control section starting on page 16. Specifically, the agency will “focus on implementing evidence-based strategies, promoting adherence to infection prevention practices, and building capacity for surveillance and response to outbreaks using the One Health approach.”³⁰

Sierra Leone’s National One Health Platform Revised Governance Manual 2023-2028 includes zoonotic diseases as a core component. Section 3.4.8, “Neglected Tropical Diseases (NTD) Zoonotic Diseases and Wildlife TWG” includes the mandate to develop different capacities related to zoonotic disease prevention, including surveillance tools and systems, coordination and collaboration at the national and international level, conduct risk assessments and offer recommendations for the prevention of disease spillover and develop capacity-building programs for zoonotic disease prevent. Section 8 of the manual details the actions bodies in the One Health Policy system should take in the event of a zoonotic spillover. ³¹

The National Health Sector Strategic Plan 2021-2025, produced by the Ministry of Health and Sanitation (MOHS), includes the objective of developing a zoonotic disease surveillance system by 2025 on page 99. ³²

The JEE ³³ reports on the existence of an Animal Diseases Strategic Plan 2021–2025, but neither that document, nor any specific zoonotic disease strategy, is publicly available, including on the website of the Ministry of Agriculture and Forestry (MAF) ³⁴, the Ministry of Health and Sanitation (MOHS) ³⁵, or the National Public Health Agency (NPHA) ³⁶.

The World Organisation for Animal Health (OIE) does not have a publicly-available Performance of Veterinary Services report for Sierra Leone. ³⁷

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 100

There is public evidence of a national strategy document that covers zoonotic disease which includes measures for risk identification and reduction for zoonotic disease spillover events from animals to humans Sierra Leone.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023 ³⁸, states that Zoonotic diseases are covered under Sierra Leone’s National Strategic Plan ³⁹ and One Health Governance Manual ⁴⁰.

The JEE ⁴⁴ reports on the existence of an Animal Diseases Strategic Plan 2021–2025, but neither that document, nor any specific zoonotic disease strategy, is publicly available, including on the website of the Ministry of Agriculture and Forestry (MAF) ⁴⁵, the Ministry of Health and Sanitation (MOHS) ⁴⁶, or the National Public Health Agency (NPHA) ⁴⁷.

The World Organisation for Animal Health (OIE) does not have a publicly-available Performance of Veterinary Services report for Sierra Leone. ⁴⁸

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

Sierra Leone has plans and guidelines for the surveillance and control of multiple zoonotic pathogens of public health concern. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, states that on p. 25 that Sierra Leone has designated anthrax; salmonellosis; plague; viral haemorrhagic fevers (Ebola Virus Disease, Marburg, and Lassa fever); rabies; and zoonotic influenza as priority zoonoses and has developed contingency plans for most of these diseases. ⁴⁹ The National Health Sector Strategic Plan 2021-2025, produced by the Ministry of Health and Sanitation (MOHS), includes the objective of developing a zoonotic disease surveillance system by 2025 on page 99. ⁵⁰
Sierra Leone’s National One Health Platform Revised Governance Manual 2023-2028 includes zoonotic diseases as a core component. Section 3.4.8, “Neglected Tropical Diseases (NTD) Zoonotic Diseases and Wildlife TWG” includes the mandate to develop different capacities related to zoonotic disease prevention, including surveillance tools and systems, coordination and collaboration at the national and international level, conduct risk assessments and offer recommendations for the prevention of disease spillover and develop capacity-building programs for zoonotic disease prevent. Section 8 of the manual details the actions bodies in the One Health Policy system should take in the event of a zoonotic spillover. ⁵¹
The JEE also reports on p. 26 that Sierra Leone has the Integrated Disease Surveillance and Response (IDSR) and eIDSR surveillance systems, which report on 26 priority diseases, including most of the priority zoonoses; the surveillance system includes weekly meeting of the Emergency Preparedness Resilience and Response Group (EPRRG), which includes human, animal and environmental representatives. ⁵² The JEE reports on the existence of the Integrated Animal Disease Surveillance and Reporting system, as outlined in the Animal Diseases Strategic Plan 2021–2025, but that document is not publicly available, including on the website of the Ministry of Agriculture and Forestry (MAF) ⁵³, the Ministry of Health and Sanitation (MOHS) ⁵⁴, or the National Public Health Agency (NPHA) ⁵⁵.

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 100

Sierra Leone has a unit dedicated to zoonotic disease that functions across ministries. The 2nd 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, states that the weekly Emergency Preparedness Resilience and Response Group (EPRRG) meeting regularly discusses and exchanges information regarding the detection and response to potentially zoonotic incidents (p.26). ⁵⁶ Further, Sierra Leone has a Technical Working Group (TWG), specifically the “Neglected Tropical Diseases (NTD) Zoonotic Diseases and Wildlife TWG”, which includes a subcomponent dedicated to Zoonotic Diseases (p.22-24). The subcomponent includes the mandate to develop different capacities related to zoonotic disease prevention, including surveillance tools and systems, coordination and collaboration at the national and international level, conduct risk assessments and offer recommendations for the prevention of disease spillover and develop capacity-building programs for zoonotic disease prevent. It is co-chaired by the Programme Manager from the Ministry of Health (MoH) the Director of Livestock and Veterinary Services, Ministry of Agriculture and Food Security (MAFS), the Director of Environment/EPA and the Director Forestry (Wildlife) and it includes members from the Ministry of Agriculture and Food Security (MAFS), the Ministry of Health (MoH), the Ministry of Environment and Climate Change (MoECC), the Office of National Security (ONS), USAID, as well as members from NGOs, ICAP, academia and research institutions. ⁵⁷

1.2.1e Presence of One Health strategic plan

Score: 0

Sierra Leone does not currently have a national One Health strategic plan in place. There is no further evidence provided by the websites of the Ministry of Health and Sanitation ⁵⁸, and the Ministry of Agriculture and Forestry ⁵⁹. The country does have a One Health National Emergency Risk Communication Strategic Plan which contributes to Sierra Leone’s preparedness and response efforts by proposing a standing One Health Risk Communication Multi Sectoral Coordination Mechanism (MCM) consisting of the lead persons tasked with communication from the three key One Health entities: the Ministry of Health and Sanitation, the Ministry of Agriculture and Forestry, and the Environment Protection Agency.⁶⁰

1.2.2 Surveillance systems for zoonotic diseases/pathogens

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 0

There is insufficient evidence that Sierra Leone has a national mechanism for owners of livestock to conduct and report on disease surveillance. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, states that the government maintains the Integrated Disease Surveillance and Response (IDSR) and eIDSR surveillance systems. ⁶¹ However, according to the technical guidelines for that system, published by the Ministry of Health and Sanitation (MoHS), contain community reporting forms but they are aimed at health professionals (pp. 305-7). ⁶² The JEE ⁶³ reports on the existence of an Animal Diseases Strategic Plan 2021–2025, but neither that document, nor any specific zoonotic disease strategy, is publicly available, including on the website of the Ministry of Agriculture and Forestry (MAF) ⁶⁴, the Ministry of Health and Sanitation (MOHS) ⁶⁵, or the National Public Health Agency (NPHA) ⁶⁶. The JEE reports that Sierra Leone’s Ministry of Agriculture and Forestry (MAF) maintains the IADSR/EMA-I surveillance system for animal health ⁶⁷, but details of that program are not available on the website of the MAF. ⁶⁸ A review of the Integrated Animal Disease Surveillance and Reporting (IADSR) system from the United Nations Food and Agriculture Organization (FAO) in 2020 reported that the system used by veterinary professionals and was not aimed at or accessible to the general public. ⁶⁹ In 2024, the UN FAO released an updated version of its EMA-i+, an Event Mobile App (EMA-i). It was “Developed to facilitate the reporting of animal diseases in real time and support the capabilities of veterinary services, this multilingual tool improves the quantity and quality of reports by generating standardized forms for suspected disease threats.” The press release notes that it is available in Sierra Leone but does not confirm its widespread use. ⁷⁰

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is insufficient evidence of laws or guidelines that safeguard the confidentiality of information generated through surveillance activities for animals (for owners) in Sierra Leone. Sierra Leone does not currently have a data protection law but according to a press release from the Ministry of Information and Civic Education (MoICE), the government plans to finalize a data protection law in 2025. ⁷¹ The website of MoICE does not contain information of such a law being in effect as of June 2025. ⁷² Sierra Leone is a signatory to the African Union Convention on Cyber Security and Personal Data Protection, which provides a normative framework to protect the privacy of individuals' data, including health data. However, it does not explicitly provide protections for owned livestock, and Sierra Leone has not yet ratified the document. ⁷³ The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023 ⁷⁴, and the National Health Sector Strategic Plan 2021-2025 of the Ministry of Health and Sanitation ⁷⁵ do not mention any such laws or guidelines in Sierra Leone. The World Organisation for Animal Health (OIE) also does not report any such laws or guidelines and does not have a publicly-available Performance of Veterinary Services report for Sierra Leone. ⁷⁶⁷⁷ Information concerning the legislation and/or regulations that safeguard the confidentiality of information generated through surveillance activities for animals is not available on the website of the Ministry of Agriculture and Forestry (MAF) ⁷⁸, the Ministry of Health and Sanitation (MOHS) ⁷⁹, or the National Public Health Agency (NPHA) ⁸⁰.

1.2.2c Wildlife zoonotic disease surveillance

Score: 100

Sierra Leone conducts surveillance of zoonotic diseases in poultry and livestock, as well as in wild animals.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023 ⁸¹, states that Sierra Leone’s animal disease surveillance system reports on 16 priority animal diseases on a weekly basis, but that the system does not conduct routine disease surveillance in wildlife (p. 26). ⁸².

The Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) includes zoonotic diseases as a core component of the Surveillance Technical Working Group (TWG); the TWG is charged to "Enhance efforts to prevent and control zoonotic infectious" (p. 21). ⁸⁴

The December 2024 “Joint National Human, Animal, and Environmental Guidelines and Standard Operating Procedures (SOPs) for Surveillance and Data Sharing for Priority Zoonotic Diseases (PZDs)” describes Sierra Leone’s system for surveillance of zoonotic diseases in Humans, Animals, and the environment, including wild animals. For animal surveillance, Section 1.3.2 lays out the process: Community Animal Health Workers (CAHWs) conduct routine visits to farms to assess the number of “sick, susceptible, and dead animals”; that data is shared with their supervisors, who then share it with the district disease surveillance focal person for compilation. The compiled data is then sent to a district official for validation before being passed on to the Epidemiological Unit of the Ministry of Agriculture and Food Security (MAFS) via electronic submission every Monday. The data is shared every Wednesday in the Emergency Preparedness, Response, and Resilience Group Meeting (EPRRG) and distributed via a weekly bulletin on Friday. Samples from suspected cases of priority zoonotic diseases are collected and sent to the central veterinary laboratory for testing. (pp. 4-5). The document also confirms that the system conducts ad-hoc surveillance of wildlife, with sampling done across a network of sentinel sites across Sierra Leone, where local community members are encouraged to report unusual deformities or deaths in wildlife to the forest guards, who then report them to the District Forest Officer for investigation (pp. 5-6). ⁸⁶

1.2.3 International reporting of animal disease outbreaks

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

Sierra Leone has a mechanism for reporting notifiable diseases to the World Organisation for Animal Health (WOAH).

1.2.4 Animal health workforce

1.2.4a Number of veterinarians per 100,000 people

Score: 0

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 0

1.2.5 Private sector and zoonotic disease

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is insufficient evidence that Sierra Leone has mechanisms for working with the private sector in controlling or responding to zoonoses. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, does not discuss plans or mechanisms for Sierra Leone to work with the private sector to control or respond to zoonoses. ⁸⁸ The National Health Sector Strategic Plan 2021-2025, produced by the Ministry of Health and Sanitation (MOHS) includes general engagement with the private sector as part of its health planning but does not specifically discuss it in the context of zoonoses. ⁸⁹ Sierra Leone’s National One Health Platform Revised Governance Manual 2023-2028 includes zoonotic diseases as a core component. Section 3.4.8, “Neglected Tropical Diseases (NTD) Zoonotic Diseases and Wildlife TWG” includes the mandate to “provide technical support and guidance to relevant stakeholders on zoonotic disease prevention: but does not explicitly mention involving or working with the private sector. ⁹⁰ The JEE reports on the existence of the Integrated Animal Disease Surveillance and Reporting system, as outlined in the Animal Diseases Strategic Plan 2021–2025, but that document is not publicly available, including on the website of the Ministry of Agriculture and Forestry (MAF) ⁹¹, the Ministry of Health and Sanitation (MOHS) ⁹², or the National Public Health Agency (NPHA) ⁹³. Those sites also do not contain evidence of mechanisms for working with the private sector to control or respond to zoonoses.

1.3 Biosecurity

1.3.1 Whole-of-government biosecurity systems

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 50

There is some evidence of facilities being tracked, but insufficient evidence of a record with details on inventory management.

According to a press release from the World Health Organization (WHO), Sierra Leone moved tens of thousands of samples of Ebola taken during the 2014-2015 Ebola outbreak from laboratories and facilities across the country to a single, secure biobank, the National Biobank Facility, equipped with Biosafety Level 2 (BSL2) and Biosafety Level 3 (BSL3) facilities in 2024. The samples will be assessed and indexed; those with scientific or research value will be securely stored and those deemed to be of no scientific value will be safely destroyed. ⁹⁴ However, there is no indication of a record of the facilities in which especially dangerous pathogens and toxins are stored or processed on the websites of the Ministry of Agriculture and Forestry (MAF) ⁹⁵, the Ministry of Health and Sanitation (MOHS) ⁹⁶, or the National Public Health Agency (NPHA) ⁹⁷.

