Sierra Leone Malaria Control Strategic Plan (2016- 2020)

The Government of Sierra Leone recognises malaria as a health and socioeconomic burden as articulated in the National Health Sector Strategic Plan (NHSSP 2010-2015), Sierra Leone Health Recovery Plan 2015–2020, National Ebola Strategy for Sierra Leone 2015-2017 and the Basic Package of Essential Health Services 2010 (revised 2015). Malaria is endemic in Sierra Leone with stable and perennial transmission in all parts of the country. Malaria is presently the leading cause of morbidity and mortality amongst children under five years of age. Although pregnant women and children under 5 are mostly affected, the entire population is risk of malaria. Malaria accounts for 40.3% of outpatient morbidity for all ages. Accounts for 47% of outpatient morbidity for under five children and accounting for 37.6% for hospilisation with a case fatality of 17.6% (sources). Malaria and poverty are closely linked. Malaria is concentrated in low income and lower income countries. Within these countries, the mostly severely affected communities are those that are the poorest and most marginalised. Such communities have the highest risks associated with malaria, and the list access to effective services for prevention, diagnostics and treatment. Malaria is a major threat to socio-economic development of the country with an estimated 7-12 days lost on the average per episode of malaria. It imposes substantial costs to individuals, households and governments. The cost to individuals and their family includes purchase of drugs for treating malaria at home; expenses to travel to and seek treatment at dispensaries and clinics; lost days of work; absence from school; expenses for preventive measures; expenses for burials in case of deaths. Households in Africa spend between $2 and $25 (USD) on malaria treatment and between $15 and $20 on prevention each month with consequent loss of resources or 3% of annual income. The amount spent on malaria in terms of prevention, treatment and loss of productivity can compromise significant portion of annual income of poor households. Furthermore, severe malaria impairs children’s learning and cognitive abilities by as much as 60%, consequently affecting the performance of Sierra Leone’s universal primary and secondary education programmes. This Sierra Leone Malaria Strategic Plan covers the 2016-2020 period. The plan stipulates priority interventions, outlines the strategic direction and the investments required for achieving the 2020 national goals. The strategic plan also outlines how the stakeholders in malaria control 1.1. Introduction Sierra Leone Malaria Control Strategic Plan 2016-2020 pg. 22 will organize themselves in achieving the objectives and goals set herein as informed by the midterm review and the other related strategic documents. In addition this plan will be a resource mobilization tool and will provide a common framework for the accelerated nationwide scale up of evidenced‐led malaria reduction interventions by the government, its development partners, the private sector and all stakeholders.

The health sector has to be viewed within the broad historical context of poverty and a high illiteracy rates in Sierra Leone (43%). Sierra Leone is recovering from multiple disasters: the civil war (1990–2002); the cholera epidemic (2012); and the EVD outbreak (2014-2015). The country was deemed to have “not attained the minimum International Health Regulations core capacities by 2012”. Nevertheless, prior to the EVD outbreak in mid-2014, Sierra Leone had made substantial progress towards a number of the Millennium Development Goal targets in the health and nutrition sectors, including a reduction in child and maternal mortality and improving coverage with a range of critical interventions such as malaria control, antenatal care, skilled birth attendance and immunization. The recent national Malaria Indicator Survey (2013) and the Demographic Health Survey (2013) also demonstrated major improvements in malaria control. Framed alongside commitments articulated in the national development plans, the National Health Strategic Plan 2010–2015, the Health Sector Strategic Plan 2015-2020, Free Health Care 2010, the Basic Package of Essential Health Services 2010 (Revised 2015), the National Health Compact 2011 and the Service Level Agreement (2015) provide the overall guidance for health system strengthening and for improving the health status of the population. Health policies, programmes and coordinating structures, such as the Health Sector Coordinating Committee chaired by the Minister of Health and Sanitation, do exist, galvanizing cooperation among health, environment and development partners in the country. The Sierra Leone Malaria Strategic Plan (SLMSP) shall follow the principles of the Paris Declaration and the Accra Agenda for action for Aid effectiveness through the International Health Partnership (IHP+) in the interaction and collaboration with national and international development partners as embedded in the health sector strategic plan. Malaria control has remained a priority action within the national health agenda in Sierra Leone. The country has favourable policies to ensure that malaria is controlled in the country. User fees were abolished in all public and few private health facilities making treatment free for malaria cases and government taxes on Long Lasting Insecticides Treated Nets (LLINs), medicines and laboratory supplies were also waived in 2005. Furthermore, the government is committed to the 2006 World Health Assembly (WHA) resolution to withdraw Artemisinin monotherapy. At the highest level, His Excellency the President is an active member of the African Leaders Malaria 1.2. National and international context and commitments Sierra Leone Malaria Control Strategic Plan 2016-2020 pg. 23 Alliance (ALMA). In order to ensure that malaria control is on the national agenda, a Parliamentary Health Committee was formed. The country has embraced global and regional commitments in malaria prevention and control. The African Union Heads of State jointly stated their commitment in 2000 during the Abuja Declaration, calling for “Universal Access” to HIV/AIDS, Tuberculosis and Malaria services by 2010. All policies and strategic plans have always been aligned to the World Health Organisation (WHO) guidelines, Roll Back Malaria (RBM) and Millennium Development Goal (MDG) targets. Following the United Nations Secretary General’s call for 100% coverage of malaria control interventions and the elimination of malaria as a threat to public health, the government of Sierra Leone has moved from targeting of malaria control interventions to universal coverage.