Journal articles: 'Sierra Leone. Ministry of Health'

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Hannigan, Bernie, Jimmy Whitworth, Miles Carroll, Allen Roberts, Christine Bruce, Thomas Samba, Foday Sahr, and Elizabeth Coates. "The Ministry of Health and Sanitation – Public Health England (MOHS-PHE) Ebola Biobank." Wellcome Open Research 4 (August 1, 2019): 115. http://dx.doi.org/10.12688/wellcomeopenres.15279.1.

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During the Ebola outbreak in 2014-2015 in Sierra Leone, residual clinical specimens and accompanying data were collected from routine diagnostic testing in Public Health England (PHE) led laboratories. Most of the samples with all the accompanying data were transferred to PHE laboratories in the UK for curation by PHE. The remainder have been kept securely in Sierra Leone. The biobank holds approximately 9955 samples of which 1108 tested positive for Ebola virus. Researchers from the UK and overseas, from academia, government other research organisations and commercial companies can submit proposals to the biobank to access and use the samples. The Ministry of Health and Sanitation in Sierra Leone (MOHS) retains ownership of the data and materials and is working with PHE and other researchers to develop and conduct a series of research projects that will inform future healthcare and public health strategies relating to Ebola. The Ebola Biobank Governance Group (EBGG) was established to guarantee equality of access to the biobank for the most scientifically valuable research including by researchers from low and middle-income countries. Ensuring benefit to the people of Sierra Leone is an over-arching principle for decisions of the EBGG. Four ongoing research collaborations are based on the first wave of biobank proposals approved by EBGG. Whilst the biobank is a valuable resource its completeness and sample quality are consistent with the outbreak conditions under which they were collected.

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Hannigan, Bernie, Jimmy Whitworth, Miles Carroll, Allen Roberts, Christine Bruce, Thomas Samba, Foday Sahr, and Elizabeth Coates. "The Ministry of Health and Sanitation, Sierra Leone – Public Health England (MOHS-PHE) Ebola Biobank." Wellcome Open Research 4 (October 30, 2019): 115. http://dx.doi.org/10.12688/wellcomeopenres.15279.2.

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During the Ebola outbreak in 2014-2015 in Sierra Leone, residual clinical specimens and accompanying data were collected from routine diagnostic testing in Public Health England (PHE) led laboratories. Most of the samples with all the accompanying data were transferred to PHE laboratories in the UK for curation by PHE. The remainder have been kept securely in Sierra Leone. The biobank holds approximately 9955 samples of which 1108 tested positive for Ebola virus. Researchers from the UK and overseas, from academia, government other research organisations and commercial companies can submit proposals to the biobank to access and use the samples. The Ministry of Health and Sanitation in Sierra Leone (MOHS) retains ownership of the data and materials and is working with PHE and other researchers to develop and conduct a series of research projects that will inform future healthcare and public health strategies relating to Ebola. The Ebola Biobank Governance Group (EBGG) was established to guarantee equality of access to the biobank for the most scientifically valuable research including by researchers from low and middle-income countries. Ensuring benefit to the people of Sierra Leone is an over-arching principle for decisions of the EBGG. Four ongoing research collaborations are based on the first wave of biobank proposals approved by EBGG. Whilst the biobank is a valuable resource its completeness and sample quality are consistent with the outbreak conditions under which they were collected.

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Kanu, Hossinatu, Kathryn Wilson, Nanah Sesay-Kamara, Sarah Bennett, Shaheen Mehtar, Julie Storr, Benedetta Allegranzi, Hassan Benya, Benjamin Park, and Amy Kolwaite. "Creation of a national infection prevention and control programme in Sierra Leone, 2015." BMJ Global Health 4, no. 3 (May 2019): e001504. http://dx.doi.org/10.1136/bmjgh-2019-001504.

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Prior to the 2014–2016 Ebola epidemic, Sierra Leone’s Ministry of Health and Sanitation had no infection prevention and control programme. High rates of Ebola virus disease transmission in healthcare facilities underscored the need for infection prevention and control in the healthcare system. The Ministry of Health and Sanitation led an effort among international partners to rapidly stand up a national infection prevention and control programme to decrease Ebola transmission in healthcare facilities and strengthen healthcare safety and quality. Leadership and ownership by the Ministry of Health and Sanitation was the catalyst for development of the programme, including the presence of an infection prevention and control champion within the ministry. A national policy and guidelines were drafted and approved to outline organisation and standards for the programme. Infection prevention and control focal persons were identified and embedded at public hospitals to manage implementation. The Ministry of Health and Sanitation and international partners initiated training for new infection prevention and control focal persons and committees. Monitoring systems to track infection prevention and control implementation were also established. This is a novel example of rapid development of a national infection prevention and control programme under challenging conditions. The approach to rapidly develop a national infection prevention and control programme in Sierra Leone may provide useful lessons for other programmes in countries or contexts starting from a low baseline for infection prevention and control.

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Fayiah, M. "Uncertainties and trends in the forest policy framework in Sierra Leone: an overview of forest sustainability challenges in the post-independence era." International Forestry Review 23, no. 2 (June 1, 2021): 139–50. http://dx.doi.org/10.1505/146554821832952744.

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Sierr a Leone is part of the Upper Guinean Forests with a climate that enhances great floral biodiversity. The exploitation of forest resources in Sierra Leone has seen a steady increase over the years while the establishment of forest plantations has witnessed a drastic decline. The relationship between forest exploitation and plantation forest decline is broadly assumed to be influenced by population growth, weak forest policies, legislatures, forest management and monitoring policies over the past century. The paper examines forests status and forest resources policy evolution since the pre-colonial era but pays particular attention to policies developed from 1988, in the post-colonial era, and the challenges facing their implementation. The paper highlights major challenges facing the healthy and sustainable growth of forest resources in Sierra Leone. The challenges range from the attachment of the Forestry Division to the Ministry of Agriculture, Forestry and Food Security (MAFFS), the overlap in ministerial mandates about forest protection, corrupt government officials, poverty, illegal logging, inadequate funding and staff, natural disaster and outdated forestry instruments. Natural factors such as climate change, drought, and landslides are considered among the issues affecting the sustainable expansion of forest resources in Sierra Leone. A flowchart of forest sustainability challenges in Sierra Leone was designed, and classified forest challenges into natural and man-made causes. The inability of the Forestry Division to become an independent body and the continued reliance of the Division on the 1988 Forestry Act to make informed decisions in the 21st century is serving as a major barrier in sustaining forests resources in Sierra Leone. Improving forest management in the country requires the collective efforts of both national and international forests protections entities and organizations. Sound forests conservation policies and adequate funding and staffing can strengthen the Forestry Division in enforcing its constitutional mandates. Adopting the best practices models from countries such as China, India and the USA will help towards the goal of managing forest resources sustainably for current and future generations.