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 50

There is evidence of regulations related to biosecurity in Sierra Leone, but insufficient information that it outlines specific requirements such as physical containment, operation practices, failure reporting systems, and/or cybersecurity of facilities.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, concludes that Sierra Leone has a draft National Biosafety and Biosecurity Policy and Guidelines that there is “no legislation or regulation in place to support a comprehensive biosafety and biosecurity system and a national oversight programme” (p.32). ⁹⁸

Sierra Leone’s “National Biosafety and Biosecurity Policy and Guidelines”, which lay out policies and procedures that cover “all activities involving biological agents, chemical substances, toxins, and all personnel working with these agents” (pp. 1-2). The require staff to be appropriately trained on biosafety and biosecurity protocols and practices for their specific responsibilities but do not specify what those practices and protocols are (pp 12-13). It also requires that facilities have biosecurity emergency response and contingency plans, which cover cover a wide range of failures and emergencies (pp. 4o-41), as well as requirements for physical security (p. 34) and information security (p. 35), however they are broad in nature and specify that certain factors should be considered without specifying how to do so. ⁹⁹

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is insufficient evidence that Sierra Leone has an established body responsible for enforcing biosecurity legislation and regulations. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, shows the establishment of the National Biosafety and Biosecurity Council and the drafting of the National Biosafety and Biosecurity Policy and Guideline. ¹⁰⁰ The guidelines lay out policies and procedures that cover “all activities involving biological agents, chemical substances, toxins, and all personnel working with these agents” (pp. 1-2); however, they do not designate a body responsible for regulation. ¹⁰¹ Under the National One Health Platform Revised Governance Manual 2023-2028, there is a technical working group focused on biosecurity, but it does not have oversight responsibilities (pp. 35-36). ¹⁰² The National Health Sector Strategic Plan 2021-2025 does not discuss assigning an agency to oversee biosecurity ¹⁰³ The National Action Plan for Health Security 2018 – 2022 discusses improvement to biosecurity in Sierra Leone (pp. 29-30) but does not discuss establishing a regulatory body for enforcing biosecurity legislation and regulation. ¹⁰⁴ No information on an established body for overseeing biosecurity is available on the website of the Ministry of Agriculture and Forestry (MAF) ¹⁰⁵, the Ministry of Health and Sanitation (MOHS) ¹⁰⁶, or the National Public Health Agency (NPHA) ¹⁰⁷.

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 50

There is public evidence that Sierra Leone has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities.

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 0

Sierra Leone has in-country capacity to conduct Polymerase Chain Reaction (PCR)-based diagnostic testing but it is unclear if such testing would preclude culturing a live pathogen. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, Sierra Leone has a trained and competent laboratory workforce with the capacity to conduct a wide range of PCR tests on routinely maintained and serviced equipment (p. 40). ¹⁰⁹ According to a 2023 article published by the China CDC on the collaboration between China and Sierra Leone on laboratory capacity building, Sierra Leone has the capacity to conduct a wide variety of PCR testing, including on Ebola. It also notes that staff in Sierra Leone have been trained on conducting PCR testing for anthrax. ¹¹⁰ However, neither source specifies that PCR testing precludes culturing a live virus.

1.3.2 Biosecurity training and practices

1.3.2a Biosecurity training using a standardised, required approach

Score: 33.33

Sierra Leone requires biosecurity training but there is only evidence of biosecurity and biosafety training being provided on an ad hoc basis.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, concludes that Sierra Leone has a draft National Biosafety and Biosecurity Policy and Guidelines but that there is “no legislation or regulation in place to support a comprehensive biosafety and biosecurity system and a national oversight programme” (p.32). ¹¹¹

Sierra Leone’s “National Biosafety and Biosecurity Policy and Guidelines”, which lay out policies and procedures that cover “all activities involving biological agents, chemical substances, toxins, and all personnel working with these agents” (pp. 1-2). The require staff to be appropriately trained on biosafety and biosecurity protocols and practices for their specific responsibilities but do not specify what those practices and protocols are (pp 12-13). They require that “The institution shall ensure that requirements and procedures for bio-risk-related training of personnel are identified, established and maintained” (p. 18) and that “The institution shall define required competency levels and shall maintain records verifying that staff members have attained and demonstrated those levels of competency for all relevant training as outlined by the WHO Biosafety manual” (p. 16) but do not specify a common curriculum or the frequency of training or re-certification. ¹¹²

The websites of the Ministry of Agriculture and Forestry (MAF) ¹¹³, the Ministry of Health and Sanitation (MOHS) ¹¹⁴, or the National Public Health Agency (NPHA) do not contain evidence of a standardized approach to training or re-certification requirements. ¹¹⁵.

1.3.3 Personnel vetting: regulating access to sensitive locations

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 33.33

Regulations require that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials undergo background checks, but not other checks. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, concludes that Sierra Leone does not have an established national body or organization responsible for registering and licensing of laboratories, or overseeing personnel, certification and accreditation (p. 39). The JEE priority recommendations include establishing a licensing and oversight body for laboratories (p.41). ¹¹⁶ Sierra Leone does have the “National Biosafety and Biosecurity Policy and Guidelines”, which lay out policies and procedures that cover “all activities involving biological agents, chemical substances, toxins, and all personnel working with these agents” (pp. 1-2). They require staff to undergo background checks (p.16) but do not mention drug testing or psychological or mental fitness checks. ¹¹⁷

1.3.4 Transportation security

1.3.4a National transport regulations for Category A and B infectious substances

Score: 100

Sierra Leone has publicly available information on national regulations on the safe and secure transport of infectious substances which specifically includes Categories A and B.
The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone has developed and is implementing guidelines concerning a specimen referral and transportation system. It found the system of documentation and delivery encompassed best practices. ¹¹⁸ Sierra Leone’s “National Biosafety and Biosecurity Policy and Guidelines” (2022) includes section 3.4.4.9, Transport of Biological Agents, Chemicals and Toxins, which requires laboratories and institutions “ shall ensure that procedures for the safe and secure transport of cultures, specimens, samples and contaminated and potentially contaminated materials are established and maintained in accordance with legal requirements for the transport of dangerous goods” (p. 37). ¹¹⁹ Sierra Leone’s guidelines specifically indicate that the World Health Organization’s (WHO’s) “Guidance On Regulations For The Transport Of Infectious Substances 2019– 2020” ¹²⁰ and any subsequent updates (with the most recent being from 2023 ¹²¹). Both the 2019 ¹²² and 2023 ¹²³ WHO regulations offer clear guidance on Categories A and B.

1.3.5 Cross-border transfer and end-user screening

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 100

Sierra Leone has regulations in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone has developed and is implementing guidelines concerning a specimen referral and transportation system that includes the transport of specimens from the intermediate to the national to the international. It found the system of documentation and delivery encompassed best practices. ¹²⁴
Sierra Leone’s “National Biosafety and Biosecurity Policy and Guidelines” (2022) includes section 3.4.4.9, Transport of Biological Agents, Chemicals and Toxins, which requires laboratories and institutions “ shall ensure that procedures for the safe and secure transport of cultures, specimens, samples and contaminated and potentially contaminated materials are established and maintained in accordance with legal requirements for the transport of dangerous goods” (p. 37). It also requires anyone involved in packaging or transporting such material “must be trained on all procedures necessary for the safe execution of all tasks and for compliance with national and international regulations” and cites the International Civil Aviation Organization’s (ICAO’s) “Technical Instructions for the Safe Transport of Dangerous Goods by Air” 2017-2018 Edition. ¹²⁵
Sierra Leone’s guidelines specifically indicate that the World Health Organization’s (WHO’s) “Guidance On Regulations For The Transport Of Infectious Substances 2019– 2020” ¹²⁶ and any subsequent updates (with the most recent being from 2023 ¹²⁷). Both the 2019 ¹²⁸ and 2023 ¹²⁹ WHO regulations offer clear guidance on the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential, as do the ICAO’s Technical Instructions. ¹³⁰

1.4 Biosafety

1.4.1 Whole-of-government biosafety systems

1.4.1a Biosafety laws/regulations

Score: 100

Sierra Leone has regulations in place to cover biosafety. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone has developed and is implementing guidelines concerning a specimen referral and transportation system that includes the transport of specimens from the intermediate to the national to the international. It found the system of documentation and delivery encompassed best practices. ¹³¹
Sierra Leone’s “National Biosafety and Biosecurity Policy and Guidelines” (2022) specifically cover “ all activities involving biological agents, chemical substances, toxins, and all personnel working with these agents. Persons handling or storing infectious materials or toxins for in-vitro or in-vivo work are to comply with this policy and guidelines, as applicable” (pp. 1-2). They include sections that cover planning, implementation and operation, infrastructure and operational management, and checking and corrective action. They are intended to be the minimum; they are superseded by national or local legislation only if those laws are stronger. ¹³² Sierra Leone’s guidelines specifically indicate that the World Health Organization’s (WHO’s) “Guidance On Regulations For The Transport Of Infectious Substances 2019– 2020” ¹³³ and any subsequent updates (with the most recent being from 2023 ¹³⁴). Both the 2019 ¹³⁵ and 2023 ¹³⁶.

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no publicly available evidence of an established agency for the enforcement of biosafety regulations. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone has established the National Biosafety and Biosecurity Council but it does not suggest that it is responsible for the enforcement of biosafety legislation (p. 31). ¹³⁷ The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation discusses biosafety in Section 7 but does not discuss an agency for enforcement. ¹³⁸ Sierra Leone’s National One Health Platform Revised Governance Manual 2023-2028 includes a biosafety technical working group but it is not charged with oversight or enforcement (p. 35). ¹³⁹ The websites of the Ministry of Agriculture and Forestry (MAF) ¹⁴⁰, the Ministry of Health and Sanitation (MOHS) ¹⁴¹, and the National Public Health Agency (NPHA) ¹⁴² do not contain evidence of an established agency for the enforcement of safety legislation. The Verification Research, Training and Information Centre (VERTIC) database does not offer information about biosafety regulations in Sierra Leone. ¹⁴³ Although Sierra Leone is party to the Biological Weapons Conventions, there is no public evidence that it has submitted Confidence Building Measures, and it is unknown if they contain information on this matter. ¹⁴⁴

1.4.2 Biosafety training and practices

1.4.2a Biosafety training using a standardised, required approach

Score: 0

Sierra Leone requires biosafety training but there is only evidence of biosecurity and biosafety training being provided on an ad hoc basis, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.

1.5 Dual-use research and culture of responsible science

1.5.1 Oversight of dual-use research

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no publicly available evidence that Sierra Leone has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone has established the National Biosafety and Biosecurity Council but it does not contain evidence that such an assessment has taken place (p. 31). ¹⁴⁷ The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation discusses biosafety in Section 7 but does not discuss an assessment of ongoing research. ¹⁴⁸Sierra Leone’s Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) does not include a technical working group focused on biosafety or biosecurity. ¹⁴⁹ The websites of the Ministry of Agriculture and Forestry (MAF) ¹⁵⁰, the Ministry of Health and Sanitation (MOHS) ¹⁵¹, and the National Public Health Agency (NPHA) ¹⁵² do not contain evidence of such an assessment. The Verification Research, Training and Information Centre (VERTIC) database does not offer information about biosafety regulations in Sierra Leone. ¹⁵³ Although Sierra Leone is party to the Biological Weapons Conventions, there is no public evidence that it has submitted Confidence Building Measures, and it is unknown if they contain information on this matter. ¹⁵⁴

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no evidence of legislation and/or regulation requiring oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research in Sierra Leone. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone has established the National Biosafety and Biosecurity Council but it does not have comprehensive biosecurity legislation or regulation that requires oversight of research with especially dangerous substances. (p. 31). ¹⁵⁵ The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation discusses biosafety in Section 7 but does not discuss such oversight. ¹⁵⁶ Sierra Leone’s Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) does not include a technical working group focused on biosafety or biosecurity. ¹⁵⁷ The National Biosafety and Biosecurity Policy and Guidelines (2022) do not specifically discuss additional regulation or oversight of especially dangerous substances. ¹⁵⁸ The websites of the Ministry of Agriculture and Forestry (MAF) ¹⁵⁹, the Ministry of Health and Sanitation (MOHS) ¹⁶⁰, and the National Public Health Agency (NPHA) ¹⁶¹ do not contain evidence of such requirements or oversight. The Verification Research, Training and Information Centre (VERTIC) database does not offer information about biosafety regulations in Sierra Leone. ¹⁶² Although Sierra Leone is party to the Biological Weapons Conventions, there is no public evidence that it has submitted Confidence Building Measures, and it is unknown if they contain information on this matter. ¹⁶³

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

There is no evidence of an agency responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research in Sierra Leone. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone has established the National Biosafety and Biosecurity Council but it does not suggest that it is responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research (p. 31). ¹⁶⁴ The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation discusses biosafety in Section 7 but does not discuss an agency for enforcement. ¹⁶⁵ Sierra Leone’s Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) does not include a technical working group focused on biosafety or biosecurity. ¹⁶⁶ The websites of the Ministry of Agriculture and Forestry (MAF) ¹⁶⁷, the Ministry of Health and Sanitation (MOHS) ¹⁶⁸, and the National Public Health Agency (NPHA) ¹⁶⁹ do not contain evidence of an established agency for the enforcement of safety legislation. The Verification Research, Training and Information Centre (VERTIC) database does not offer information about biosafety regulations in Sierra Leone. ¹⁷⁰ Although Sierra Leone is party to the Biological Weapons Conventions, there is no public evidence that it has submitted Confidence Building Measures, and it is unknown if they contain information on this matter. ¹⁷¹

1.5.2 Screening requirements for providers of genetic material

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no evidence of legislation and/or regulation requiring the screening of synthesized DNA (deoxyribonucleic acid) against lists of known pathogens and toxins before it is sold in Sierra Leone. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, does not mention or discuss a requirement for the screening of synthesized DNA before it is sold (p. 31). ¹⁷² The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation discusses biosafety in Section 7 but does not discuss such a requirement. ¹⁷³ Sierra Leone’s Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) does not include a technical working group focused on biosafety or biosecurity. ¹⁷⁴ The National Biosafety and Biosecurity Policy and Guidelines (2022) do not contain such a requirement. ¹⁷⁵ The websites of the Ministry of Agriculture and Forestry (MAF) ¹⁷⁶, the Ministry of Health and Sanitation (MOHS) ¹⁷⁷, and the National Public Health Agency (NPHA) ¹⁷⁸ do not contain evidence of such a requirement. The Verification Research, Training and Information Centre (VERTIC) database does not offer information about biosafety regulations in Sierra Leone. ¹⁷⁹ Although Sierra Leone is party to the Biological Weapons Conventions, there is no public evidence that it has submitted Confidence Building Measures, and it is unknown if they contain information on this matter. ¹⁸⁰

1.6 Immunization

1.6.1 Vaccination rates

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 0

The World Animal Health Information System (WAHIS) database from the World Organization for Animal Health (WOAH) does not contain official foot-and-mouth disease (FMD) vaccination figures for livestock for Sierra Leone. ¹⁸¹

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

Sierra Leone has a national immunization strategy, that includes a plan to ensure equitable distribution and strategies specifically aimed at overcoming barriers to vaccination but it is outdated.

