Fast-tracking international health regulations in Sierra Leone through implementation of the third edition of Integrated Disease Surveillance and Response (IDSR) guidelines during COVID-19 pandemic, 2019-2021: a mixed methods study.

backgroundInternational Health Regulations (IHR) are crucial for enhanced global health security. Integrated Disease Surveillance and Response (IDSR) strategy acts as a vehicle for implementing IHR in most African countries. The WHO regional office for Africa released the third edition of the IDSR guidelines and tools in 2019 which contains enhanced strategies for strengthening health security. These strategies include event and community-based surveillance, cross border surveillance, One Health approach and innovative technologies for surveillance. Based on lessons learnt from the 2014–2016 Ebola Virus Disease outbreak, Sierra Leone embarked on fast adaptation and implementation of the new IDSR guidelines in 2019. We report on this process and its outcome.

methodsThis was a mixed methods study where the process of adapting and implementing the third edition of IDSR guidelines in Sierra Leone was observed and monitored from November 2019 to September 2021. Workshops were held to adapt the guidelines/tools followed by cascaded trainings at national, district and health facility levels. Nine months after training was completed, 156 health facilities were randomly selected nationally and assessed to document the status of implementation.

resultsSierra Leone was among the first countries to adapt and implement the new IDSR guidelines to all 1464 health facilities. Adaptation was done the same year the guidelines were released by WHO, and this was a major departure from the past where the country took 5–7 years to adapt new guidelines. Nine months after implementation, 96% of the health facilities were using the updated third edition of reporting tools with completeness and timeliness of health facility surveillance reporting being 96% and 92%, respectively. Facility level data analysis had improved markedly but event and community based surveillance were still under developed and required more time for implementation and assessment. Key enablers were funding availability and government policy for early adaptation, while COVID-19 was the main challenge. The average cost of training was $244 per health worker.

conclusionThe third generation of IDSR guidelines were promptly adapted and implemented in Sierra Leone despite the COVID-19 pandemic. However, more follow up is required to assess the full impact of implementing the guidelines.