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Squire, James Sylvester, Katrina Hann, Olga Denisiuk, and Rony Zachariah. "Staffing in public health facilities after the Ebola outbreak in rural Sierra Leone: How much has changed?" F1000Research 8 (June 6, 2019): 793. http://dx.doi.org/10.12688/f1000research.18566.1.

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Background: The 2014-2015 Ebola outbreak in Sierra Leone led the Ministry of Health and Sanitation to set minimum standards of staffing (medical/non-medical) at the district level for the provision of basic essential health services (BPEHS). In one of the worst Ebola affected districts in Sierra Leone, we assessed staffing levels measured against these stipulated standards before, during, and 16 months after the Ebola outbreak. Methods: The study population included all health workers in 83 health facilities. We assessed staffing levels at three points in time: pre-Ebola (April 2014); the end of the outbreak (November 2015); and 16 months post-Ebola (March 2017). April 2014 was immediately prior to the Ebola outbreak and thus representative of the human resource situation before the outbreak. November 2015 was the month when Sierra Leone was declared Ebola-free, and thus reflects the end-situation after Ebola. March 2017 was two years since the launch of the BPEHS, and some progress should be expected. Results: Against recommended medical staff numbers during pre-, intra- and post-Ebola periods, deficits were 67%, 65% and 60% respectively. Similarly, against recommended non-medical staff numbers during pre-, intra- and post-Ebola periods, the deficit remained at 92% throughout. In the post-Ebola period, there was a deficit of 73% against 1,389 recommended health worker positions. Conclusions: Nothing has really changed in the state of human resources for health, and urgent measures are needed to rectify the situation and prevent a déjà vu in the advent of a new Ebola outbreak.

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Squire, James Sylvester, Katrina Hann, Olga Denisiuk, and Rony Zachariah. "Staffing in public health facilities after the Ebola outbreak in rural Sierra Leone: How much has changed?" F1000Research 8 (January 9, 2020): 793. http://dx.doi.org/10.12688/f1000research.18566.2.

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Background: The 2014-2015 Ebola outbreak in Sierra Leone led the Ministry of Health and Sanitation to set minimum standards of staffing (medical/non-medical) at the district level for the provision of basic essential health services (BPEHS). In one of the worst Ebola affected districts in Sierra Leone, we assessed staffing levels measured against these stipulated standards before, during, and 16 months after the Ebola outbreak. Methods: The study population included all health workers in 83 health facilities. We assessed staffing levels at three points in time: pre-Ebola (April 2014); the end of the outbreak (November 2015); and 16 months post-Ebola (March 2017). April 2014 was immediately prior to the Ebola outbreak and thus representative of the human resource situation before the outbreak. November 2015 was the month when Sierra Leone was declared Ebola-free, and thus reflects the end-situation after Ebola. March 2017 was two years since the launch of the BPEHS, and some progress should be expected. Results: Against recommended medical staff numbers during pre-, intra- and post-Ebola periods, deficits were 67%, 65% and 60% respectively. Similarly, against recommended non-medical staff numbers during pre-, intra- and post-Ebola periods, the deficit remained at 92% throughout. In the post-Ebola period, there was a deficit of 73% against 1,389 recommended health worker positions. Conclusions: Nothing has really changed in the state of human resources for health, and urgent measures are needed to rectify the situation and prevent a déjà vu in the advent of a new Ebola outbreak.

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Decosas, Josef. "Planning for Primary Health Care: The Case of the Sierra Leone National Action Plan." International Journal of Health Services 20, no. 1 (January 1990): 167–77. http://dx.doi.org/10.2190/y5pr-a1bq-lmrq-plgk.

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The National Action Plan for Primary Health Care, a planning document of the Sierra Leonean Ministry of Health for the restructuring of the country's rural health services, is analyzed in its social, economic, and historical context. It appears to be an attempt of the national government to gain control over the highly devolved health care delivery system, but the state has neither the political will nor the power to achieve this goal. The utility of the document is therefore in doubt, which raises two important questions: Whose interests does this plan serve, and at whose cost?

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Musoke, Robert, Alexander Chimbaru, Amara Jambai, Charles Njuguna, Janet Kayita, James Bunn, Anderson Latt, et al. "A Public Health Response to a Mudslide in Freetown, Sierra Leone, 2017: Lessons Learnt." Disaster Medicine and Public Health Preparedness 14, no. 2 (August 19, 2019): 256–64. http://dx.doi.org/10.1017/dmp.2019.53.

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ABSTRACTOn August 14, 2017, a 6-kilometer mudslide occurred in Regent Area, Western Area District of Sierra Leone following a torrential downpour that lasted 3 days. More than 300 houses along River Juba were submerged; 1141 people were reported dead or missing and 5905 displaced. In response to the mudslide, the World Health Organization (WHO) Country Office in Sierra Leone moved swiftly to verify the emergency and constitute an incident management team to coordinate the response. Early contact was made with the Ministry of Health and Sanitation and health sector partners. A Public Health Emergency Operations Center was set up to coordinate the response. Joint assessments, planning, and response among health sector partners ensured effectiveness and efficiency. Oral cholera vaccination was administered to high-risk populations to prevent a cholera outbreak. Surveillance for 4 waterborne diseases was enhanced through daily reporting from 9 health facilities serving the affected population. Performance standards from the WHO Emergency Response Framework were used to monitor the emergency response. An assessment of the country’s performance showed that the country’s response was well executed. To improve future response, we recommend enhanced district level preparedness, update of disaster response protocols, and pre-disaster mapping of health sector partners.

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Lumicao, Paulo Jose. "The Ebola Outbreak inthe DRC." Ethics & Medics 44, no. 10 (2019): 3–4. http://dx.doi.org/10.5840/em2019441015.

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A recent outbreak of Ebola starting in August 2018 has spread rapidly in North Kivu and Ituri, north-eastern provinces of the Democratic Republic of the Congo (DRC). This is the tenth outbreak in forty years. Nevertheless, Tedros Ghebreyesus, the director-general of the World Health Organization (WHO), recently stated that the outbreak is not yet a “public health emergency of inter- national concern.” Declaring such an emergency would trigger “a response across the United Nations, mobilizing multiple agencies, funding, and personnel . . . the sort of global response that belatedly resolved the [Ebola] epidemics in Liberia, Sierra Leone, and Guinea in 2014 and 2015.” Instead, the WHO and its partners are working with the DRC Ministry of Health to mount a more local response.

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Weiss, Jamine, Amy Kolwaite, Meghan Lyman, Getachew Kassa, Miriam Rabkin, Anna Maruta, Marita Murrman, Hassan Benya, and Christiana Conteh. "The Design and Implementation of an IPC Certificate Course: Experiences From Sierra Leone." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s498. http://dx.doi.org/10.1017/ice.2020.1177.