The Comprehensive EPI Multi-Year Plan (2017 – 2021), formulated in 2016, covers is the national immunization strategy and it “has been formulated on the fundamental principles of human rights, equity, ownership and empowerment” (p. Iv). Section 1.19, Routine Immunization, states that “The Expanded Programme on Immunisation aims at reducing infant and child death and disability by preventing children from being infected with the ten major childhood vaccine preventable diseases – Tuberculosis, Pertussis, Tetanus, Diphtheria, Poliomyelitis, Measles, Yellow Fever, Hepatitis B, Haemophilus influenza, Pneumococcal pneumonia and Diarrhoea diseases” and “also forms a solid base for the delivery of other high impact, evidence based and cost effective interventions such as de-worming, LLINS, vitamin A and the promotion of Health Education messages” (p. 29). ¹⁸²

Table 2, “Summary of Strategies/Initiatives for improving Immunisation Coverage”, includes free healthcare nationwide because it “Addresses most important barrier of cost”, as well as Outreach and Defaulter Tracing Activities nationwide because it “Captures missed & defaulting children”. The table also include Periodic Intensified Routine Immunization
(PIRI) in selected districts with low vaccination rates (p. 20). ¹⁸³

Section 1.25, Advocacy and Communication, outlines the mechanisms to improve immunization outreach, which include District Social Mobilization Committees, radio station broadcasting in every district, and the national-level Communication and Social Mobilization Committee, which partners with civil society organizations to encourage vaccination (pp. 29-30). ¹⁸⁴ The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, notes that “Special teams are assigned to marginalized and vulnerable populations to improve access and coverage during outreach services and mass vaccination campaigns” (p. 35). ¹⁸⁵

The JEE notes that Sierra Leone’s immunization strategy is outdated but that it is in the process of developing an updated one (p. 35). ¹⁸⁶ The websites of the Ministry of Agriculture and Forestry (MAF) ¹⁸⁷, the Ministry of Health and Sanitation (MOHS) ¹⁸⁸, or the National Public Health Agency (NPHA) do not contain evidence of an updated immunization strategy as of July 2025. ¹⁸⁹. Gavi, the Vaccine Alliance, does not contain evidence of a current immunization strategy for Sierra Leone. ¹⁹⁰

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 100

Sierra Leone’s national immunization strategy includes measures to address vaccine hesitancy and build public trust in vaccines.

The Comprehensive EPI Multi-Year Plan (2017 – 2021), formulated in 2016, covers is the national immunization strategy. Section 1.25, Advocacy and Communication, outlines the mechanisms to improve immunization outreach, which include District Social Mobilization Committees, radio station broadcasting in every district, and the national-level Communication and Social Mobilization Committee, which partners with civil society organizations to encourage vaccination (pp. 29-30). ¹⁹¹

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, notes that Sierra Leone’s immunization strategy is outdated but that it is in the process of developing an updated one (p. 35). ¹⁹² The websites of the Ministry of Agriculture and Forestry (MAF) ¹⁹³, the Ministry of Health and Sanitation (MOHS) ¹⁹⁴, or the National Public Health Agency (NPHA) do not contain evidence of an updated immunization strategy as of July 2025. ¹⁹⁵. Gavi, the Vaccine Alliance, does not contain evidence of a current immunization strategy for Sierra Leone. ¹⁹⁶

1.6.1e National advisory group for immunization strategy/plan

Score: 100

Sierra Leone has a national advisory group that provides technical guidance and advice on the immunization strategy/plan to government.

The World Health Organization (WHO) reports that Sierra Leone has a National Immunization Advisory Mechanism in place. ¹⁹⁷ A November 2024 Facebook post from the Sierra Leone News Agency (SLENA) reported on a workshop held by the Ministry of Health and Sanitation (MoHS) and the National Public Health Agency (NPHA) to update stakeholders after the National Immunization Technical Advisory Group Sierra Leone (NITAG-SL) updated its guidance on HPV vaccinations, showing that the national advisory group is active in practice. ¹⁹⁸

1.6.1f Presence of an immunization programme for influenza

Score: 0

There is insufficient evidence that Sierra Leone has an immunization programme for influenza.

The World Health Organization (WHO) reports that Sierra Leone has an influenza vaccination policy but does not disclose if a specific influenza vaccination programme exists or the number of vaccinations available in the country. ¹⁹⁹ The (outdated) Comprehensive EPI Multi-Year Plan (2017 – 2021) does not discuss a yearly influenza vaccination campaign, although it does include Haemophilus influenza as part of its vaccination regimen (p. 29). ²⁰⁰ The websites of the Ministry of Agriculture and Forestry (MAF) ²⁰¹, the Ministry of Health and Sanitation (MOHS) ²⁰², or the National Public Health Agency (NPHA) do not contain evidence of a separate, yearly immunization programme for influenza. ²⁰³.

1.7 Climate change adaptation and vector transmission

1.7.1 Health system resilience

1.7.1a Strategy/plan for resilience of health system

Score: 50

Sierra Leone has a strategy or plan to develop a health system but there is insufficient evidence that it includes considerations that specifically address evolving threat of infectious diseases, changing weather patterns and acute events following extreme weather events.

Sierra Leone’s "National Health Sector Strategic Plan 2021-2025" (2021) includes Section 7, Health Security and Emergency, but it is focused on acute crises and it does not specifically address changing weather patterns or climate change, although it does focus on the future threat of emerging infectious diseases. ²⁰⁴

Early Detection

2.1 Laboratory systems strength and quality

2.1.1 Lab capacity for detecting priority diseases

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 100

There is evidence that the national laboratory system in Sierra Leone has the capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests and the tests are named. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, concluded that the laboratory system has “a wide range of diagnostic platforms, including RT-PCR, bacterial culture, serology and Microscopy” (p. 40) but does not specify which tests are available. ²⁰⁵ According to a 2023 article published by the China CDC on the collaboration between China and Sierra Leone on laboratory capacity building, Sierra Leone has the capacity to conduct a wide variety of PCR testing; the paper lists the following tests as having been conducted between 2015 and 2022: Ebola, Plasmodium, Lassa Feaver, Marburg, Chikungunya Fever, Salmonella, Rift Valley fever, Zika, Dengue, Vibrio cholerae, Vibrio parahaemolyticus, Shingella, E. Coli, Monkeypox, Measles, Varicella zoster, Rubella and Coxsacke. ²⁰⁶

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no evidence of a national plan, strategy or similar document for conducting testing during a public health emergency, which includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing in Sierra Leone. There is no evidence provided on testing for novel pathogens in the "National Health Laboratory Strategic Plan 2016-2020". ²⁰⁷ The "National Health Sector Strategic Plan 2021-2025" includes the goal of developing a national strategy on diagnostics and laboratory services by 2025, as well as engaging in capacity building for diagnostics and laboratory services (p. 55) but does not discuss testing of novel pathogens or scaling capacity. ²⁰⁸ “The Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018)” does not include information or plans to for testing novel pathogens or scaling capacity. ²⁰⁹ The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, concluded that Sierra Leone lacks a strategic framework for conducting operational research during an emergency and includes the recommendation that Sierra Leone develop such a document (p. 52). ²¹⁰ The websites of the Ministry of Agriculture and Forestry (MAF) ²¹¹, the Ministry of Health and Sanitation (MOHS) ²¹², and the National Public Health Agency (NPHA) ²¹³ do not contain evidence of such a plan or strategy.

2.1.2 Laboratory quality systems

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 0

There is insufficient evidence of a national laboratory that serves as a reference facility which is accredited in Sierra Leone. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone has two reference laboratories, the Central Public Health Reference Laboratory (CPHRL) and the Central Veterinary Laboratory (CVL). The report notes that both laboratories are in the process of implementing quality management systems that adhere to the ISO 15189 standards (p. 39). ²¹⁴ According to a review by the Pan-Africa Network for Genomic Surveillance of Poverty Related Disease and Emerging Pathogens (PANGenS) project, the CPHRL aimed to be fully compliant with ISO 15189 standards by 2024 but does not state if this goal has been achieved. ²¹⁵ The website of the National Public Health Agency (NPHA) offers an overview of the laboratories available in Sierra Leone but does not discuss standards or accreditation. ²¹⁶ Neither the National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation ²¹⁷ nor the Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ²¹⁸ includes information on certification or accreditation for the national reference laboratories.

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

There is evidence of the national laboratory being subject to external quality assurance review. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone has two reference laboratories, the Central Public Health Reference Laboratory (CPHRL) and the Central Veterinary Laboratory (CVL). The report notes that Sierra Leone participates in external quality assurance (EQA) programs for selected pathogens (but not for bacterial pathogens) (p. 39). ²¹⁹ According to the website of the East African Regional External Quality Assessment Scheme (EA-REQAS), Sierra Leone is a participating member. ²²⁰ According to a review by the Pan-Africa Network for Genomic Surveillance of Poverty Related Disease and Emerging Pathogens (PANGenS) project, the CPHRL “oversees the technical operations of the regional and peripheral laboratories in the country through the implementation of external quality assessment (EQA) and continuous quality improvement”. ²²¹ The website of the National Public Health Agency (NPHA) offers an overview of the laboratories available in Sierra Leone but does not discuss EQA. ²²²

2.2 Laboratory supply chains

2.2.1 Specimen referral and transport system

2.2.1a Nationwide specimen transport system

Score: 100

There is evidence that Sierra Leone has a nationwide system for specimen transport. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone has a national specimen transport system, but that it needs improvement (p. 40). The JEE also reports on the existence of the National Guidelines for the Sierra Leone Hub and Spoke Specimen Transport System (2022), but those do not appear to be publicly available. ²²³ The National Public Health Agency (NPHA) reported in 2024 that it was holding a national stakeholder workshop for the purpose of revising and improving the sample transportation guidelines. ²²⁴ Neither an update on that process nor the guidelines themselves are available on the website of the NPHA. ²²⁵ The National Biosafety and Biosecurity Policy and Guidelines (2022) include requirements that anyone involved in “taking, packaging and transporting specimens” be properly trained and refers to WHO guidance on regulations for the transport of infectious substances (pp. 37-38) but does not give details about the specimen transport system as a whole. ²²⁶

2.2.2 Laboratory cooperation and coordination

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is insufficient evidence of a plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, notes that “There is no national strategic framework for operational research in health emergencies” (p. 52). ²²⁷ Section 7 of the 2016 National Health Laboratory Strategic Plan 2016-2020 covers emergency response, but this does not include provisions to rapidly authorize or license laboratories to supplement the capacity of the national laboratory system during an outbreak. ²²⁸ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) ²²⁹ and the The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) ²³⁰ do not contain evidence of such a plan. Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ²³¹ and the One Health National Emergency Risk Communication Strategic Plan (2019) ²³² also do not contain evidence of such a plan. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ²³³, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ²³⁴, the Ministry of Health and Sanitation (MOHS) ²³⁵, or the National Public Health Agency (NPHA) as of July 2025. ²³⁶

2.3 Real-time surveillance and reporting

2.3.1 Indicator and event-based surveillance and reporting systems

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

There is evidence of ongoing event-based surveillance and but insufficient evidence that the data is being analyzed on a daily basis in Sierra Leone.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone’s disease surveillance system is based on the WHO African Region’s IDSR strategy (3rd edition). The system “uses a four-layer structure (community, health facility, district and national) to achieve the global health security goal of prevention, early detection and response to public health threats. The country conducts real-time surveillance using a developed early warning surveillance system that can detect public health threats in a timely fashion” (p. 52). It includes both an electronic monitoring system and a weekly bulletin that is distributed to stakeholders across the government but does not specify the frequency of data analysis. ²³⁷

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

There is publicly available evidence that Sierra Leone has mechanisms for reporting notifiable diseases to the WHO. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, confirms that Sierra Leone has mechanisms for reporting a PHEIC to the WHO. ²³⁸ Additionally, Sierra Leone has been regularly reporting Mpox cases in the country to the WHO ²³⁹, which was declared a PHEIC in 2022. ²⁴⁰

2.3.2 Interoperable, interconnected, electronic real-time reporting systems

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

Sierra Leone operates an electronic reporting surveillance system at both the national and the sub-national level.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that Sierra Leone’s disease surveillance system is based on the WHO African Region’s IDSR strategy (3rd edition). The system “uses a four-layer structure (community, health facility, district and national) to achieve the global health security goal of prevention, early detection and response to public health threats. The
country conducts real-time surveillance using a developed early warning surveillance system that can detect public health threats in a timely fashion” (p. 52). It includes both an electronic monitoring system and weekly bulletin that is distributed to stakeholders across the government. ²⁴¹

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 100

There is evidence that the electronic reporting surveillance system collects ongoing or real-time laboratory data in Sierra Leone and it can be disaggregated. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, confirms that Sierra Leone maintains a real-time electronic reporting surveillance system, which includes effective information sharing at the national and district levels and data verification (pp. 42-43). However, it does not mention if that data can be disaggregated by specific indicators. ²⁴² The National Public Health Agency (NPHA) maintains an outbreak dashboard that covers Lassa Fever and Mpox, which includes a breakdown by gender and district. ²⁴³

2.3.3 Wastewater surveillance

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within Sierra Leone. The WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 5 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.²⁴⁴

The ES programme was established in 2021. The environmental surveillance sites for polio are mainly located at Freetown. It detects poliovirus in sewage, offering an early warning by identifying virus particles shed in the feces of infected individuals. While the Environmental Surveillance experts from WHO visited the sites and hoped to expand it to other towns, there is no evidence suggesting that the programme has developed into national scale. ²⁴⁵

