Sierra Leone: From Reactive to Proactive

Outbreaks of pathogenic diseases in Sierra Leone used to follow a pattern. Laboratorians would valiantly pivot to address each crisis, but the public health system didn’t have the capacity to address all of the diseases at once or perform sufficient surveillance to nip outbreaks in the bud. The Ministry of Health saw the need to improve the entire system and asked longtime partner APHL to help. The results are effective system-building efforts, including a sustainable workforce training model that invested in people and has changed the public health paradigm. The guiding vision is creation of a network on the US model, with 14 distinct labs including regional ones and a leadership pipeline that connects clinical and teaching laboratories. This vision is at the heart of APHL’s collaboration with the Ministry of Health, CDC and multiple international organizations, including the African Society for Laboratory Medicine — and points the way to a healthier future for Sierra Leone.

From Reactive to Proactive

Until now, public health laboratory services played an essential reactive role in tackling disease threats:
  • During the Ebola virus outbreak, broad reach and fast turnaround in testing helped make the difference in containing the devastation; APHL helped coordinate the work of 16 international partners in this effort.
  • The long-running battle with HIV/AIDS has turned a corner thanks to increased capacity in testing, a result of seven years of Ministry of Health/APHL collaboration on PEPFAR projects. Notable advances include maternal/child testing, where women need immediate and convenient services, and tracking viral loads, which helps reduce transmission risk.
  • Ongoing challenges such as tuberculosis, cholera, dengue and influenza are also significant.
Sierra Leone’s Ministry of Health developed with APHL assistance a National Public Health Laboratory Strategic Plan and National Surveillance Strategic Plan. From here, the partners are taking a proactive approach: creating a new culture where public health laboratories and resilient laboratory networks are integral to the health system.

People at the Core

The new culture is appealing to medical school graduates, who may not have seen laboratory leadership as a possible career track. By improving training at all levels and increasing professional standards and opportunities, APHL is helping Sierra Leone not only fill in the gaps in the health system but also dramatically change its effectiveness. This opportunity for transformation is one reason APHL consultant Isatta Wurie, PhD, returned to her native Sierra Leone after years of public health training and teaching abroad. She sees that strengthening the laboratory system means building on the foundation of skilled people.

A Glimpse of the Future

An early success story rising from this new emphasis is that of the mobile, 12-member Rapid Response Team, which has become integral to the nation’s early-detection system and addressing outbreaks of any kind. For example, one country helping during the Ebola outbreak had to pull out its lab technicians, putting ongoing response capacity in question. But the Rapid Response Team took over immediately, preserving the quality and turnaround time of all steps in the elaborate testing process. Since then, the team has cross-trained on tests for other pathogenic diseases. This knowledge of rapid molecular diagnostics and a mindset of teamwork make them ideal mentors for the next generation.

Transforming the Reference Lab

APHL is collaborating with Dr. Doris Harding, Director of the Central Public Health Reference Laboratory (CPHRL) to provide comprehensive training and mentoring in testing methods, quality systems and accreditation. Physical improvements were the first order of business to get the lab up to meeting surveillance needs. During the Ebola outbreak, the CPHRL had been reduced to a space for logistics and storage, and afterward it had been damaged by extreme weather. APHL helped with planning, expertise, and resources to transform a collection of buildings into a knowledge hub and laboratory network component. Power and plumbing were restored, and the CPHRL will renovate an unused building to become the storage facility for Ebola-related supplies, with a structured inventory management system. Plans include renovating another building for use for National External Quality Assurance programs, upgrading and integrating a Level 4 mobile containment lab, and re-establishing molecular testing. APHL is also helping make repairs to the College of Medical and Applied Sciences training laboratory on the CPHRL campus, providing running water, bench tops and renovated floors and ceilings.

Positioned for the Next Challenges

Sierra Leone now has a new level of technology and focus on quality, with a comprehensive approach to training future laboratorians and leaders that will endure. The results are already remarkable: a rise in system capacity from near zero (due to the Ebola crisis) to a level equal to leading countries.