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Abstract Background All countries are required to implement International Health Regulations (IHR) through development and implementation of multi-year National Action Plans for Health Security (NAPHS). IHR implementation requires annual operational planning which involves several tools such as NAPHS, State Party Annual Report (SPAR), Joint External Evaluation (JEE) and WHO IHR Benchmarks tool. Sierra Leone has successfully improved IHR capacities across the years through successful annual operational planning using the above tools. We conducted a study to document and share the country’s unique approach to implementation of NAPHS. Methods This was an observational study where the process of implementing and monitoring NAPHS in Sierra Leone was observed at the national level from 2018 to 2021. Data was obtained through review and analysis of NAPHS annual operational plans, quarterly review reports and annual IHR assessment reports. Available data was supplemented by information from key informants. Qualitative data was captured as notes and analysed for various themes while quantitative data was analyzed mainly for means and proportions. Results The overall national IHR Joint External Evaluation self-assessment score for human health improved from 44% in 2018 to 51% in 2019 and 57% in 2020. The score for the animal sector improved from 32% in 2018 to 43% in 2019 and 52% in 2020. A new JEE tool with new indicators was used in 2021 and the score for both human and animal sectors declined slightly to 51%. Key enablers of success included strong political commitment, whole-of-government approach, annual assessments using JEE tool, annual operational planning using WHO IHR Benchmarks tool and real time online monitoring of progress. Key challenges included disruption created by COVID-19 response, poor health infrastructure, low funding and inadequate health workforce. Conclusion IHR annual operational planning and implementation using evidence-based data and tools can facilitate strengthening of IHR capacity and should be encouraged.

In Sierra Leone, two operational research (OR) studies in 2019 and 2021 showed deficiencies in the data being captured by the Integrated Animal Disease Surveillance and Reporting (IADSR) system. This third OR study was conducted in 2023 to assess whether the second OR study’s results and recommendations were disseminated with the key stakeholders, the uptake of the recommendations, improvements in data capture in the IADSR system, and to describe the data on livestock disease and antimicrobial use. In 2022, on seven occasions, the authors of the second OR study disseminated the study’s findings. Of the four recommendations, the one on improving laboratory infrastructure for confirmation of animal disease was not implemented. The district animal health weekly surveillance reports received through the IADSR system were sustained at 88% between the second (2021) and third (2023) studies. In both studies, the proportion of sick animals receiving antibiotics (25%) remained the same, but the use of “critically important antimicrobials for veterinary use” declined from 77% (in 2021) to 69% (in 2023). The IADSR system has improved considerably in providing information on animal health and antibiotic use, and sequential OR studies have played a key role in its improvement.

Antimicrobials help in the prevention and treatment of infections and are crucial for animal production, but overuse can result in antimicrobial resistance. Hence, understanding data quality on livestock antimicrobial use is essential. We assessed frequency of reporting, completeness, and concordance of reported data and availability of human resources and infrastructure in 14 districts in Sierra Leone. This was a cross-sectional study involving a review of district and sub-district animal treatment forms submitted from January 2016 to August 2019. Out of the 14 districts, only 3 had filled forms available for review: A total of 6 (0.97% of 616 expected) district forms and 79 (1.15% of 6840 expected) sub-district forms. Data between district and sub-district treatment forms were fully discordant. Hence, completeness of data could not be assessed. All districts had livestock officers (barring one) and livestock assistants but no veterinarians. The gap in community animal health workers ranged from 14 to 100% per district. No districts had a functional computer or internet access. Reporting was non-existent in 11 districts and poor in the other 3. Resources are urgently needed to address critical gaps in human resources and capacity and computer and Internet connectivity to develop critical One Health surveillance functions at the national and sub-national levels.