Moreover, as of 6 May 2026, GPEI, reported that four cVDPV2-positive environmental sample were reported in the Western Area, including Sierra Leone, this week, suggesting that ES is conducted on a regular basis, although it is unclear whether this is at the national level.²⁴⁶

2.4 Surveillance data accessibility and transparency

2.4.1 Coverage and use of electronic health records

2.4.1a Common usage of electronic health records

Score: 50

There is evidence of electronic health records in Sierra Leone but they are not commonly in use. A 2019 article from the World Health Organization (WHO) notes that Sierra Leone is the first country in Africa to fully transition its disease surveillance system from a paper-based system to a web-based electronic platform. ²⁴⁷ In 2020, the Ministry of Health and Sanitation (MoHS) released the “Electronic Medical Records Guidelines” that will serve as the basis for the development and as “a first step towards a push for an integrated ICT-
enabled health system in Sierra Leone” (p. 1). ²⁴⁸ In 2023, the MoHS announced a pilot EMR project at the Connaught Hospital in Freetown. ²⁴⁹ The “National Digital Health Roadmap 2024 – 2026” includes prioritizing the development and implementation of an electronic health records system, but notes that only 8 pilot projects are currently being implemented throughout the country (pp. 23-24); the project aims to have EMRs in 25% of tertiary/district hospitals by 2026 (pp. 68-69). ²⁵⁰

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no publicly available evidence that the national public health system has access to electronic health records of individuals in their country. The “National Digital Health Roadmap 2024 – 2026” includes prioritizing the development and implementation of an electronic health records system, but notes that only 8 pilot projects are currently being implemented throughout the country (pp. 23-24); it does not discuss whether the national public health system would have access to health records of individuals. ²⁵¹ Likewise, the Ministry of Health and Sanitation (MoHS) released the “Electronic Medical Records Guidelines” in 2020, but they do not state whether the ministry will have access to individual health records. ²⁵²

2.4.1c Existence of data standards for health record data comparability

Score: 0

There is publicly available evidence of a requirement for interoperability but no evidence of specific data standards to ensure that data is comparable.
The Ministry of Health and Sanitation’s (MoHS’s) “Electronic Medical Records Guidelines” (2020) specify that one of the key selection criteria for EMR systems will be “interoperability” but do not specify beyond that (pp. 7-8). ²⁵³ The “National Digital Health Roadmap 2024 – 2026” includes the strategic objective to “Establish and maintain a well-defined, standards and requirement based, interoperable enterprise architecture for consistent and accurate collection and exchange of health Information” (p. 28). ²⁵⁴

2.4.2 Data integration between human, animal and environmental health sectors

2.4.2a Data sharing mechanisms

Score: 100

Sierra Leone has established mechanisms at the relevant ministries responsible for animal, human, and wildlife surveillance to share data. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that the weekly multisectoral Emergency Preparedness Resilience and Response Group (EPRRG) meeting involves coordinating across agencies, including human and animal surveillance, laboratory and clinical service and others (p. 18). The weekly EPRRG meeting also includes the “exchange of information regarding potential and confirmed cases of zoonotic diseases” (p. 26). ²⁵⁵ The Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) also includes the Preparedness and Response Technical Working Group, which is responsible for both developing effective communication strategies across the One Health platform and organizing “regular inter-district and international cross-border meetings to support information sharing for tracking events, especially through effective networking and monitoring of potential threats” (p. 22). ²⁵⁶ According to a press release from the National Public Health Agency (NPHA), the governance manual for the one health platform was updated in late 2024 ²⁵⁷, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ²⁵⁸, the Ministry of Health and Sanitation (MOHS) ²⁵⁹, or the National Public Health Agency (NPHA) as of July 2025. ²⁶⁰

2.4.3 Transparency of surveillance data

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 100

There is evidence that Sierra Leone makes de-identified health surveillance data on infectious diseases publicly available via reports (or other format) on government websites, however they are not updated weekly. The National Public Health Agency (NPHA) maintains an outbreak dashboard that covers Lassa Fever and Mpox, which includes a breakdown by gender and district. ²⁶¹ The Ministry of Health and Sanitation of Sierra Leone sends surveillance data collected on a district and national level to the World Health Organisation (WHO) and a weekly bulletin is published, however the latest data covers 2017. ²⁶² The "Health Information Bulletin" posted on the website of the Ministry of Health and Sanitation contains data on various infectious diseases such as malaria, HIV, tuberculosis, etc. The bulletin reports the number of infectious, the number of those being treated, number of children being affected, number of pregnant women being affected, etc. However, the latest report was published in September 2020 and is no longer available on the MoHS website. ²⁶³ The website of the NPHA has a link listed for a “Data Hub” however, as of June 2025, the link is non-functional. ²⁶⁴

2.4.4 Ethical considerations during surveillance

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 0

There is insufficient evidence of legislation and/or regulations that safeguard the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities in Sierra Leone. Sierra Leone does not currently have a data protection law but according to a press release from the Ministry of Information and Civic Education (MoICE), the government plans to finalize a data protection law in 2025. ²⁶⁵ The website of MoICE does not contain information of such a law being in effect as of June 2025. ²⁶⁶ Sierra Leone is a signatory to the African Union Convention on Cyber Security and Personal Data Protection, which provides a normative framework to protect the privacy of individuals' data, including health data. However, Sierra Leone has not yet ratified the document. ²⁶⁷ The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023 ²⁶⁸, and the National Health Sector Strategic Plan 2021-2025 of the Ministry of Health and Sanitation ²⁶⁹ do not mention any such laws or guidelines in Sierra Leone. Information concerning the legislation and/or regulations that safeguard the confidentiality of information generated through surveillance activities is not available on the website of the Ministry of Agriculture and Forestry (MAF) ²⁷⁰, the Ministry of Health and Sanitation (MOHS) ²⁷¹, or the National Public Health Agency (NPHA) ²⁷².

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

There is insufficient evidence of legislation and/or regulations that safeguard the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities in Sierra Leone. Sierra Leone does not currently have a data protection law but according to a press release from the Ministry of Information and Civic Education (MoICE), the government plans to finalize a data protection law in 2025. ²⁷³ The website of MoICE does not contain information of such a law being in effect as of June 2025. ²⁷⁴ Sierra Leone is a signatory to the African Union Convention on Cyber Security and Personal Data Protection, which provides a normative framework to protect the privacy of individuals' data, including health data. However, Sierra Leone has not yet ratified the document. ²⁷⁵ The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023 ²⁷⁶, and the National Health Sector Strategic Plan 2021-2025 of the Ministry of Health and Sanitation ²⁷⁷ do not mention any such laws or guidelines in Sierra Leone. Information concerning the legislation and/or regulations that safeguard the confidentiality of information generated through surveillance activities is not available on the website of the Ministry of Agriculture and Forestry (MAF) ²⁷⁸, the Ministry of Health and Sanitation (MOHS) ²⁷⁹, or the National Public Health Agency (NPHA) ²⁸⁰.

2.4.5 International data sharing

2.4.5a Cooperative commitments or agreements within regions

Score: 50

There is evidence that Sierra Leone has made a commitment via public statements, legislation and/or a cooperative agreement to share surveillance data during a public health emergency with other countries, but only for one disease.

The 1st Joint External Evaluation (JEE) report for Sierra Leone, which was completed in October-November 2016, states that there exist bilateral agreements between some districts and their counterparts in neighboring countries, but in general, the arrangements for bilateral information sharing need strengthening (pp. 5-6). ²⁸¹ The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, does not include information about sharing surveillance data during a public health emergency with other countries. ²⁸² The Memorandum of Understanding between Sierra Leone's Kambia district and Guinea's Forecariah Prefecture specifies the sharing of epidemiological data across borders, as well as the sharing of surveillance information in the case of an outbreak of Ebola, which constituted a public health emergency in those countries at the time this agreement was signed. ²⁸³

The Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) includes “Organize and hold regular international cross-border and inter-district meetings to support information sharing for tracking events including effective networking, monitoring of potential threats and identifying opportunities to collaborate with stakeholders” under the remit of the Protection/ Point of Entry Technical Working Group (p. 17) and the Preparedness and Response Technical Working Group (p. 22) but do not discuss a formal mandate or provide examples of this working in practice. ²⁸⁴ According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ²⁸⁵, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ²⁸⁶, the Ministry of Health and Sanitation (MOHS) ²⁸⁷, or the National Public Health Agency (NPHA) as of July 2025. ²⁸⁸

The Sierra Leone Public Health Surveillance Strategic Plan (2019-2023) (2019), includes under Expected Key Result Area (EKRA) 6, Stronger partnership, networking & resource mobilisation, the objective of “Strengthen cross border surveillance” with the action being “Communicate daily updates with neighbouring countries during outbreaks” (p. 54); EKRAs are defined as “must achieve” goals (pp. 39-40). ²⁸⁹

The National Health Sector Strategic Plan 2021-2025 (2021) of the Ministry of Health and Sanitation ²⁹⁰ and the One Health National Emergency Risk Communication Strategic Plan (2019) ²⁹¹ do not include evidence of cooperative agreements to share surveillance data during a public health emergency with other countries. Information concerning a commitment to share surveillance data during a public health emergency with other countries is not available on the website of the Ministry of Agriculture and Forestry (MAF) ²⁹², the Ministry of Health and Sanitation (MOHS) ²⁹³, or the National Public Health Agency (NPHA) ²⁹⁴.

2.5 Case-based investigation

2.5.1 Case investigation and contact tracing

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 0

There is no evidence of a national system in place to provide support at the sub-national level (e.g. training, metrics standardization and/or financial resources) to conduct contact tracing in the event of a public health emergency in Sierra Leone. The "National Ebola Recovery Strategy For Sierra Leone 2015-2017" of 2015 mentions that volunteers were engaged for contact tracing during the Ebola outbreak. It does not provide any further evidence on the matter. ²⁹⁵ A 2020 press release from the Directorate of Health Security and Emergencies of the Ministry of Health and Sanitation (MoHS) shows field epidemiologists being trained on contact tracing, as well as case searching, screening and detection, as part of the response to Covid-19. ²⁹⁶ The National Infection Prevention and Control (IPC) Guidelines (2022) include contact tracing as part of outbreak investigations in health facilities (p. 24) but does not discuss plans or support for contact tracing. ²⁹⁷ The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023 ²⁹⁸, and the National Health Sector Strategic Plan 2021-2025 of the Ministry of Health and Sanitation ²⁹⁹ do not discuss plans for contact tracing. Information concerning plans or systems for contact tracing is not available on the website of the Ministry of Agriculture and Forestry (MAF) ³⁰⁰, the Ministry of Health and Sanitation (MOHS) ³⁰¹, or the National Public Health Agency (NPHA) ³⁰².

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 0

There is no evidence that Sierra Leone provides wraparound services to enable infected people and their contacts to self-isolate or quarantine as recommended, particularly economic support (paycheck, job security) and medical attention. The "National Health Sector Strategic Plan 2021-2025" does not include wraparound services to enable infected people and their contacts to self-isolate or quarantine. ³⁰³ “The National One Health Platform Revised Governance Manual 2023-2028” does not include information or plans for such services either. ³⁰⁴ The websites of the Ministry of Agriculture and Forestry (MAF) ³⁰⁵, the Ministry of Health and Sanitation (MOHS) ³⁰⁶, and the National Public Health Agency (NPHA) ³⁰⁷ do not contain evidence of such a plan or strategy.

2.5.2 Point of entry management

2.5.2a Strategy for tracing and quarantining international travelers

Score: 50

There is a joint plan agreement between the public health system and border control authorities to identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of a public health emergency but those plans are in place only in response to active public health emergencies.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that “There is no formal MoU or agreement between the security and other sectors for information- sharing and joint response to public health events” and “Activities, coordination and training between public health and security authorities takes place on an ad hoc basis”, both of which cover border control authorities. However, “Protocols and activities are developed and implemented between public health and security authorities during major outbreaks” and “Protocols and activities are developed and implemented between public health and security authorities during major outbreaks” (p. 53). ³⁰⁸

A 2024 news report from the WHO highlighted Sierra Leone’s commitment to improving border health measures and reported that it has specifically made commitments, including “strengthening communication and coordination among relevant agencies”. ³⁰⁹

The includes the Border/POE Technical Working Group which is mandated to “Advocate for the development of reporting protocols, guidelines and manuals for technical staff (Human health, Animal health, and the Environment) at district and national levels” but it does not itself contain a plan to identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of a public health emergency. ³¹⁰ According to a press release from the National Public Health Agency (NPHA), the governance manual for the one health platform was updated in late 2024 ³¹¹, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ³¹², the Ministry of Health and Sanitation (MOHS) ³¹³, or the National Public Health Agency (NPHA) as of July 2025. ³¹⁴

The Sierra Leone Public Health Surveillance Strategic Plan (2019-2023) (2019) ³¹⁵ and the National Health Sector Strategic Plan 2021-2025 (2021) ³¹⁶ do not contain any relevant evidence.

2.6 Epidemiology workforce

2.6.1 Existence of applied epidemiology training program such FETP and FETPV

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

There is evidence that epidemiology training program (such as FETP) is available in Sierra Leone, but there is no evidence that resources are provided by the government to send citizens to another country to participate in applied epidemiology training programs (such as FETP). The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that two levels of training on FETP, frontline, intermediate, are available in the country, as well as trainers and mentors (p. 47); however, it reports that funding for training is lacking and does not report resources to send citizens abroad for training. ³¹⁷ A 2022 press release from the Directorate of Health Security and Emergencies of the Ministry of Health and Sanitation (MoHS) reported that 20 trainees had completed the frontline FETP program and 15 had completed the intermediate FETP program, bringing the total trained in all FETP programs since 2016 to 335. ³¹⁸ The website for TEPHINET reports that the intermediate FETP programme in Sierra Leone has been accredited by TEPHINET since 2022. ³¹⁹ Neither the website of the Ministry of Health and Sanitation (MOHS) ³²⁰ nor the website of the National Public Health Agency (NPHA) ³²¹ includes information about sending citizens abroad for FETP training.