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Background: Trained infection prevention and control (IPC) practitioners are critical to reducing healthcare-associated infections (HAI) and improving patient safety. Despite having HAI rates 3 times higher than high-income countries, many low- and middle-income countries (LMICs) lack trained IPC professionals. During the 2014–2016 Ebola outbreak in West Africa, the Sierra Leone Ministry of Health and Sanitation (MoHS) recognized this need and appointed and trained IPC focal persons at all district hospitals. Following the outbreak, MoHS requested assistance from the US CDC to develop and implement a comprehensive IPC training program for IPC specialists. Methods: The CDC, alongside its partners, convened a multidisciplinary team to develop an IPC certificate course. ICAP led the curriculum development process using a “backwards design” approach, starting with development of competencies and learning objectives, then designing an evaluation framework and learning strategies, and finally, identifying course content. The curriculum was based on existing resources, primarily designed for high-income countries, which were adapted to the Sierra Leone context and aligned with national IPC policies and guidelines. Additionally, an IPC steering committee, led by MoHS, was established to provide national leadership and oversight and make country-level decisions regarding accreditation and career pathways for IPC specialists. Results: The course includes three 2-week workshops over 6 months consisting of classroom didactics and hands-on activities. Topics include standard and transmission-based precautions, microbiology, laboratory, HAI, quality improvement, leadership, and scientific writing. Between sessions, participants conduct IPC activities at their work site and share results during subsequent workshops. Participants receive electronic tablets, which contain course content, assessment tools, and references, to upload their work into a cloud-based storage system for facilitators to provide feedback. They also receive in-person mentorship and connect with peers through a group messaging platform to share lessons learned. Participants’ knowledge and skills are assessed using a before-and-after test and observing them perform IPC practices using standardized checklists. The first cohort of 25 participants will complete the course in November 2019. Conclusions: The IPC certificate course is the first comprehensive, competency-based IPC training in Sierra Leone. Successes, challenges, sustainability, and lessons learned remain to be determined; however, based on similar models, the course has the potential to significantly improve IPC in Sierra Leone. Additionally, it is a model that can be replicated in other resource-limited settings.Funding: NoneDisclosure:None

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Ross, Emma. "Command and control of Sierra Leone's Ebola outbreak response: evolution of the response architecture." Philosophical Transactions of the Royal Society B: Biological Sciences 372, no. 1721 (April 10, 2017): 20160306. http://dx.doi.org/10.1098/rstb.2016.0306.

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Management, coordination and logistics were critical for responding effectively to the Ebola outbreak in Sierra Leone, and the duration of the epidemic provided a rare opportunity to study the management of an outbreak that endured long enough for the response to mature. This qualitative study examines the structures and systems used to manage the response, and how and why they changed and evolved. It also discusses the quality of relationships between key responders and their impact. Early coordination mechanisms failed and the President took operational control away from the Ministry of Health and Sanitation and established a National Ebola Response Centre, headed by the Minister of Defence, and District Ebola Response Centres. British civilian and military personnel were deeply embedded in this command and control architecture and, together with the United Nations Mission for Ebola Emergency Response lead, were the dominant coordination partners at the national level. Coordination, politics and tensions in relationships hampered the response, but as the response mechanisms matured, coordination improved and rifts healed. Simultaneously setting up new organizations, processes and plans as well as attempting to reconcile different cultures, working practices and personalities in such an emergency was bound to be challenging. This article is part of the themed issue ‘The 2013–2016 West African Ebola epidemic: data, decision-making and disease control’.

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Rondinelli, Ilka, Gillian Dougherty, Caitlin A. Madevu-Matson, Mame Toure, Adewale Akinjeji, Irene Ogongo, Amy Kolwaite, et al. "An innovative quality improvement approach for rapid improvement of infection prevention and control at health facilities in Sierra Leone." International Journal for Quality in Health Care 32, no. 2 (February 13, 2020): 85–92. http://dx.doi.org/10.1093/intqhc/mzz137.

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Abstract Quality challenge The Sierra Leone (SL) Ministry of Health and Sanitation’s National Infection Prevention and Control Unit (NIPCU) launched National Infection and Prevention Control (IPC) Policy and Guidelines in 2015, but a 2017 assessment found suboptimal compliance with standards on environmental cleanliness (EC), waste disposal (WD) and personal protective equipment (PPE) use. Methods ICAP at Columbia University (ICAP), NIPCU and the Centers for Disease Control and Prevention (CDC) designed and implemented a Rapid Improvement Model (RIM) quality improvement (QI) initiative with a compressed timeframe of 6 months to improve EC, WD and PPE at eight purposively selected health facilities (HFs). Targets were collaboratively developed, and a 37-item checklist was designed to monitor performance. HF teams received QI training and weekly coaching and convened monthly to review progress and exchange best practices. At the final learning session, a “harvest package” of the most effective ideas and tools was developed for use at additional HFs. Results The RIM resulted in marked improvement in WD and EC performance and modest improvement in PPE. Aggregate compliance for the 37 indicators increased from 67 to 96% over the course of 4 months, with all HFs showing improvement. Average PPE compliance improved from 85 to 89%, WD from 63 to 99% and EC from 51 to 99%. Lessons learned The RIM QIC approach is feasible and effective in SL’s austere health system and led to marked improvement in IPC performance. The best practices are being scaled up and the RIM QIC methodology is being applied to other domains.

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Westercamp, Matthew, Aqueelah Barrie, Christiana Conteh, Danica Gomes, Hassan Benya, Jamine Weiss, Anna Maruta, and Rachel Smith. "Feasible Surgical Site Infection Surveillance in Resource-Limited Settings: A Pilot in Sierra Leone." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s38. http://dx.doi.org/10.1017/ice.2020.517.

