Sierra Leone: Sharing Lessons Learned Among African Public Health Institutes

R to L: Dennis Jarvis (U.S. CDC); Dr. Mark Salter (Public Health England); Dr. Foday Dafae (SL MOHS); Rev. Dr. Thomas T. Samba (SL NPHA)

President Dr. Ernest Bai Koroma of Sierra Leone recently described the Ebola outbreak as "an eye-opener to the improvement of the country’s health care delivery system." The devastating Ebola epidemic killed approximately 11,300 people and infected 28,600 worldwide, including the lives of 4,000 Sierra Leoneans. In 2015 the World Health Organization (WHO) declared Sierra Leone Ebola-free and strengthening its public health system has been a priority for the Ministry of Health and Sanitation. 

Most NPHIs are part of or closely linked to the ministry of health and focus on the major public health problems affecting their country. NPHIs use scientific evidence as the basis for policy implementation and resource allocation and are accountable to ministries of health and to the public they serve. The delegation from Sierra Leone sought to capture lessons learned from Mozambique and Uganda. “Life is too short for us to keep inventing the wheels. If you know the stumbling blocks, then you can jump over them.” said, Dr. Foday Dafae, director of Disease Prevention and Control Directorate at Sierra Leone's Ministry of Health and Sanitation.

Officials at both host institutes noted the need for strong leadership. An essential component for establishing a NPHI is a full-time lead who is passionate, visionary and respected, such that they can bring together a wide range of stakeholders under the auspice of a national public health institute. Whilst it is important that national public health laws spell out and reflect the legal authority of the NPHI, various core public health functions can be brought together as long as there is political will, leadership, and support. Co-locating (bringing together, under one roof) the staff that will make up the NPHI is important to develop a single, institutional identity and help staff communicate and work with each other more effectively.

However, a new NPHI must also begin to develop an identity and culture of its own, as co-location alone won't bring about the changes needed to effect change and improve delivery of public health functions. Uganda provides an example of how public health functions have been brought together under one roof while legislation authorizing the national public health institute is being sought.

As the NPHI evolves over time and becomes more efficient and effective in public health matters, the ministry of health may grant the institute greater authority for specific core public health functions. This growth does not diminish the mandate of the ministry; as the institute is still part of the ministry or health sector and its mandate is delegated. Having a fully functional NPHI provides an opportunity for the ministry to accomplish more, and allows experts (both within the Institute and the Ministry) to focus on their strengths and expertise.

Rev. Dr. TT. Samba (center) leading a discussion with the Sierra Leone NPHI technical working group on NPHA development (pictured: Zhang Hunglong; Zhang Gonin, CCDC)

Both host institutes also noted the need for transparency as key to ensuring the new planned institute is trusted as a source of evidence-based, public health information and a home for donor funding as emphasized by Eduardo Samo Gudo, scientific director of Mozambique INS. Dr. Samo Gudo noted, “In order to ensure its credibility and reputation, the institute needs to have legitimacy and transparency.” Dr. Ario Alex Riolexus, director of the Uganda National Institute of Public Health, emphasized the importance of national public health agency being “A credible organization such that [development] partners can give their resources without hesitation.”

IANPHI is excited to be a part of the ongoing efforts in Sierra Leone to build a NPHI and applauds the time and generosity given by our member colleagues from the Mozambique and Ugandan institutes.