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

There is evidence that there are available field epidemiology training programs explicitly inclusive of animal health professionals or is there a specific animal health field epidemiology training program offered (such as FETPV) in Sierra Leone. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that the frontline level of the In-service Applied Veterinary Epidemiology Training programme (ISAVET), as well as trainers and mentors, is in place. ³²² A 2024 press release from the UN Food and Agriculture Organization (FAO) reports that the FAO, in collaboration with the Ministry of Agriculture (MAFS), and United States Agency for International Development (USAID), launched the second cohort of the ISAVET program in Sierra Leone in 2024. The program was first launched in 2022. ³²³

2.6.2 Epidemiology workforce capacity

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 100

There is evidence that Sierra Leone has 1 trained field epidemiologist per 200,000 people. According to the WHO, Sierra Leone had a population of 8.46 million in 2023. ³²⁴ According to a press release from the Directorate of Health Security and Emergencies, Sierra Leone had 335 trained epidemiologists at all levels. ³²⁵ This is roughly 1 epidemiologist per 25,253 people.

Rapid Response

3.1 Emergency preparedness and response planning

3.1.1 National public health emergency preparedness and response plan

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 66.67

Sierra Leone has an overarching national public health emergency response plan in place that covers multiple threat types, it is publicly available but there is insufficient evidence that it has dedicated funding.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that the country uses the One Health Strategic Plan as the key part of its emergency response planning (p. 19). The JEE also reports that there is insufficient funding to support the implementation of international health regulations in the country (p. 16). ³²⁶

The Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) includes multiple threat types. It has technical working groups (TWGs) that cover antimicrobial resistance, biosafety and biosecurity, zoonotic diseases and radioactive/chemical events (pp. 13-38), which are designed to plan, coordinate and prepare for potentially occurring health threats. The document does not discuss having a dedicated source of funding. According to a press release from the National Public Health Agency (NPHA), the governance manual for the one health platform was updated in late 2024 ³²⁷, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ³²⁸, the Ministry of Health and Sanitation (MOHS) ³²⁹, or the National Public Health Agency (NPHA) as of July 2025. ³³⁰

The NPHA Strategic Plan (2023-2026) (2023), reports that the NPHA itself is funded through the national budget (p. 2, Legislative and Policy Context) but does not disclose a budget or budgets for a national public health emergency response plan. ³³¹

3.1.1b National public health emergency response plan published in past 3 years

Score: 100

Sierra Leone has an overarching national public health emergency response plan in place that has been updated in the last 3 years. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that the country uses the One Health Strategic Plan as the key part of its emergency response planning (p. 19). ³³² The National One Health Platform Revised Governance Manual 2023-2028, was published in 2023. ³³³

3.1.1c One health principles by covering multiple threat types

Score: 100

Sierra Leone has an overarching national public health emergency response plan in place that covers multiple threat types. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that the country uses the One Health Strategic Plan as the key part of its emergency response planning (p. 19). ³³⁴ The National One Health Platform Revised Governance Manual 2023-2028 includes multiple threat types. It has technical working groups (TWGs) that cover antimicrobial resistance, biosafety and biosecurity, zoonotic diseases and radioactive/chemical events (pp. 13-38), which are designed to plan, coordinate and prepare for potentially occurring health threats. ³³⁵

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

Sierra Leone has an overarching national public health emergency response plan but it does not include considerations of the impact of health equity or concrete or concerted mechanisms for considering the needs of vulnerable populations. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that the country uses the One Health Strategic Plan as the key part of its emergency response planning (p. 19). [1] The National One Health Platform Revised Governance Manual 2023-2028 identifies “strong community participation, equity, and inclusion” and “promotion of gender equality and cultural diversity” as two key values (p. 5). [2] The Research and Gender TWG includes the aim of “Engaging] with policymakers to embed gender and One Health considerations in policies and programs (p. 37). The Occupational Health and Safety TWG includes assessing the risks to various workers in across the country, making sure they have adequate protective equipment and “advocate for the provision of support services for workers based on the risks identified” (p. 27). However, the does not include considerations of the impact of health equity or concrete or concerted mechanisms for considering the needs of vulnerable populations. [2]

3.1.2 Private sector involvement in response planning

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 100

There is evidence that Sierra Leone has a specific mechanism(s) for engaging with the private sector to assist with outbreak emergency preparedness and response. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that the private sector is not involved with preparedness plans or other readiness activates (p. 50). ³³⁶ The National One Health Platform Revised Governance Manual 2023-2028 includes directors from the private sector on the One Health Coordinating Committee (OHCC), which provides policy guidance and leadership on Sierra Leone’s One Health response program (p. 8). The Regional One Health Coordination Committee (ROHCC) is tasked with, among other objectives, “Communication and Collaboration: The committee fosters communication and collaboration between regional stakeholders, including government agencies, NGOs, community leaders, and the private sector” (p. 9). ³³⁷

3.1.3 Non-pharmaceutical interventions planning

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 0

There is insufficient public evidence that Sierra Leone has a policy, plan and/or guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic.

Sierra Leone’s National Disaster Preparedness, Response, and Recovery Plan (2024) assigns the responsibility of organizing and supporting non-pharmaceutical interventions to both the national and the local/district governments as part of the public health emergency response function (p. 89) but does not offer detailed guidelines or instructions. ³³⁸ The Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) encompasses Sierra Leone’s emergency public health response. It does not directly address non-pharmaceutical interventions. According to a press release from the National Public Health Agency (NPHA), the governance manual for the one health platform was updated in late 2024 ³³⁹, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ³⁴⁰, the Ministry of Health and Sanitation (MOHS) ³⁴¹, or the National Public Health Agency (NPHA) as of July 2025. ³⁴²

3.2 Exercising response plans

3.2.1 Activating response plans

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 100

There is evidence that Sierra Leone has both activated their national emergency response plan for an infectious disease outbreak and completed a national-level biological threat-focused exercise in the last year. In June 2025, Sierra Leone activated its AVoHC-SURGE team in response to an outbreak of Mpox in the country. ³⁴³ The country also held a health briefing, also in June 2025, to show the national mobilization and response to its regional and international partners. ³⁴⁴ In June 2024, the National Public Health Agency (NPHA) and the Ministry of Health and Sanitation (MoHS) held a combined 10-day exercise for the AVoHC-SURGE team, which covered "simulations, workshops, and lectures that cover a wide range of critical areas: Emergency Medical Response, focusing on first aid, trauma care, and medical evacuation procedures; Disaster Preparedness, addressing strategies for managing natural and man-made disasters, including disease outbreaks and environmental crises; Coordination and Communication, enhancing collaboration between healthcare agencies and improving communication during emergencies; and Public Health Surveillance, strengthening the ability to monitor and respond to public health threats in real-time.” ³⁴⁵

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 50

There is evidence that Sierra Leone has identified a list of gaps and best practices in response (through a biological-threat focused exercise) and developed a plan to improve response capabilities in the past year. In February 2025, Sierra Leone hosted an EU-sponsored chemical, biological, radiological and nuclear (CBRN) comprehensive training exercise, which included “began with a dedicated needs assessment, bringing together project experts and local response agencies to evaluate existing protocols, equipment availability, and coordination mechanisms” and which “culminated in equipment training sessions and live drills, providing participants with hands-on experience in managing realistic CBRN incidents”. ³⁴⁶ However, there is not evidence of of published plan on the website of the Ministry of Health and Sanitation (MoHS) ³⁴⁷ or the National Public Health Agency (NPHA) ³⁴⁸.

3.2.2 Private sector engagement in exercises

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no evidence that Sierra Leone in the past year has undergone a national-level biological threat-focused exercise that has included private sector representatives. In June 2024, the National Public Health Agency (NPHA) and the Ministry of Health and Sanitation (MoHS) held a combined 10-day exercise for the AVoHC-SURGE team, but there is no evidence that private-sector representatives were involved. ³⁴⁹ The websites of the Ministry of Health and Sanitation (MOHS) ³⁵⁰ and the National Public Health Agency (NPHA) ³⁵¹ do not contain evidence of national-level biological threat-focused exercises that has included private sector representatives

3.3 Emergency response operation

3.3.1 Emergency response operation

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

Sierra Leone has a national Emergency Operations Center (EOC). The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports Sierra Leone has a public health emergency operations center (PHEOC), that is staffed around the clock and prepared to respond to emergencies within 120 minutes (p. 50). It also reports that district EOCs have been established at the sub-national level and are functional (p. 50). ³⁵² Neither the website of the Public Health National Emergency Operation Center ³⁵³ nor its Facebook page ³⁵⁴ are accessible as of June 2025.

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is insufficient evidence that the Emergency Operations Centre (EOC) in Sierra Leone is required to conduct a drill for a public health emergency scenario at least once per year or that they conduct a drill at least once per year.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports Sierra Leone has a public health emergency operations center (PHEOC), that is staffed around the clock and prepared to respond to emergencies within 120 minutes (p. 50). ³⁵⁵ Neither the website of the Public Health National Emergency Operation Center ³⁵⁶ nor its Facebook page ³⁵⁷ is accessible as of June 2025. The websites of the Ministry of Health and Sanitation (MOHS) ³⁵⁸ and the National Public Health Agency (NPHA) ³⁵⁹ do not contain evidence that the PHEOC has conducted an emergency response or emergency response exercise in the last year.

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is insufficient evidence that the Emergency Operations Centre (EOC) in Sierra Leone has conducted within the last year a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of the public health emergency/scenario. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports Sierra Leone has a public health emergency operations center (PHEOC), that is staffed around the clock and prepared to respond to emergencies within 120 minutes (p. 50). ³⁶⁰ Neither the website of the Public Health National Emergency Operation Center ³⁶¹ nor its Facebook page ³⁶² is accessible as of June 2025. The websites of the Ministry of Health and Sanitation (MOHS) ³⁶³ and the National Public Health Agency (NPHA) ³⁶⁴ do not contain evidence that the PHEOC has conducted an emergency response or emergency response exercise in the last year.

3.4 Linking public health and security authorities

3.4.1 Public health and security authorities linked for a biological event

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is insufficient evidence that public health, animal health, the private sector and national security authorities have carried out an exercise to respond to a potential deliberate biological event in Sierra Leone or that there are publicly available standard operating procedures, guidelines, memorandums of understanding (MOUs), or other agreements between the public health, animal health, the private sector and security authorities to respond to a potential deliberate biological event.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, does not discuss bioterrorism or other deliberate biological events. ³⁶⁵ Neither the website of the Public Health National Emergency Operation Center ³⁶⁶ nor its Facebook page ³⁶⁷ is accessible as of June 2025. The websites of the Ministry of Health and Sanitation (MOHS) ³⁶⁸ and the National Public Health Agency (NPHA) ³⁶⁹ do not contain evidence that Sierra Leone has carried out an exercise to respond to a potential deliberate biological event in Sierra.

The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) ³⁷⁰ and the National Disaster Preparedness, Response, and Recovery Plan (2024) ³⁷¹ discuss either terrorism or a biological event but do not discuss a deliberate biological event or a response to one.

The Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) includes multiple threat types. It has technical working groups (TWGs) that cover antimicrobial resistance, biosafety and biosecurity, zoonotic diseases and radioactive/chemical events (pp. 13-38), which are designed to plan, coordinate and prepare for potentially occurring health threats, but it does not discuss bioterrorism or a response plan for bioterrorism. ³⁷² According to a press release from the National Public Health Agency (NPHA), the governance manual for the one health platform was updated in late 2024 ³⁷³, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ³⁷⁴, the Ministry of Health and Sanitation (MOHS) ³⁷⁵, or the National Public Health Agency (NPHA) as of July 2025. ³⁷⁶

3.5 Risk communication

3.5.1 Risk communication planning

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 100

There is evidence that Sierra Leone has in place, either in the national public health emergency response plan or in other legislation, regulation, or strategy documents, a section detailing a risk communication plan that is specifically intended for use during a public health emergency. The "One Health National Emergency Risk Communication Strategic Plan" of 2019 aims to strengthen the coordination, collaboration, and communication between, human, animal, and environment authorities and partners for better health outcomes. The plan serves to ensure consistent communication between health, animal and environmental authorities and partners in order to design messages, inform, increase awareness, mobilize communities to respond to health emergencies, etc. It serves to strengthen preparedness and response among communities in general and in times of outbreaks or emergencies. ³⁷⁷

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 100

There is evidence that the risk communication plan outlines how messages will reach populations and sectors with different communications needs. The "One Health National Emergency Risk Communication Strategic Plan" of 2019 provisions for various methods in which messages may reach populations and sectors such as media updates, press conferences, news releases, community engagements such as door to door outreach, public meetings, text messaging, and social media. ³⁷⁸ The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, particularly praises Sierra Leone for its radio programs for RCCE communication (p. 60). It also noted “ongoing proactive outreach through a variety of channels (e.g. hotline, complaint systems, social listening)” and daily monitoring of online and offline media for feedback, and insights, with the gathered data being used to adjust and improve risk communication strategies. Further, it found that there was “strong infodemic management using search mechanisms for online or/and offline sources to shape messages and strategies” and a “coordination of risk communication strategies and messages across sectors and levels of government” (p. 61). ³⁷⁹

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

There is insufficient evidence that the risk communication plan designates a specific position within the government to serve as the primary spokesperson to the public during a public health emergency. The "One Health National Emergency Risk Communication Strategic Plan" of 2019 sets as a strategic goal the identification of trusted and trained spokespersons in the Ministry of Health and Sanitation, Ministry of Agriculture and Sanitation, Environment Protection Agency, and the Office of National Security. ³⁸⁰ Furthermore, it designates the health promotion officer from the Health and Education Division attached to the Directorate of Health Security and Emergencies of the Ministry of Health and Sanitation to serve as the lead communication chair. The chair works closely with the information technology team to ensure that relevant and current information is posted on time. There is no further evidence provided on the website of the Ministry of Health and Sanitation. ³⁸¹ The Public Health National Emergency Operation Center of Sierra Leone does not have a website, and it does not provide any evidence on its Facebook page. ³⁸²

3.5.2 Public health systems communication

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 100

There is evidence that Sierra Leone’s public health system actively and regularly shares messages via online media platforms to inform the public about ongoing public health concerns and/or dispel rumors, misinformation or disinformation.