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Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs) in low- and middle-income countries (LMICs). SSI surveillance can be challenging and resource-intensive to implement in LMICs. To support feasible LMIC SSI surveillance, we piloted a multisite SSI surveillance protocol using simplified case definitions and methodology in Sierra Leone. Methods: A standardized evaluation tool was used to assess SSI surveillance knowledge, capacity, and attitudes at 5 proposed facilities. We used simplified case definitions restricted to objective, observable criteria (eg, wound purulence or intentional reopening) without considering the depth of infection. Surveillance was limited to post-cesarean delivery patients to control variability of patient-level infection risk and to decrease data collection requirements. Phone-based patient interviews at 30-days facilitated postdischarge case finding. Surveillance activities utilized existing clinical staff without monetary incentives. The Ministry of Health provided training and support for data management and analysis. Results: Three facilities were selected for initial implementation. At all facilities, administration and surgical staff described most, or all, infections as “preventable” and all considered SSIs an “important problem” at their facility. However, capacity assessments revealed limited staff availability to support surveillance activities, limited experience in systematic data collection, nonstandardized patient records as the basis for data collection, lack of unique and consistent patient identifiers to link patient encounters, and no quality-assured microbiology services. To limit system demands and to maximize usefulness, our surveillance data collection elements were built into a newly developed clinical surgical safety checklist that was designed to support surgeons’ clinical decision making. Following implementation and 2 months of SSI surveillance activities, 77% (392 of 509) of post-cesarean delivery patients had a checklist completed within the surveillance system. Only 145 of 392 patients (37%) under surveillance were contacted for final 30-day phone interview. Combined SSI rate for the initial 2-months of data collection in Sierra Leone was 8% (32 of 392) with 31% (10 of 32) identified through postdischarge case finding. Discussion: The surveillance strategy piloted in Sierra Leone represents a departure from established HAI strategies in the use of simplified case definitions and implementation methods that prioritize current feasibility in a resource-limited setting. However, our pilot implementation results suggest that even these simplified SSI surveillance methods may lack sustainability without additional resources, especially in postdischarge case finding. However, even limited phone-based patient interviews identified a substantial number of infections in this population. Although it was not addressed in this pilot study, feasible laboratory capacity building to support HAI surveillance efforts and promote appropriate treatment should be explored.Funding: NoneDisclosures: None

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Chaple, Enrique Beldarraín, and Mary Anne Mercer. "The Cuban Response to the Ebola Epidemic in West Africa." International Journal of Health Services 47, no. 1 (December 11, 2016): 134–49. http://dx.doi.org/10.1177/0020731416681892.

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In December 2013 the first case of Ebola appeared in Guinea. In September 2014 the United Nations (UN) and its specialized agency the World Health Organization (WHO) issued a call for medical collaboration in response to the medical crisis and social disaster caused by the Ebola virus epidemic in West Africa. Cuban authorities responded immediately to the call by offering specialized help for the epidemic, in collaboration with WHO. A group of 256 Cuban doctors, nurses and other health professionals provided direct care during the Ebola epidemic in Sierra Leone, Liberia and Equatorial Guinea from October 2014 to April 2015. This paper explains the main features of the Cuban health system, describes the development of Cuba's international medical cooperation approach, and highlights the work done by Cuban health collaborators in addressing the damage caused by the Ebola epidemic. Information used includes reports and documents of the Ministry of Public Health of Cuba, reports of WHO and PAHO, and articles published in scientific journals and newspaper articles. The response of the Cuban medical teams to the Ebola epidemic in West Africa is only one example of the Cuban efforts to strengthening health care provision in areas of need throughout the world.

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Koroma, Zikan, Francis Moses, Alexandre Delamou, Katrina Hann, Engy Ali, Freddy Eric Kitutu, Juliet Sanyu Namugambe, et al. "High Levels of Antibiotic Resistance Patterns in Two Referral Hospitals during the Post-Ebola Era in Free-Town, Sierra Leone: 2017–2019." Tropical Medicine and Infectious Disease 6, no. 2 (June 16, 2021): 103. http://dx.doi.org/10.3390/tropicalmed6020103.

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The Post-Ebola era (2017–2019) presented an opportunity for laboratory investments in Sierra Leone. US CDC supported the Ministry of Health and Sanitation to establish a microbiological unit for routine antimicrobial sensitivity testing in two referral (pediatric and maternity) hospitals in Freetown. This study describes resistance patterns among patients’ laboratory samples from 2017 to 2019 using routine data. Samples included urine, stool, cerebrospinal fluid, pus-wound, pleural fluid, and high vaginal swabs. Selected Gram-positive and Gram-negative bacterial isolates were tested for antimicrobial susceptibility. Of 200 samples received by the laboratory, 89 returned positive bacterial isolates with urine and pus-wound swabs accounting for 75% of positive isolates. The number of positive isolates increased annually from one in 2017 to 42 in 2018 and 46 in 2019. Resistance of the cultures to at least one antibiotic was high (91%), and even higher in the pediatric hospital (94%). Resistance was highest with penicillin (81%) for Gram-positive bacteria and lowest with nitrofurantoin (13%). Gram-negative bacteria were most resistant to ampicillin, gentamycin, streptomycin, tetracycline, cephalothin and penicillin (100%) and least resistant to novobiocin (0%). Antibiotic resistance for commonly prescribed antibiotics was high in two referral hospitals, highlighting the urgent need for antimicrobial stewardship and access to reserve antibiotics.

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Witter, Sophie, Alex Jones, and Tim Ensor. "How to (or not to) … measure performance against the Abuja target for public health expenditure." Health Policy and Planning 29, no. 4 (May 21, 2013): 450–55. http://dx.doi.org/10.1093/heapol/czt031.

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Abstract In 2001, African heads of state committed ‘to set a target of allocating at least 15% of our annual budget to the improvement of the health sector’. This target has since been used as a benchmark to hold governments accountable. However, it was never followed by a set of guidelines as to how it should be measured in practice. This article sets out some of the areas of ambiguity and argues for an interpretation which focuses on actual expenditure, rather than budgets (which are theoretical), and which captures areas of spending that are subject to government discretion. These are largely domestic sources, but include budget support, which is externally derived but subject to Ministry of Finance sectoral allocation. Theoretical and practical arguments in favour of this recommendation are recommended using a case study from Sierra Leone. It is recommended that all discretionary spending by government is included in the numerator and denominator when calculating performance against the target, including spending by all ministries on health, social health insurance payments, debt relief funds and budget support. Conversely, all forms of private payment and earmarked aid should be excluded. The authors argue that the target, while an important vehicle for tracking political commitment to the sector, should be assessed intelligently by governments, which have legitimate wider public finance objectives of maximizing overall social returns, and should be complemented by a wider range of indicators, to avoid distortions.

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Shantha, Jessica G., Ian Crozier, Colleen S. Kraft, Donald G. Grant, Augustine Goba, Brent R. Hayek, Caleb Hartley, et al. "Implementation of the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) study: Lessons learned for vision health systems strengthening in Sierra Leone." PLOS ONE 16, no. 7 (July 9, 2021): e0252905. http://dx.doi.org/10.1371/journal.pone.0252905.

