Preventing Epidemics in Sierra Leone through Health Systems Strengthening

Project description

Title: Health Systems Strengthening and Epidemic Prevention in Sierra Leone
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Sierra Leone
Lead executing agency: Ministry of Health and Sanitation (MoHS) of Sierra Leone
Overall term: 2016 to 2019


GIZ team together with key MoHS partners, 2017


Between 2014 and 2016, Sierra Leone and its neighbouring countries, Liberia and Guinea, were severely afflicted by the Ebola outbreak. The epidemic overburdened the countries’ fragile health systems. To date, Sierra Leone’s Ministry of Health and Sanitation (MoHS) is in the process of strengthening the country’s health system. Health services are underfunded and understaffed and in many cases fail to meet the demand. The situation is particularly precarious in maternal and child health. Moreover, the system for collecting and processing health related data is not fully developed and cannot be managed efficiently. As a result, there are insufficient capacities to respond adequately in the event of an epidemic outbreak.

Participants at the MoHS-GIZ Strategic and Operational Planning Workshop, 2017


Sierra Leone has a resilient health system that is responsive to its demands.


The project Health Systems Strengthening and Epidemic Prevention in Sierra Leone provides technical support to Sierra Leone´s Ministry of Health and Sanitation (MoHS). The project´s implementation areas are aligned to MoHS Health Sector Recovery Plan 2015-2020, which the government established to strengthen the health care system and to improve nutrition, health and hygiene in the country.

The three areas of action of the project are:

Management of Human Resources in Health (HRH)

The Ebola crisis exacerbated the pre-existing shortage of health workers, high rates of attrition, uneven distribution of health workers, and poor employment conditions. Critical areas, such as human resource (HR) management, are under administration of the central government.

The project supports the MoHS in the decentralization of HR management through capacity development on district level, rollout of a health worker database system, as well as developing rural retention strategies, a long term health workforce production plan and an in-service training policy.

In addition, the project assigned two development workers to the National School of Midwifery in Sierra Leone’s capital Freetown and to the School of Midwifery in Makeni, the capital city of the Northern Province, to provide technical support in school management, enhance teaching methods and develop the curricula.

Financing for Human Resources in Health 

External resources as well as government allocations for health increased considerably during the Ebola Outbreak. Government expenditure on health, however, is mostly spent on the payrolls of the health workforce. Insufficient funding leads to skills shortages in the sector:not enough people work in the health care sector, the distribution of skilled personnel throughout the country is uneven. Moreover, the competence of people in the health workforce is in many cases insufficient to provide adequate health care to the population. The Government of Sierra Leone needs to increase spending on the health workforce and there is a need to improve efficiencies in managing and deploying resources for health.

The project will conduct a pilot study on sustainable workforce financing, and provide the MoHS at various levels with capacity building, as well as policy and strategy advice towards a sustainable financing system for the Sierra Leonean health workforce.

Cross Border Epidemic Prevention and Response

In Sierra Leone’s border regions, there are challenges to early detect, report, and respond to outbreaks of diseases, that might result in epidemics. This is a result of critical shortages in human resources for effective and efficient collection, collation and processing of health-related data.

To mitigate serious impact of any future or potential epidemic outbreak, the project works in close cooperation with the MoHS Emergency Operations Centre and other key partners. The project furthermore is strengthening the Integrated Disease Surveillance and Response (IDSR) system in the border districts of Kailahun and Kambia, which were severely hit by the Ebola outbreak. This includes supporting the national roll out of a digitalised real-life surveillance IDSR system, strengthening the capacity of key actors on district and community level in preparedness and response, and maintaining monthly cross-border meetings with the Guinean and Liberian counterparts.

Students at the National School of Midwifery in Freetown, 2017


  • Human Resource Officers and Assistants have been trained and deployed to all districts; the formation of technical working groups in HRH and rural retention have contributed towards realising the Health Workforce Production Plan, a holist Rural Retention Plan and an in-service Training Policy.
  •   An assessment of Sierra Leone´s health financing landscape was conducted to identify health financing gaps and possible intervention areas. The results are the basis to develop adequate finance strategies for the health workforce and a social health insurance scheme.
  •   A joint assessment in the two border districts Kambia and Kailahun was conducted to determine the districts’ capacities to prevent, detect and respond to notifiable diseases and epidemics. This will help to determine the necessary steps to react promptly in the case of an outbreak of a disease in the future.
  •   Immediate aid intervention: To prevent a cholera outbreak following the devastating landslide in Freetown in August 2017, the project trained and supported 400 community health workers in cholera prevention.