The One Health National Emergency Risk Communication Strategic Plan (2019) includes using social media as part of its “Communication Objectives” section (p. 26).

The National Public Health Agency (NPHA) regularly shares information on its Facebook page. The NPHA is sharing near-daily updates concerning the Mpox outbreak, as of July 2025, that include new cases, recovered cases, total active cases and total cumulative cases. ³⁸³³⁸⁴ The NPHA has also shared posts discussing the Mpox and immunosuppressed individuals (July 14, 2025) ³⁸⁵, how Mpox spreads (July 8, 2025) ³⁸⁶, and reminding people that gin is not a cure for Mpox (July 6, 2025) ³⁸⁷.

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no evidence that senior leaders in Sierra Leone have shared misinformation or disinformation on infectious diseases in the past two years

No evidence of misinformation or disinformation was identified on the website of the Statehouse of Sierra Leone, which includes the president and key ministers. ³⁸⁸

3.6 Access to communications infrastructure

3.6.1 Internet users

3.6.1a Percentage of households with Internet

Score: 21.16

3.6.2 Mobile subscribers

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 0

3.6.3 Female access to a mobile phone

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 53.33

3.6.4 Female access to the Internet

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 79.17

3.7 Trade and travel restrictions

3.7.1 Trade restrictions

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no evidence of restrictions on the export/import of medical goods due to an infectious disease outbreak on the websites of the Ministry of Agriculture and Forestry (MAF) ³⁸⁹, the Ministry of Health and Sanitation (MOHS) ³⁹⁰, or the National Public Health Agency (NPHA). ³⁹¹

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no evidence of restrictions on the export/import of non-medical goods due to an infectious disease outbreak on the websites of the Ministry of Agriculture and Forestry (MAF) ³⁹², the Ministry of Health and Sanitation (MOHS) ³⁹³, or the National Public Health Agency (NPHA). ³⁹⁴

3.7.2 Travel restrictions

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no evidence of inbound or outbound travel restrictions due to an infectious disease outbreak on the websites of the Ministry of Agriculture and Forestry (MAF) ³⁹⁵, the Ministry of Health and Sanitation (MOHS) ³⁹⁶, or the National Public Health Agency (NPHA). ³⁹⁷

3.7.2b Risk-based approach to international travel-related measures

Score: 0

There is insufficient evidence that Sierra Leone uses a risk-based approach to international travel-related measures.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, includes in its “Recommendations for priority actions” in the PoE: Points of entry and border health section, “Develop and implement a national multisectoral process with a mechanism to determine the adoption of international travel-related measures with a risk-based approach” (p. 67). ³⁹⁸ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) ³⁹⁹ and the National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) ⁴⁰⁰ do not contain evidence of a risk-based approach to international travel-related measures. Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁴⁰¹ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁴⁰² also do not contain evidence of such an approach. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁴⁰³, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁴⁰⁴, the Ministry of Health and Sanitation (MOHS) ⁴⁰⁵, or the National Public Health Agency (NPHA) as of July 2025. ⁴⁰⁶

Health System

4.1 Health capacity in clinics, hospitals and community care centers

4.1.1 Available human resources for the broader healthcare system

4.1.1a Doctors per 100,000 people

Score: 1.46

4.1.1b Nurses and midwives per 100,000 people

Score: 14.11

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 100

Sierra Leone has a health workforce strategy in place, updated in the past 5 years, to identify fields where there is an insufficient workforce and strategies to address these shortcomings. The health workforce strategy is part of the National Health Sector Strategic Plan (NHSSP) 2021-2025, with the section “Human Resources for Health” including objectives and measures related to improving the health workforce. Specifically, it contains the strategic objective: “Attain a minimum density of 45 skilled health workers per 10,000 members of the population and sustain a high performing workforce that is equitably distributed and delivering high-quality care services by 2025” (p. 29). Key activities connected to the strategic objective include “Support scholarship programmes for critical cadres of staff”, “Conduct post graduate training for doctors, nurses, midwives and CHOs”, “Conduct graduate training for doctors, nurses and CHOs”, “Assess the capacity of medical training institutions (all cadres) and programmes to deliver competency-based education programmes”, “Institute an annual multi-stakeholder HRH forum with training institutions and other relevant stakeholders to plan the numbers and priorities [sic] areas for student in-take in line with the needs of the health sector”, “Collaborate with academia (training institutions and Ministry of Education) to scale up the training of health workers to ensure supply responds to epidemiological and demographic transitions of the country”, and “Institute short-term programme(s) to rapidly upgrade qualified excess state-enrolled community health nurses (SECHNs) to become midwives and nurses” (pp. 29-30).

4.1.1d Health system capacity for essential health services

Score: 0

There is insufficient evidence that there is sufficient capacity within the health system of Sierra Leone to deliver essential health services.

The 2023 Joint external evaluation of IHR core capacities of Sierra Leone says that a package of EHS has been defined and documented (2015). Guidelines for continuity of essential health services were developed for COVID-19 in 2020. However, a mechanism for monitoring service continuity may not be fully functional or documented with regular report. Key challenges include: the current health sector plan and national emergency preparedness and response plans do not have explicit consideration for the continuity of EHS. Hence there is need for a comprehensive plan for continuity of EHS during emergencies; and there is no EHS continuity plan/guideline or dedicated section in other emergency operations/management plans available.⁴⁰⁷

According to the Global Health Observatory of the WHO, Sierra Leone scored 41 out of 100 on the “Coverage of essential health services (SDG 3.8.1)” indicator in 2021, which indicates a lack of capacity in the health system as a whole. ⁴⁰⁸

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is a requirement but no evidence of a specific plan to ensure continuity of essential health services during a public health emergency in Sierra Leone. Sierra Leone’s National Disaster Risk Management Policy (2024) includes epidemics and pandemics within its hazard and risk profile (Table 4: Classification of hazards/threats for the National Disaster Risk Management Policy; Table 5: Spatial Disaggregation of Hazard Profile and Impacts in Sierra Leone). Section 8.7 of that plan identifies key Ministries, Departments, and Agencies (MDAs) to be assigned specific roles in disasters, as well as “Ensure operational services and business continuity for public and private sectors by identifying priority services, establishing response coordination mechanisms, and maintaining communication with staff and partner organizations” (p. 94). Table 8: Roles and responsibilities of lead sector ministries/agencies and private sector, lays out each agency's area of responsibility during a disaster. ⁴⁰⁹

4.1.2 Facilities capacity

4.1.2a Hospital beds per 100,000 people

Score: 5.75

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 100

Sierra Leone has the capacity to isolate patients with highly communicable diseases in a biocontainment patient care unit and/or patient isolation room/unit located within the country.

The National Public Health Agency (NPHA) lists 5 isolation facilities on its website: the China-Sierra Leone Friendship Hospital, Hastings Treatment Centre, the 34 Military Hospital, the Sierra Leone Police Hospital and the Infectious Disease Unit, Connaught Hospital. ⁴¹⁰

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 100

There is evidence that Sierra Leone has demonstrated capacity to expand isolation capacity in response to an infectious disease outbreak in the past two years. According to a Facebook post from the National Public Health Agency (NPHA), in May 2025, Sierra Leone opened a dedicated 50-bed Mpox hospital, which included patient isolation measures. It also is opening the Mpox Treatment Center with a total capacity for 950 patients requiring specialized treatment, but does not specify how isolation capacity will function there. ⁴¹¹

4.2 Supply chain for health system and healthcare workers

4.2.1 Routine health care and laboratory system supply

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 50

There is publicly available evidence suggesting that Sierra Leone has a national procurement protocol in place which can be utilized by the Ministry of Health but not the Ministry of Agriculture for the acquisition of laboratory supplies (e.g. equipment, reagents and media) and medical supplies (e.g. equipment, PPE) for routine needs. The "National Medical Supplies Agency Act 2017" of Sierra Leone has established the National Medical Supplies Agency as the public service agency that is responsible for procurement, warehousing and distribution of drugs and medical supplies for all public institutions in Sierra Leone. This includes laboratory supplies and reagents, and medical supplies. The Act is intended for the procurement of drugs, laboratory supplies and medical supplies for and on behalf of all public institutions throughout Sierra Leone. The Act specifically says that it is inclusive of all public institutions, therefore it does not exclude the Ministry of Agriculture. ⁴¹²

4.2.2 Stockpiling for emergencies

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 0

There is insufficient evidence that Sierra Leone has a stockpile of medical supplies for national use during a public health emergency.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that “There is no budget to support stockpiling for emergencies” in Sierra Leone (p. 51). ⁴¹³ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) includes Objective 1.9, “Provide support for the development of a comprehensive emergency response logistics policy, including stockpile essential resources for emergency response at the national and district level” under its Strategic Objectives and Activities (p. 18) ⁴¹⁴, but there is no evidence of implementation on the websites of the Ministry of Agriculture and Forestry (MAF) ⁴¹⁵, the Ministry of Health and Sanitation (MOHS) ⁴¹⁶, or the National Public Health Agency (NPHA). ⁴¹⁷

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is insufficient evidence that Sierra Leone has a stockpile of laboratory supplies for national use during a public health emergency.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that “There is no budget to support stockpiling for emergencies” in Sierra Leone (p. 51). ⁴¹⁸ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) includes Objective 1.9, “Provide support for the development of a comprehensive emergency response logistics policy, including stockpile essential resources for emergency response at the national and district level” under its Strategic Objectives and Activities (p. 18) ⁴¹⁹, but there is no evidence of implementation on the websites of the Ministry of Agriculture and Forestry (MAF) ⁴²⁰, the Ministry of Health and Sanitation (MOHS) ⁴²¹, or the National Public Health Agency (NPHA). ⁴²²

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is insufficient evidence that Sierra Leone has a stockpile of medical supplies for national use during a public health emergency.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, reports that “There is no budget to support stockpiling for emergencies” in Sierra Leone (p. 51). ⁴²³ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) includes Objective 1.9, “Provide support for the development of a comprehensive emergency response logistics policy, including stockpile essential resources for emergency response at the national and district level” under its Strategic Objectives and Activities (p. 18) ⁴²⁴, but there is no evidence of implementation on the websites of the Ministry of Agriculture and Forestry (MAF) ⁴²⁵, the Ministry of Health and Sanitation (MOHS) ⁴²⁶, or the National Public Health Agency (NPHA). ⁴²⁷

4.2.3 Manufacturing and procurement for emergencies

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 0

There is insufficient evidence that Sierra Leone has a plan or agreement to leverage public and/or private sector domestic (including regional) manufacturing capacity to produce or procure medical supplies or to expedite medical supplies through points of entry.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, notes in the “R1. Health emergency management” section, “Sierra Leone has demonstrated its capacity to expand the normal supply chain system rapidly to accommodate the demand posed by public health emergencies” (p. 51) but it does not contain specifics. ⁴²⁸ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) includes Section 14: Procurement, which covers goals related to establishing a routine procurement system but it does not contain specifics related to emergency procurement during a public health emergency. (pp. 32-37). ⁴²⁹ The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) also contains evidence of routine procurement planning and improvement as part of Strategic Pillar 4: Health Infrastructure (Section 3.3, pp. 32-42) but does not address emergency procurement during a public health emergency. ⁴³⁰ Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁴³¹ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁴³² also do not contain evidence of such a plan. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁴³³, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁴³⁴, the Ministry of Health and Sanitation (MOHS) ⁴³⁵, or the National Public Health Agency (NPHA) as of July 2025. ⁴³⁶

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

There is insufficient evidence that Sierra Leone has a plan or agreement to leverage public and/or private sector domestic (including regional) manufacturing capacity to produce or procure laboratory supplies or to expedite laboratory supplies through points of entry.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, notes in the “R1. Health emergency management” section, “Sierra Leone has demonstrated its capacity to expand the normal supply chain system rapidly to accommodate the demand posed by public health emergencies” (p. 51) but it does not contain specifics. ⁴³⁷ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) includes Section 14: Procurement, which covers goals related to establishing a routine procurement system but it does not contain specifics related to emergency procurement during a public health emergency. (pp. 32-37). ⁴³⁸ The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) also contains evidence of routine procurement planning and improvement as part of Strategic Pillar 4: Health Infrastructure (Section 3.3, pp. 32-42) but does not address emergency procurement during a public health emergency. ⁴³⁹ Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) includes advocating for financing the routine procurement of laboratory supplies as the responsibility of the Laboratory Technical Working Group (TWG) but only for routine operations (p. 19). ⁴⁴⁰ According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁴⁴¹, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁴⁴², the Ministry of Health and Sanitation (MOHS) ⁴⁴³, or the National Public Health Agency (NPHA) as of July 2025. ⁴⁴⁴

4.2.3c Mechanism emergency logistics and supply chain management

Score: 0

There is evidence that Sierra Leone has a system or mechanism for national and subnational levels for emergency logistics and supply chain management, but there is insufficient evidence that it is exercised, reviewed, evaluated and updated on a regular basis, that it covers specific considerations or that it covers the public and private sectors.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, notes in the “R1. Health emergency management” section, “Sierra Leone has demonstrated its capacity to expand the normal supply chain system rapidly to accommodate the demand posed by public health emergencies” and reports that it has “a validated medical countermeasure response plan and an emergency supply chain playbook” (p. 51). ⁴⁴⁵ However, neither the medical countermeasure response plan nor the emergency supply chain playbook is publicly available. The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) includes Section 14: Procurement, which covers goals related to establishing a routine procurement system but it does not contain specifics related to emergency procurement during a public health emergency. (pp. 32-37). ⁴⁴⁶ The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) also contains evidence of routine procurement planning and improvement as part of Strategic Pillar 4: Health Infrastructure (Section 3.3, pp. 32-42) but does not address emergency procurement during a public health emergency. ⁴⁴⁷ Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁴⁴⁸ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁴⁴⁹ also do not contain evidence of such a plan. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁴⁵⁰, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁴⁵¹, the Ministry of Health and Sanitation (MOHS) ⁴⁵², or the National Public Health Agency (NPHA) as of July 2025. ⁴⁵³