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Background Following the West African Ebola virus disease (EVD) outbreak of 2013–2016 and more recent EVD outbreaks in the Democratic Republic of Congo, thousands of EVD survivors are at-risk for sequelae including uveitis, which can lead to unremitting inflammation and vision loss from cataract. Because of the known risk of Ebola virus persistence in ocular fluid and the need to provide vision-restorative, safe cataract surgery, the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study was implemented in Sierra Leone. During implementation of this multi-national study, challenges included regulatory approvals, mobilization, community engagement, infection prevention and control, and collaboration between multiple disciplines. In this report, we address the multifacted approach to address these challenges and the impact of implementation science research to address an urgent clinical subspecialty need in an outbreak setting. Methodology/Principal findings Given the patient care need to develop a protocol to evaluate ocular fluid for Ebola virus RNA persistence prior to cataract surgery, as well as protocols to provide reassurance to ophthalmologists caring for EVD survivors with cataracts, the EVICT study was designed and implemented through the work of the Ministry of Health, Sierra Leone National Eye Programme, and international partnerships. The EVICT study showed that all 50 patients who underwent ocular fluid sampling at 19 and 34 months, respectively, tested negative for Ebola virus RNA. Thirty-four patients underwent successful cataract surgery with visual acuity improvement. Here we describe the methodology for study implementation, challenges encountered, and key issues that impacted EVD vision care in the immediate aftermath of the EVD outbreak. Key aspects of the EVICT study included defining the pertinent questions and clinical need, partnership alignment with key stakeholders, community engagement with EVD survivor associations, in-country and international regulatory approvals, study site design for infection prevention and control, and thorough plans for EVD survivor follow-up care and monitoring. Challenges encountered included patient mobilization owing to transportation routes and distance of patients in rural districts. Strong in-country partnerships and multiple international organizations overcame these challenges so that lessons learned could be applied for future EVD outbreaks in West and Central Africa including EVD outbreaks that are ongoing in Guinea and Democratic Republic of Congo. Conclusions/Significance The EVICT Study showed that cataract surgery with a protocol-driven approach was safe and vision-restorative for EVD survivors, which provided guidance for EVD ophthalmic surgical care. Ophthalmologic care remains a key aspect of the public health response for EVD outbreaks but requires a meticulous, yet partnered approach with international and local in-country partners. Future efforts may build on this framework for clinical care and to improve our understanding of ophthalmic sequelae, develop treatment paradigms for EVD survivors, and strengthen vision health systems in resource-limited settings.

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Fofanah, Bobson Derrick, Christiana Conteh, and Jamine Weiss. "Road to Increasing AMR: A Study on Antibiotics Prescribing Pattern." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s496—s497. http://dx.doi.org/10.1017/ice.2020.1174.

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Background: Infectious diseases and the rapid emergence of multidrug-resistant pathogens continue to pose a threat to global health. The development of antimicrobial-resistant organisms is an alarming issue caused by inappropriate use of antibiotic agents. It is estimated that death from antimicrobial resistant pathogens could increase >10-fold to ~10 million deaths annually by 2050 if action is not taken. “It is essential to have reliable data on how medicines are used in order to identify areas to develop targeted interventions” (WHO 2011). Investigating antimicrobial use in hospitals is the first step in evaluating the underlying causes of AMR. In Sierra Leone, no other study related to antibiotic prescribing patterns in hospital setting has been undertaken. Objective: To investigate antibiotic prescription patterns using the WHO hospital antimicrobial use indicator tool at the Kingharman Hospital for 1 month. Methods: Data were collected from patient charts for 1 month, January 1–31, 2019. A data extraction tool was used to capture information on patient demographics, diagnosis, and antibiotics prescription details regarding dosage, duration, and frequency of administration. The tool adopted 6 selected indicators from the WHO antimicrobial use manual to measure the extent of antibiotic use in hospital and performance among prescribers. Results: Of the 189 charts reviewed, 175 included antibiotic prescriptions. The percentage of prescriptions involving antibiotics was 92.5%. The average number of drugs prescribed was 2, with an average duration of 5.2 days. Moreover, 50.5% of antibiotics prescribed were generic, and 96.6% were from the Ministry of Health and Sanitation Essential Medicine List (EML). The most commonly used antibiotics were ciprofloxacin (38.8%), followed by ceftriaxone (23.0%), amoxicillin (16.8%), metronidazole (8.5%), and others(12.7%). Typhoid accounted for 34.8% of broad-spectrum antibiotics, UTI accounted for 17.7%, malaria accounted for 12.5%, 25.5% were unspecified, and 9.5% were for unclear diagnoses. Typically, combinations of fluroquinolones and cephalosporins were used to treat typhoid and UTIs. Conclusions: This cross-sectional study represents a broad picture of antibiotic prescribing patterns at the King Harman Hospital. There was no strict adherence to the WHO recommended prescribing guidelines. These findings also indicate the degree of irrational and inappropriate prescribing of broad-spectrum antibiotics. This study highlights the need for a comprehensive assessment of antimicrobial use to gain a better understanding of national antibiotic use and to guide interventions to reducing AMR.Funding: NoneDisclosures: NoneIf I am discussing specific healthcare products or services, I will use generic names to extent possible. If I need to use trade names, I will use trade names from several companies when available, and not just trade names from any single company.DisagreeChristiana Kallon

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Harris, Dawn, Tarik Endale, Unn Hege Lind, Stephen Sevalie, Abdulai Jawo Bah, Abdul Jalloh, and Florence Baingana. "Mental health in Sierra Leone." BJPsych International 17, no. 1 (July 22, 2019): 14–16. http://dx.doi.org/10.1192/bji.2019.17.

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Sierra Leone is a West African country with a population of just over 7 million. Many Sierra Leoneans lived through the psychologically distressing events of the civil war (1991–2002), the 2014 Ebola outbreak and frequent floods. Traditionally, mental health services have been delivered at the oldest mental health hospital in sub-Saharan Africa, with no services available anywhere else in the country. Mental illness remains highly stigmatised. Recent advances include revision of the Mental Health Policy and Strategic Plan and the strengthening of mental health governance and district services. Many challenges lie ahead, with the crucial next steps including securing a national budget line for mental health, reviewing mental health legislation, systematising training of mental health specialists and prioritising the procurement of psychotropic medications. National and international commitment must be made to reduce the treatment gap and provide quality care for people with mental illness in Sierra Leone.

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Asare, Joe, and Lynne Jones. "Tackling mental health in Sierra Leone." BMJ 331, no. 7519 (September 29, 2005): 720.3. http://dx.doi.org/10.1136/bmj.331.7519.720-b.

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Kusuma, Ardli Johan, and Isabella Putri Maharani. "Peran World Health Organization dalam Menangani Isu Female Genital Mutilation di Sierra Leone." Journal of Political Issues 2, no. 2 (January 31, 2021): 79–88. http://dx.doi.org/10.33019/jpi.v2i2.41.