4.3 Medical countermeasures and personnel deployment

4.3.1 System for dispensing MCMs during a public health emergency

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

There is evidence that Sierra Leone has a plan for dispensing medical countermeasures (MCM) during a public health emergency, but the policy itself is not publicly available.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, notes in the “R1. Health emergency management” section that Sierra Leone has “a validated medical countermeasure response plan and an emergency supply chain playbook” (p. 51). ⁴⁵⁴ However, neither the medical countermeasure response plan nor the emergency supply chain playbook is publicly available. The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) ⁴⁵⁵ and the National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) do not address the deployment of medical countermeasures during a public health emergency. ⁴⁵⁶ Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁴⁵⁷ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁴⁵⁸ also do not contain evidence of such a plan. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁴⁵⁹, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁴⁶⁰, the Ministry of Health and Sanitation (MOHS) ⁴⁶¹, or the National Public Health Agency (NPHA) as of July 2025. ⁴⁶²

4.3.2 System for receiving foreign health personnel during a public health emergency

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 0

There is insufficient public evidence of a plan to facilitate a workforce surge in an emergency.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, notes in the “R1. Health emergency management” that “Sierra Leone has developed and validated a plan that outlines mechanisms and decision-making related to sending and receiving health personnel during a public health emergency” and “The validated plan addresses regulatory, licensure, safety, financial and liability concerns for sending and receiving personnel for public health emergency response.” (p. 51). ⁴⁶³ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) includes the section Public Health Emergency Management, which “will include the implementation of evidence-based interventions, foster collaborations, and coordination of permanent and surge staff capacities” (p.18); the section on Workforce Development includes Objective 5.5 “Support the development of surge staff utilization policy and SOPs in collaboration with relevant authorities” (p. 21). However, the document does not include a plan. ⁴⁶⁴

The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) does not address a plan to facilitate workforce surge. ⁴⁶⁵ Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁴⁶⁶ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁴⁶⁷ also do not contain evidence of such a plan. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁴⁶⁸, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁴⁶⁹, the Ministry of Health and Sanitation (MOHS) ⁴⁷⁰, or the National Public Health Agency (NPHA) as of July 2025. ⁴⁷¹ Those sites also do not contain a plan a plan to facilitate workforce surge in an emergency.

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is insufficient public evidence of a plan to facilitate a workforce surge in an emergency.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, notes in the “R1. Health emergency management” that “Sierra Leone has developed and validated a plan that outlines mechanisms and decision-making related to sending and receiving health personnel during a public health emergency” and “The validated plan addresses regulatory, licensure, safety, financial and liability concerns for sending and receiving personnel for public health emergency response.” (p. 51). ⁴⁷² However, the plan is not publically available on government websites. ⁴⁷³⁴⁷⁴⁴⁷⁵⁴⁷⁶ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) includes the section Public Health Emergency Management, which “will include the implementation of evidence-based interventions, foster collaborations, and coordination of permanent and surge staff capacities” (p.18); the section on Workforce Development includes Objective 5.5 “Support the development of surge staff utilization policy and SOPs in collaboration with relevant authorities” (p. 21). However, the document does not include a plan. ⁴⁷⁷

The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) does not address a plan to facilitate workforce surge. ⁴⁷⁸ Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁴⁷⁹ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁴⁸⁰ also do not contain evidence of such a plan. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁴⁸¹, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁴⁸², the Ministry of Health and Sanitation (MOHS) ⁴⁸³, or the National Public Health Agency (NPHA) as of July 2025. ⁴⁸⁴ Those sites also do not contain a plan a plan to facilitate workforce surge in an emergency.

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

There is insufficient public evidence of a plan to facilitate a workforce surge in an emergency.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, notes in the “R1. Health emergency management” that “Sierra Leone has developed and validated a plan that outlines mechanisms and decision-making related to sending and receiving health personnel during a public health emergency” and “The validated plan addresses regulatory, licensure, safety, financial and liability concerns for sending and receiving personnel for public health emergency response.” (p. 51). ⁴⁸⁵ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) includes the section Public Health Emergency Management, which “will include the implementation of evidence-based interventions, foster collaborations, and coordination of permanent and surge staff capacities” (p.18); the section on Workforce Development includes Objective 5.5 “Support the development of surge staff utilization policy and SOPs in collaboration with relevant authorities” (p. 21). However, the document does not include a plan. ⁴⁸⁶

The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) does not address a plan to facilitate workforce surge. ⁴⁸⁷ Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁴⁸⁸ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁴⁸⁹ also do not contain evidence of such a plan. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁴⁹⁰, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁴⁹¹, the Ministry of Health and Sanitation (MOHS) ⁴⁹², or the National Public Health Agency (NPHA) as of July 2025. ⁴⁹³ Those sites also do not contain a plan a plan to facilitate workforce surge in an emergency.

4.4 Healthcare access

4.4.1 Access to healthcare

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 50

The Constitution of Sierra Leone guarantees citizens’ right to medical care as aspirational or subject to progressive realization. Section 8(3) states that “The State shall direct its policy towards ensuring that … d. there are adequate medical and health facilities for all persons, having due regard to the resources of the State” ⁴⁹⁴.

4.4.1b Access to skilled birth attendants (% of population)

Score: 80.88

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 88.73

4.4.1d Coverage of essential health services through universal health coverage

Score: 29.17

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 41.49

4.4.1f Rate of mortality amenable to health care

Score: 76.38

4.4.2 Paid medical leave

4.4.2a Guaranteed paid sick leave

Score: 66.67

Sierra Leone guarantees paid sick leave but does not specify if mental health is included in paid sick leave. Section 78 of the Employment Act of 2023 requires employers to grant paid sick leave to their employees but also requires a medical certificate for sick leave. The act does not state whether sick leave includes mental health conditions. ⁴⁹⁵

4.4.3 Healthcare worker access to healthcare

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is insufficient evidence of legislation, a policy, or a public statement committing to provide prioritized healthcare services to healthcare workers who become sick as a result of responding to a public health emergency in Sierra Leone.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, does not mention such a guarantee. ⁴⁹⁶ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) ⁴⁹⁷ and the National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) do not address such a guarantee. ⁴⁹⁸ Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁴⁹⁹ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁵⁰⁰ also do not contain evidence of such a guarantee. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁵⁰¹, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁵⁰², the Ministry of Health and Sanitation (MOHS) ⁵⁰³, or the National Public Health Agency (NPHA) as of July 2025. ⁵⁰⁴ Those sites also do not contain evidence of such a guarantee.

4.5 Communications with healthcare workers during a public health emergency

4.5.1 Communication with healthcare workers

4.5.1a Existence of system for communication during a public health emergency

Score: 0

There is insufficient evidence of a system in place for public health officials and healthcare workers to communicate during a public health emergency in Sierra Leone.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, does not discuss a communication system specifically for healthcare works to communicate with public health officials. ⁵⁰⁵ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) ⁵⁰⁶ and the The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) ⁵⁰⁷ do not contain evidence of such a communication system. Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁵⁰⁸ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁵⁰⁹ also do not contain evidence of such a system. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁵¹⁰, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁵¹¹, the Ministry of Health and Sanitation (MOHS) ⁵¹², or the National Public Health Agency (NPHA) as of July 2025. ⁵¹³

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is insufficient evidence of a system in place for public health officials and healthcare workers to communicate during a public health emergency in Sierra Leone that encompasses healthcare workers in both the public and private sector.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, does not discuss a communication system specifically for healthcare works to communicate with public health officials. ⁵¹⁴ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) ⁵¹⁵ and the The National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) ⁵¹⁶ do not contain evidence of such a communication system. Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁵¹⁷ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁵¹⁸ also do not contain evidence of such a system. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁵¹⁹, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁵²⁰, the Ministry of Health and Sanitation (MOHS) ⁵²¹, or the National Public Health Agency (NPHA) as of July 2025. ⁵²²

4.6 Infection control practices

4.6.1 Healthcare-associated infection (HCAI) monitoring

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no evidence that the national public health system in Sierra Leone is monitoring for and tracking the number of healthcare associated infectious (HCAI) that take place in healthcare facilities. The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, confirms that a national IPC plan exists, covers both public and private health care facilities, and meets WHO minimum standards and “Surgical Site Infection (SSI) surveillance on caesarean section monitoring is ongoing in 16 Hospitals” (p. 58). But it also found that Sierra Leone does not have a National Strategic Plan for HCAI Surveillance and that “The microbiology laboratory is inadequate for culture and sensitivity testing to conduct HCAI point prevalence surveys in health-care facilities using the new WHO and ECDC protocols” (p. 58). ⁵²³ The “Sierra Leone Public Health Surveillance Strategic Plan (2019-2023)” includes objectives related to HCAI data and tracking, but they are about training staff to recognize HCAIs and lay the groundwork for creating a surveillance system but not the system itself (p. 44). ⁵²⁴ The "National Health Sector Strategic Plan 2021-2025" does not contain information or evidence of a system for monitoring HCAIs in Sierra Leone. ⁵²⁵ The National Health Sector Monitoring and Evaluation Strategy 2021 – 2025 also does not contain information or evidence of a system for monitoring HCAIs in Sierra Leone. ⁵²⁶ Neither the website of the Ministry of Health and Sanitation (MOHS) ⁵²⁷ nor the website of the National Public Health Agency (NPHA) ⁵²⁸ contains statistics for HCAIs in Sierra Leone.

4.6.1b Infection prevention and control programme

Score: 100

Sierra Leone has a national infection and control programme. Sierra Leone, in coordination with the World Health Organization and the US Centers for Disease Control and Prevention, developed and published the “National Infection Prevention and Control Guidelines” in 2022. The programme was “developed around eight core components will contribute to improved and sustainable IPC practices, infrastructures and culture.” ⁵²⁹ The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, confirms that a national IPC plan exists, covers both public and private health care facilities, and meets WHO minimum standards (p. 58). ⁵³⁰

4.6.1c National plan to ensure a safe environment in health facilities

Score: 100

There is evidence of a plan to ensure a safe environment in health facilities nationally in Sierra Leone.

The 5.1 Strategic Pillar 9: Quality of Care in the National Health Sector Strategic Plan 2021-2025 (2021) includes, “a) Minimise harm to patients, including from medical errors and preventable injuries”, “c) Respectful and responsive care to needs, values and preferences” and “f) Equitable care in terms of quality and accessibility irrespective of person” (p. 79). It has specific objectives and actions, including “Develop appropriate guidelines, standards and tools for health sector regulation, licensing, certification, quality assurance and accreditation” and “Conduct inspection and licensing of private and public healthcare facilities” with the goal of having 80% of healthcare facilitates licensed and accredited by the end of 2025 (p. 81). ⁵³¹ The 2017 “Standards & Guidelines For Water, Sanitation and Hygiene (WASH) Services in Healthcare Facilities in Sierra Leone” sets the Minimum WASH Package for Health Care Facilities as well as the Provision of Hardware Component; it also includes an annex of standard designs. ⁵³²

4.7 Capacity to test and approve new medical countermeasures

4.7.1 Regulatory process for clinical trials of unregistered interventions

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

There is evidence of a national requirement for ethical review before beginning a clinical trial in Sierra Leone.

Section 5.1.7, Sierra Leone Ethics and Scientific Review Approval, of Sierra Leone’s “Guidelines for Application and Authorisation of Clinical Trials of Medicines, Vaccines, Medical Devices and Food Supplements in Sierra Leone” (2021) states that “Ethical Clearance for all phases of clinical trials in humans shall be sought from the SLESRC [Sierra Leone Ethics and Scientific Review Committee] in the conduct of clinical trials in Sierra Leone” (p. 18). ⁵³³

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 100

There is evidence of an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) to treat ongoing epidemics in Sierra Leone. Sierra Leone’s “Guidelines for Application and Authorisation of Clinical Trials of Medicines, Vaccines, Medical Devices and Food Supplements in Sierra Leone” (2021) includes an expedited process for clinical trials in Section 5.14, “Regulatory and Scientific considerations for the application and authorization of clinical trials during a public health emergency” (pp. 42-43). Specifically, the Pharmacy Board Of Sierra Leone can agree to such measures as a rolling submission, or Expand Access Programme as during a public health emergency, which include shorter review times, simultaneous review by different groups and that the staff assigned to the emergency review are devoted entirely to the review process. ⁵³⁴ The guidelines explicitly address unregistered MCMs: "'Compassionate use' means access to unregistered medical products in special or emergency situations. In general, either the patient has a severe or life-threatening illness and existing therapy has failed, or the disease is a rare one for which specialist medicines do not have a local marketing authorization. The medical products are still experimental, or at any rate unproven, and the government is not obliged to fund their supply" (p. 9). ⁵³⁵

4.7.2 Regulatory process for approving medical countermeasures

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

The Pharmacy Board Of Sierra Leone is responsible for approving new medical countermeasures (MCM) for humans and their guidelines for doing so are publicly available. ⁵³⁶

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 100

There is evidence of an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) during public health emergencies in Sierra Leone. Sierra Leone’s “Guidelines for Application and Authorisation of Clinical Trials of Medicines, Vaccines, Medical Devices and Food Supplements in Sierra Leone” (2021) includes an expedited process for clinical trials in Section 5.14, “Regulatory and Scientific considerations for the application and authorization of clinical trials during a public health emergency” (pp. 42-43). Specifically, the Pharmacy Board Of Sierra Leone can agree to such measures as a rolling submission, or Expand Access Programme as during a public health emergency, which include shorter review times, simultaneous review by different groups and that the staff assigned to the emergency review are devoted entirely to the review process. ⁵³⁷ The guidelines explicitly address unregistered MCMs: "'Compassionate use' means access to unregistered medical products in special or emergency situations. In general, either the patient has a severe or life-threatening illness and existing therapy has failed, or the disease is a rare one for which specialist medicines do not have a local marketing authorization. The medical products are still experimental, or at any rate unproven, and the government is not obliged to fund their supply" (p. 9). ⁵³⁸

Commitment to International Norms

5.1 IHR reporting compliance and disaster risk reduction

5.1.1 Official IHR reporting

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Sierra Leone has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁵³⁹