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Penelitian ini menjelaskan tentang peran WHO dalam menangani isu Female Genital Mutilation di Sierra Leone. Dalam penelitian ini peneliti berfokus pada implementasi peran WHO melalui CEDAW dan Maputo Protocol yang telah diratifikasi oleh Sierra Leone dalam penghapusan praktek FGM yang merupakan budaya dari masyarakat Sierra Leone untuk proses wanita menuju dewasa serta gerakan dari aktivisi internasional dan organisasi internasional yang berfokus pada penghapusan praktik FGM. Budaya FGM sendiri merupakan salah satu bentuk diskriminasi terhadap perempuan. Penelitian ini menggunakan metode kualitatif, dengan pendekatan deskriptif analitik, dimana data-data yang dikumpulkan dengan menggunakan studi pustaka. Dalam menjelaskan penelitian ini Peneliti memperoleh data melalui Jurnal, Buku, Tesis, Laporan Ilmiah, internet dan laporan pemerintah serta respon organisasi internasional yang berfokus pada FGM di Sierra Leone. Teori yang digunakan adalah HAM, Organisasi Internasional dan Peran. Data-data yang diperoleh kemudian diklasifikasikan untuk kemudian dianalsis dengan menggunakan teori yang digunakan untuk menarik kesimpulan. Dari hasil analisi, peneliti mengambil kesimpulan bahwa implementasi CEDAW oleh pemerintah Sierra Leone dalam masalah penghapusan Female Genital Mutilation tidak diterapkan secara baik oleh pemerintah Sierra Leone dikarenakan pemerintah tidak memasukan undang-undang kedalam hukum nasionalnya mengenai penghapusan praktik tradisional berbahaya yaitu FGM. Alasan pemerintah adalah dikhwatirkan mengancam kepentingan nasionalnya.

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Ighobor, Kingsley. "Sierra Leone: nursing agriculture back to health." Africa Renewal 27, no. 4 (December 31, 2014): 18–19. http://dx.doi.org/10.18356/ffdcf0e9-en.

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Secor, Andrew, Rose Macauley, Laurentiu Stan, Meba Kagone, Sidibe Sidikiba, Sadou Sow, Dana Aronovich, et al. "Mental health among Ebola survivors in Liberia, Sierra Leone and Guinea: results from a cross-sectional study." BMJ Open 10, no. 5 (May 2020): e035217. http://dx.doi.org/10.1136/bmjopen-2019-035217.

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ObjectivesTo describe the prevalence and correlates of depression and anxiety among adult Ebola virus disease (EVD) survivors in Liberia, Sierra Leone and Guinea.DesignCross-sectional.SettingOne-on-one surveys were conducted in EVD-affected communities in Liberia, Sierra Leone and Guinea in early 2018.Participants1495 adult EVD survivors (726 male, 769 female).Primary and secondary outcome measuresPatient Health Questionnaire-9 (PHQ-9) depression scores and Generalised Anxiety Disorder-7 (GAD-7) scores.ResultsPrevalence and severity of depression and anxiety varied across the three countries. Sierra Leone had the highest prevalence of depression, with 22.0% of participants meeting the criteria for a tentative diagnosis of depression, compared with 20.2% in Liberia and 13.0% in Guinea. Sierra Leone also showed the highest prevalence of anxiety, with 10.7% of participants meeting criteria for generalized anxiety disorder (GAD-7 score ≥10), compared with 9.9% in Liberia and 4.2% in Guinea. Between one-third and one-half of respondents reported little interest or pleasure in doing things in the previous 2 weeks (range: 47.0% in Liberia to 37.6% in Sierra Leone), and more than 1 in 10 respondents reported ideation of self-harm or suicide (range: 19.4% in Sierra Leone to 10.4% in Guinea). Higher depression and anxiety scores were statistically significantly associated with each other and with experiences of health facility-based stigma in all three countries. Other associations between mental health scores and respondent characteristics varied across countries.ConclusionsOur results indicate that both depression and anxiety are common among EVD survivors in Liberia, Sierra Leone and Guinea, but that there is country-level heterogeneity in prevalence, severity and correlates of these conditions. All three countries should work to make mental health services available for survivors, and governments and organisations should consider the intersection between EVD-related stigma and mental health when designing programmes and training healthcare providers.

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Burgess, Robin, Edward Miguel, and Charlotte Stanton. "War and deforestation in Sierra Leone." Environmental Research Letters 10, no. 9 (September 1, 2015): 095014. http://dx.doi.org/10.1088/1748-9326/10/9/095014.

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Kane, Luke. "Understanding Health Systems: from Sierra Leone to WONCA." London Journal of Primary Care 8, no. 3 (May 3, 2016): 35–36. http://dx.doi.org/10.1080/17571472.2016.1173428.

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Donnelly, John. "How did Sierra Leone provide free health care?" Lancet 377, no. 9775 (April 2011): 1393–96. http://dx.doi.org/10.1016/s0140-6736(11)60559-x.

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Shackman, Jane, and Brian K. Price. "Mental health capacity building in northern Sierra Leone." Intervention 11, no. 3 (November 2013): 261–75. http://dx.doi.org/10.1097/wtf.0000000000000010.

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M'Jamtu-Sie, Nance. "Disseminating Health Information in Sierra Leone: the challenge." Information Development 19, no. 4 (December 2003): 250–54. http://dx.doi.org/10.1177/026666690301900404.

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Groen, Reinou S., Julie Solomon, Mohamed Samai, Thaim B. Kamara, Laura D. Cassidy, Lucie Blok, Adam L. Kushner, Mitra Dhanaraj, and Jelle Stekelenburg. "Female Health and Family Planning in Sierra Leone." Obstetrics & Gynecology 122, no. 3 (September 2013): 525–31. http://dx.doi.org/10.1097/aog.0b013e31829a2808.

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Shaffer, Jeffrey G., Donald S. Grant, John S. Schieffelin, Matt L. Boisen, Augustine Goba, Jessica N. Hartnett, Danielle C. Levy, et al. "Lassa Fever in Post-Conflict Sierra Leone." PLoS Neglected Tropical Diseases 8, no. 3 (March 20, 2014): e2748. http://dx.doi.org/10.1371/journal.pntd.0002748.

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Chattaway, Marie Anne, Abdul Kamara, Fay Rhodes, Konneh Kaffeta, Amara Jambai, Wondimagegnehu Alemu, Mohammed Sirajul Islam, et al. "Establishing an enteric bacteria reference laboratory in Sierra Leone." Journal of Infection in Developing Countries 8, no. 07 (June 9, 2014): 933–41. http://dx.doi.org/10.3855/jidc.5074.

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In 2012, Sierra Leone experienced its worst cholera outbreak in over 15 years affecting 12 of the country’s 13 districts. With limited diagnostic capability, particularly in bacterial culture, the cholera outbreak was initially confirmed by microbiological testing of clinical specimens outside of Sierra Leone. During 2012 – 2013, in direct response to the lack of diagnostic microbiology facilities, and to assist in investigating and monitoring the cholera outbreak, diagnostic and reference services were established in Sierra Leone at the Central Public Health Reference Laboratory focusing specifically on isolating and identifying Vibrio cholerae and other enteric bacterial pathogens. Sierra Leone is now capable of confirming cholera cases by reference laboratory testing.

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Lacoux, Philippe A., Xavier Lassalle, Pauline M. McGoldrick, Iain K. Crombie, and William A. Macrae. "Treatment of neuropathic pain in Sierra Leone." Transactions of the Royal Society of Tropical Medicine and Hygiene 97, no. 6 (November 2003): 619–21. http://dx.doi.org/10.1016/s0035-9203(03)80049-4.

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Campbell, Eugene K. "Fertility, family size preferences and future fertility prospects of men in the western area of Sierra Leone." Journal of Biosocial Science 26, no. 2 (April 1994): 273–77. http://dx.doi.org/10.1017/s0021932000021301.

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SummaryThis paper examines the current fertility of men and women in the Western area of Sierra Leone and the prospects for future fertility behaviour. Probably due to the effect of rapid economic decline in Sierra Leone since 1980, the desired family size has fallen. But indications are that the preferred completed family size is lower than the desired family size

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Morris, Kelly. "Uncertainty remains over health-care provision in Sierra Leone." Lancet 351, no. 9102 (February 1998): 580. http://dx.doi.org/10.1016/s0140-6736(05)78579-2.

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Harris, Dawn, Alie Wurie, Florence Baingana, Stephen Sevalie, and Fenella Beynon. "Mental health nurses and disaster response in Sierra Leone." Lancet Global Health 6, no. 2 (February 2018): e146-e147. http://dx.doi.org/10.1016/s2214-109x(17)30492-8.

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Aitken, I. W., and B. Walls. "Maternal Height and Cephalopelvic Disproportion in Sierra Leone." Tropical Doctor 16, no. 3 (July 1986): 132–34. http://dx.doi.org/10.1177/004947558601600313.

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Cummins, David. "Foot Trauma Due to Rodents in Sierra Leone." Tropical Doctor 18, no. 4 (October 1988): 189–90. http://dx.doi.org/10.1177/004947558801800416.

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Aguayo, Victor M., Sylvetta Scott, and Jay Ross. "Sierra Leone – investing in nutrition to reduce poverty: a call for action." Public Health Nutrition 6, no. 7 (October 2003): 653–57. http://dx.doi.org/10.1079/phn2003484.

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AbstractBackground:Malnutrition rates in Sierra Leone are among the highest in the world. However, policy-makers do not always recognise the fight against malnutrition as a policy priority to ensure the healthy human capital needed to fight poverty and achieve sustained positive economic growth.Objective:The analysis presented here was conducted by an intersectoral and inter-agency group of Sierra Leonean senior policy advisors to quantify some of the potential human and economic benefits of improved policies and programmes to reduce malnutrition.Findings:The analysis revealed that 46% of child deaths in Sierra Leone are attributable to malnutrition, the single greatest cause of child mortality in the country. In the absence of adequate policy and programme action, malnutrition will be the underlying cause of an estimated 74000 child deaths over the next five years. The analysis also revealed that if current levels of iodine deficiency remain unchanged over the next five years, 252000 children could be born with varying degrees of mental retardation as a result of intrauterine iodine deficiency. Finally, the analysis showed that, in the absence of adequate policy and programme action to reduce the unacceptable rates of anaemia in women, the monetary value of agricultural productivity losses associated with anaemia in the female labour force over the next five years will exceed $94.5 million.Conclusion:Sustained investment in nutrition in Sierra Leone could bring about enormous human and economic benefits to develop the social sector, revitalise the economy, and attain the poverty reduction goals that Sierra Leone has set forth.

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Subba, Kamala. "Short Review of Health Care Activities in Sierra Leone during UN Peace Keeping Mission." Medical Journal of Shree Birendra Hospital 5 (December 1, 2002): 58–60. http://dx.doi.org/10.3126/mjsbh.v5i0.21395.

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Hu, Beiyi. "HIV exceptionalism: development through disease in Sierra Leone." New Genetics and Society 38, no. 4 (April 2, 2019): 457–59. http://dx.doi.org/10.1080/14636778.2019.1601011.

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Haja, Wurie. "OC 8586 INSTITUTIONAL RESEARCH CAPACITY BUILDING FOR MULTI-DISCIPLINARY HEALTH RESEARCH TO SUPPORT THE HEALTH SYSTEM REBUILDING PHASE IN SIERRA LEONE." BMJ Global Health 4, Suppl 3 (April 2019): A15.1—A15. http://dx.doi.org/10.1136/bmjgh-2019-edc.36.

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BackgroundThe EDCTP-funded project ‘Institutional capacity development for multi-disciplinary health research to support the health system rebuilding phase in Sierra Leone’ (RECAP-SL) created a solid platform on which sustainable research capacity can be built at the College of Medicine and Allied Health Sciences (COMAHS) at the University of Sierra Leone. This in turn will support the much-needed evidence-based health systems reconstruction phase in Sierra Leone and support the evolution of the research landscape at COMAHS.Methods and resultsWe established a research centre at COMAHS and conducted a research needs assessment. This informed the development of short- and long-term action plans to support sustainable institutional research capacity development and enabled the development of a four-year research strategy. These plans also served as a guide for subsequent research partnerships in terms of capacity building efforts to address identified challenges.We also focused on training four research fellows and developed a wider student engagement platform to help cultivate a research culture. The research fellows will support other researchers at COMAHS, thus promoting sustainability of the research centre. Continued professional development opportunities for the fellows are also being actively sought, to develop them up to doctoral level, which addresses one of the gaps identified in the capacity assessment report.ConclusionTo support sustainability, capacity building efforts are being designed to ensure that these gains are maintained over time, with international and national research partners and funders recognising the importance of further developing local research capacity. Through a multi-pronged approach, health systems research capacity has been strengthened in Sierra Leone. This will support the generation of evidence that will inform building sustainable health systems fit for responding cohesively to outbreaks and for delivering services across the country, especially for the most disadvantaged populations.

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Keen, Sarah, Hashina Begum, Howard S. Friedman, and Chris D. James. "Scaling up family planning in Sierra Leone: A prospective cost–benefit analysis." Women's Health 13, no. 3 (August 29, 2017): 43–57. http://dx.doi.org/10.1177/1745505717724617.

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Family planning is commonly regarded as a highly cost-effective health intervention with wider social and economic benefits. Yet use of family planning services in Sierra Leone is currently low and 25.0% of married women have an unmet need for contraception. This study aims to estimate the costs and benefits of scaling up family planning in Sierra Leone. Using the OneHealth Tool, two scenarios of scaling up family planning coverage to currently married women in Sierra Leone over 2013–2035 were assessed and compared to a ‘no-change’ counterfactual. Our costing included direct costs of drugs, supplies and personnel time, programme costs and a share of health facility overhead costs. To monetise the benefits, we projected the cost savings of the government providing five essential social services – primary education, child immunisation, malaria prevention, maternal health services and improved drinking water – in the scale-up scenarios compared to the counterfactual. The total population, estimated at 6.1 million in 2013, is projected to reach 8.3 million by 2035 in the high scenario compared to a counterfactual of 9.6 million. We estimate that by 2035, there will be 1400 fewer maternal deaths and 700 fewer infant deaths in the high scenario compared to the counterfactual. Our modelling suggests that total costs of the family planning programme in Sierra Leone will increase from US$4.2 million in 2013 to US$10.6 million a year by 2035 in the high scenario. For every dollar spent on family planning, Sierra Leone is estimated to save US$2.10 in expenditure on the five selected social sector services over the period. There is a strong investment case for scaling up family planning services in Sierra Leone. The ambitious scale-up scenarios have historical precedent in other sub-Saharan African countries, but the extent to which they will be achieved depends on a commitment from both the government and donors to strengthening Sierra Leone’s health system post-Ebola.