5.1.2 Integration of health into disaster risk reduction

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 100

There is evidence that epidemics and pandemics are integrated into the national risk reduction strategy for Sierra Leone. Sierra Leone’s National Disaster Risk Management Policy (2024) includes epidemics and pandemics within its hazard and risk profile (Table 4: Classification of hazards/threats for the National Disaster Risk Management Policy; Table 5: Spatial Disaggregation of Hazard Profile and Impacts in Sierra Leone). As part of its guiding principles, it includes epidemics as the target of capacity building across all sectors (Section 6.2). ⁵⁴⁰

5.2 Cross-border agreements on public health and animal health emergency response

5.2.1 Cross-border agreements

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 100

There is evidence that Sierra Leone has cross-border agreements, protocols, or MOUs with neighboring countries, or as part of a regional group, with regards to public health emergencies, and there is no evidence of gaps in implementation. The 1st Joint External Evaluation (JEE) report for Sierra Leone, which was completed in October-November 2016, states that Sierra Leone has Memorandums of Understanding with Guinea and Liberia with regards to Ebola virus disease. There is also evidence of specific agreements between some districts in Sierra Leone and their counterparts in Guinea for information sharing and joint planning and response (pp. ). ⁵⁴¹ The Memorandum of Understanding between Sierra Leone's Kambia district and Guinea's Forecariah Prefecture specifies the sharing of epidemiological data across borders in the case of an outbreak of Ebola, which constituted a public health emergency in those countries at the time this agreement was signed. ⁵⁴² The collaboration of the government of Sierra Leone, Liberia, and Guinea has been key to stopping Ebola, and has been credited with the reduction in new infectious. As a result of this collaboration, these governments have established the Ebola Recovery Trust Fund and have sought $USD 4.75 Billion to offset the economic impact caused by the outbreak. ⁵⁴³ The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, does not include further information on cross-border agreements, protocols, or MOUs with neighboring countries. ⁵⁴⁴ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) ⁵⁴⁵ and the National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) ⁵⁴⁶ do not contain evidence of cross-border agreements, protocols, or MOUs with neighboring countries. Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁵⁴⁷ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁵⁴⁸ also do not contain evidence of such agreements. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁵⁴⁹, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁵⁵⁰, the Ministry of Health and Sanitation (MOHS) ⁵⁵¹, or the National Public Health Agency (NPHA) as of July 2025. ⁵⁵² These websites also do not contain further evidence of cross-border agreements, protocols, or MOUs with neighboring countries.

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 0

There is insufficient evidence that Sierra Leone has cross-border agreements, protocols, or MOUs with neighboring countries, or as part of a regional group, with regards to animal health emergencies.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, does not include evidence of cross-border agreements, protocols, or MOUs with neighboring countries with regard to animal health emergencies. ⁵⁵³ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) ⁵⁵⁴ and the National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) ⁵⁵⁵ does not include evidence of cross-border agreements, protocols, or MOUs with neighboring countries with regards to animal health emergencies. Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁵⁵⁶ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁵⁵⁷ also do not contain evidence of such agreements. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁵⁵⁸, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁵⁵⁹, the Ministry of Health and Sanitation (MOHS) ⁵⁶⁰, or the National Public Health Agency (NPHA) as of July 2025. ⁵⁶¹ The 2024 “Joint National Human, Animal, and Environmental Guidelines and Standard Operating Procedures (SOPs) for Surveillance and Data Sharing for Priority Zoonotic Diseases (PZDs)” confirms that Sierra Leone shares data on Zoonotic diseases with both the World Organisation for Animal Health (WOAH) and the UN Food and Agriculture Oranization (FAO) on a weekly basis but it does not contain evidence of cross-border agreements, protocols, or MOUs with neighboring countries with regard to animal health emergencies. ⁵⁶²

5.3 International commitments

5.3.1 Participation in international agreements

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Sierra Leone has signatory and ratification status to the Biological Weapons Convention. ⁵⁶³

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 100

Sierra Leone submitted confidence building measure for the Biological Weapons Convention in 2024. ⁵⁶⁴

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Sierra Leone has provided the required United Nations Security Council Resolution (UNSCR) 1540 report to the Security Council Committee established pursuant to resolution 1540 (1540 Committee). ⁵⁶⁵

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

5.3.2 Voluntary memberships

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Sierra Leone is not a member of any of the listed groups.

Sierra Leone is not a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction ⁵⁶⁶, the Australia Group (AG) ⁵⁶⁷ or the Proliferation Security Initiative (PSI). ⁵⁶⁸⁵⁶⁹

5.4 JEE and PVS

5.4.1 Completion and publication of a JEE assessment and gap analysis

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 100

Sierra Leone completed a Joint External Evaluation (JEE) in 2017 ⁵⁷⁰ and 2023 ⁵⁷¹.

5.4.2 Completion and publication of a PVS assessment and gap analysis

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

Sierra Leone has not completed and published a Performance of Veterinary Services (PVS) assessment in the last five years, having last done so in 2010. ⁵⁷²

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

Sierra Leone has not completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years, having last done so in 2012. ⁵⁷³

5.5 Financing

5.5.1 National financing for epidemic preparedness

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 100

There is evidence that Sierra Leone has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years.

Sierra Leone created the National Public Health Authority (NPHA) in 2023 as part of Act 17 of 2023, (Public Health Act 2022) of 2023, which includes a mandate to prepare for pandemic and epidemic threats and a dedicated budget. ⁵⁷⁴ The NPHA has its own strategic plan which lays out its role in pandemic and epidemic capacity building. ⁵⁷⁵ The Government Budget and Statement of Economic and Financial Policies for the Financial Year 2025 reports that “An amount of NLe9.0 million [397,000 USD] is also allocated to the National Public Health Agency and NLe6.5 million [286,000 USD] to the Health Service Commission” (p. 36). ⁵⁷⁶

5.5.2 Financing under JEE and PVS reports and gap analyses

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, does not contain evidence of specific funding from the national budget to address identified gaps. ⁵⁷⁷

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

Sierra Leone has not completed and published a Performance of Veterinary Services (PVS) assessment or gap analysis in the last five years. ⁵⁷⁸

5.5.3 Financing for emergency response

5.5.3a Emergency public financing during a public health emergency

Score: 100

Sierra Leone has a publicly identified special emergency public financing mechanism and funds which the country can access in the face of a public health emergency. In 2023, Sierra Leone established the Public Health Emergency Trust Fund under the National Public Health Agency (NPHA). It will “facilitate the immediate deployment of resources and expertise to effectively manage and mitigate the impact of public health emergencies for the first thirty days, whether they are infectious disease outbreaks or natural disasters.” ⁵⁷⁹ However, exact details of the trust fund were not available on the website of the Ministry of Health and Sanitation (MoHS) ⁵⁸⁰ or the website of the National Public Health Agency (NPHA) ⁵⁸¹. According to the World Bank, Sierra Leone is an IDA-eligible borrowing country. ⁵⁸²

5.5.4 Accountability for international commitments to address epidemic threats

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that senior leaders (president or ministers), in the past three years, have made a public commitment to improve the country's domestic capacity to address epidemic threats by expanding financing or requesting support to improve capacity, but there is no evidence of support to other countries to improve capacity to address epidemic threats by providing financing or support. In March 2025, Sierra Leone’s President, Julius Maada Bio, confirmed the receipt of $20 million USD from the Pandemic Fund, which “will be utilized to enhance disease surveillance, strengthen laboratory capacity, and expand workforce training, reinforcing the country’s health security infrastructure.” ⁵⁸³ In June 2024, Sierra Leone secured $136 million USD as part of two programs to combat AIDS, tuberculosis (TB) and malaria and strengthen the health system between 2024 and 2027. As part of the acceptance ceremony, President Julius Maada Bio also reiterated his commitment to strengthening Sierra Leone’s health system and achieving universal health coverage. ⁵⁸⁴ There is no publicly available evidence of a commitment to support other countries for capacity building for epidemic threats through financing or support from Sierra Leone in the past three years. The websites of the Ministry of Health and Sanitation ⁵⁸⁵, the Ministry of Foreign Affairs and International Cooperation ⁵⁸⁶, the United Nations ⁵⁸⁷ and the World Health Organization (WHO) ⁵⁸⁸ do not offer information about such a commitment from Sierra Leone.

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence that Sierra Leone has requested financing or technical support from donors to improve the country’s domestic capacity to address epidemic threats but there is no evidence that it provided other countries with financing or technical support . In responding to the Mpox outbreak, Sierra Leone has received medical equipment ⁵⁸⁹, essential medical supplies ⁵⁹⁰ and laboratory equipment and vehicles ⁵⁹¹ in 2025. The WHO website does not contain evidence of Sierra Leone providing other countries with financing or technical support. ⁵⁹²

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 0

There is evidence that Sierra Leone has failed to fulfill its full contribution to the WHO within the past two years. The WHO’s “Assessed contributions overview for all Member States as at 31 December 2023” found that Sierra Leone had an outstanding balance of US$18,679. ⁵⁹³

5.6 Commitment to sharing of genetic & biological data & specimens

5.6.1 Commitment to share data and specimens in emergency/non-emergency research

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is insufficient evidence of a publicly available plan or policy for sharing genetic data, clinical specimens, and/or isolated specimens (biological materials) along with the associated epidemiological data with international organizations and/or other countries that goes beyond influenza.

The 2nd Joint External Evaluation (JEE) report for Sierra Leone, which was completed in February-March 2023, does not note a plan or policy for sharing genetic data, clinical specimens, and/or isolated specimens (biological materials) along with the associated epidemiological data with international organizations and/or other countries that goes beyond influenza. ⁵⁹⁴ The “Strategic Plan 2023-2026” of the National Public Health Agency (NPHA) ⁵⁹⁵ and the National Health Sector Strategic Plan 2021-2025 from the Ministry of Health and Sanitation (MoHS) do not address a plan or policy for sharing genetic data, clinical specimens, and/or isolated specimens. ⁵⁹⁶ Governance Manual – Sierra Leone National One Health Platform (NOHP) (2018) ⁵⁹⁷ and the One Health National Emergency Risk Communication Strategic Plan (2019) ⁵⁹⁸ also do not contain evidence of such a plan. According to a press release from the NPHA, the governance manual for the one health platform was updated in late 2024 ⁵⁹⁹, but that revised version is not available on the websites of the Ministry of Agriculture and Forestry (MAF) ⁶⁰⁰, the Ministry of Health and Sanitation (MOHS) ⁶⁰¹, or the National Public Health Agency (NPHA) as of July 2025. ⁶⁰² Those sites also do not contain a plan or policy for sharing genetic data, clinical specimens, and/or isolated specimens.

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no public evidence that Sierra Leone has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) framework in the past two years. The most recent report on the PIP framework, covering 1 January to 30 June 2024, does not contain evidence that Sierra Leone has not shared samples in accordance with the framework. ⁶⁰³ Neither the World Health Organization (WHO) ⁶⁰⁴ nor the WHO Regional Office for Africa ⁶⁰⁵ reports that Côte d’Ivoire has not shared shared pandemic pathogen samples during an outbreak in the past two years. No evidence was identified in local or international media that the country has not shared pandemic pathogen samples during an outbreak in the past two years.

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no public evidence that Sierra Leone has not shared pandemic pathogen samples during an outbreak in the past two years. The World Health Organisation has not reported any refusal to share pandemic pathogen samples from Sierra Leone, including COVID-19 samples. ⁶⁰⁶ Media outlets document difficulty in obtaining Ebola samples in 2014, but more recent documentation is not available. ⁶⁰⁷

Risk Environment

6.1 Political and security risk

6.1.1 Government effectiveness

6.1.1a Policy formation

Score: 50

6.1.1b Quality of bureaucracy

Score: 25

6.1.1c Excessive bureaucracy/red tape

Score: 0

6.1.1d Vested interests/cronyism

Score: 25

6.1.1e Corruption

Score: 33

6.1.1f Accountability of public officials

Score: 25

6.1.1g Human rights risk

Score: 25

6.1.2 Orderly transfers of power

6.1.2a Orderly transfers of power

Score: 25

6.1.3 Risk of social unrest

6.1.3a Risk of social unrest

Score: 25

6.1.4 Illicit activities by non-state actors

6.1.4a Risk of terrorism

Score: 50

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 50

6.1.5 Armed conflict

6.1.5a Presence or risk of armed conflict

Score: 75

6.1.6 Government territorial control

6.1.6a Government territorial control

Score: 100

6.1.7 International tensions

6.1.7a International tensions

Score: 75

6.2 Socio-economic resilience

6.2.1 Literacy

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 45.95

6.2.2 Gender equality

6.2.2a UNDP Gender Inequality Index score

Score: 25.28

6.2.3 Social inclusion

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 32.77

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4 Public confidence in government

6.2.4a Public confidence in government

Score: 0

6.2.5 Local media and reporting

6.2.5a Robust, open, diverse local media and reporting

Score: 50

6.2.6 Inequality

6.2.6a Gini coefficient

Score: 64.3

6.3 Infrastructure adequacy

6.3.1 Adequacy of road network

6.3.1a Adequacy of road network

Score: 0

6.3.2 Adequacy of airports

6.3.2a Adequacy of airports

Score: 25

6.3.3 Adequacy of power network

6.3.3a Adequacy of power network

Score: 0

6.4 Environmental risks

6.4.1 Urbanisation

6.4.1a Urban population (% of total population)

Score: 61.1

6.4.2 Land use

6.4.2a Change in forest area (percentage points)

Score: 44.03

6.4.3 Natural disaster risk

6.4.3a Natural disaster risk

Score: 25

6.5 Public health vulnerabilities

6.5.1 Access to quality healthcare

6.5.1a Total life expectancy (years)

Score: 33.22

6.5.1b NCD mortality rate

Score: 61.74

6.5.1c Population aged 65+

Score: 88.81

6.5.1d Tobacco use (% of adults)

Score: 52.02

6.5.1e Level of adult obesity (%)

Score: 90.44

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 85.82

6.5.2 Access to potable water and sanitation

6.5.2a Access to potable water

Score: 67.96

6.5.2b Access to at least basic sanitation facilities

Score: 24.89

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 39.58

6.5.3 Public healthcare spending levels per capita

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 2.39

6.5.4 Trust in medical and health advice

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50

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