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Zuilkowski, Stephanie Simmons, Elyse Joan Thulin, Kristen McLean, Tia McGill Rogers, Adeyinka M. Akinsulure-Smith, and Theresa S. Betancourt. "Parenting and discipline in post-conflict Sierra Leone." Child Abuse & Neglect 97 (November 2019): 104138. http://dx.doi.org/10.1016/j.chiabu.2019.104138.

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M’Cormack-Hale, Fredline A. O., and Josephine Beoku-Betts. "General Introduction." African and Asian Studies 14, no. 1-2 (March 27, 2015): 8–17. http://dx.doi.org/10.1163/15692108-12341327.

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Although much has been written on many different aspects of post-conflict reconstruction, democracy building, and the role of the international community in Sierra Leone, there is no definitive publication that focuses on exploring the ways in which various interventions targeted at women in Sierra Leone have resulted in socio-economic and political change, following the Sierra Leone civil war. This special issue explores the multi-faceted subject of women’s empowerment in post-war Sierra Leone. Employing a variety of theoretical frameworks, the papers examine a broad range of themes addressing women’s socio-economic and political development, ranging from health to political participation, from paramount chiefs and parliamentarians to traditional birth attendants and refugees. An underlying argument is that post-war contexts provide the space to advance policies and practices that contribute to women’s empowerment. To this end, the papers examine the varied ways in which women have individually and collectively responded to, shaped, negotiated, and been affected by national and international initiatives and processes.

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Bolton, W. S., A. J. H. Howard, A. C. W. Santos, T. J. Chippendale, I. Bundu, D. G. Jayne, and A. M. Wood. "Lessons identified in delivering an orthopaedic training course in Freetown, Sierra Leone as part of the NIHR Global Health Research Group FIXT trial." Journal of The Royal Naval Medical Service 105, no. 3 (2019): 161–66. http://dx.doi.org/10.1136/jrnms-105-161.

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AbstractAimsThere are many challenges in delivering an orthopaedic training programme in Sierra Leone, West Africa, including human resource and equipment constraints. We provide a reflective analysis of adaptive strategies to overcome these.MethodsAn orthopaedic surgical training course was delivered in preparation for a clinical trial in Connaught Hospital, Freetown, Sierra Leone. The trial examines the implementation of Ilizarov frame fixation for tibia fractures in adults.ResultsWhilst it is possible to deliver a high-quality course in Sierra Leone, a significant amount of prior planning and preparation, including adaptive and contingency strategies, is required to achieve the desired outcome.ConclusionsWith the Royal Navy increasing its global reach, including deployment of new aircraft carriers, there are increasing opportunities to deliver medical training in low and middle-income countries in both the military and civilian sector. We believe this article may be useful for service and civilian practitioners intending to deliver education and training around the world.

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Jefferson, Andrew M., and Ahmed S. Jalloh. "Health provision and health professional roles under compromised circumstances: Lessons from Sierra Leone’s prisons." Criminology & Criminal Justice 19, no. 5 (July 19, 2018): 572–90. http://dx.doi.org/10.1177/1748895818787016.

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This article adds to a growing body of empirical work on prisons in the global south. It reports on a survey into prison health provision in Sierra Leone, West Africa conducted by a local non-governmental organization (Prison Watch – Sierra Leone). Taking the survey results as the point of departure and engaging with the limited literature on prison health provision in the South we discuss the role of health professionals in preventing violence in prisons, suggesting that, under compromised circumstances where a punitive penal ethos often subverts good intentions and appeals to professionalism, advocacy for prisoner health and torture prevention initiatives must be broad-based and include a more radical questioning of the foundations of the penal apparatus. Such circumstances call for a more critical interrogation of dominant forms of penality and generic modes of intervention than has hitherto been the case.

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Al-Rifai, Miriam Saey, and Afraim Salek-Haddadi. "CASE PRESENTATION: THE DANCING MAN FROM SIERRA LEONE." Journal of Neurology, Neurosurgery & Psychiatry 87, no. 12 (November 15, 2016): e1.156-e1. http://dx.doi.org/10.1136/jnnp-2016-315106.239.

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Mabey, Prince T., Wei Li, Abu J. Sundufu, and Akhtar H. Lashari. "The Potential of Strategic Environmental Assessment to Improve Urban Planning in Sierra Leone." International Journal of Environmental Research and Public Health 18, no. 18 (September 8, 2021): 9454. http://dx.doi.org/10.3390/ijerph18189454.

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Strategic Environmental Assessment (SEA) is a proactive and collaborative method for environmental management designed to integrate environmental considerations into decision-making; and it is good for Sierra Leone. To understand whether SEA would be useful in the context of Sierra Leone, the authors interviewed 64 out of 78 experts face to face from March to July 2019. In addition, government policies and regulatory documents on environmental management and sustainable development, published articles served as secondary sources of data. Data were analyzed using descriptive statistics. These Sierra Leonean experts agreed that SEA would be useful for integration and achievement of improved sustainable urban planning strategies. However, the barriers identified to integrating SEA include: not addressing environmental issues during the preparation of policies and programs, insufficient political will, the absence of clear objectives, targets, principles and approaches, overlapping mandates among environmental institutions, and inadequate institutional coordination and non-integrated development framework as barriers to integrating SEA into their work. The study shows that SEA has the potential to have a positive impact on environmental concerns in decision-making, but it would need to be supported by stronger political will, legal frameworks, and improved technical guidance from the policy perspective. Moreover, we propose a conceptual framework for the inclusion of SEA into the urban planning process in Sierra Leone.

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Rushton, Simon. "Health and Peacebuilding: Resuscitating the Failed State in Sierra Leone." International Relations 19, no. 4 (December 2005): 441–56. http://dx.doi.org/10.1177/0047117805058534.

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Obermann, Konrad. "Free health care in Sierra Leone: a mite too optimistic?" Lancet 378, no. 9789 (July 2011): 400–401. http://dx.doi.org/10.1016/s0140-6736(11)61209-9.

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Journal articles on the topic 'Sierra Leone. Ministry of Health'

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