Frontline health workers in primary health care play a vital role in the fight against infectious disease outbreaks. However, without the necessary tools, training, and systems, their ability to detect and respond to outbreaks remains limited.
With support from Resolve to Save Lives (RTSL) and in collaboration with district health management teams, ICAP at Columbia University and the National Public Health Agency (NPHA) introduced the Epidemic-Ready Primary Healthcare (ERPHC) model in Sierra Leone, where the high prevalence of infectious disease continues to cause preventable deaths across the country.
ERPHC is an innovative approach designed to strengthen public health care systems by integrating epidemic preparedness with routine clinical care. It empowers health care workers to engage with communities, detect early signs of priority diseases, and implement infection prevention and control (IPC) measures. Through ICAP and the NPHA, the model was first deployed in the eastern Sierra Leonean district of Kenema, initially targeting 20 health facilities to improve resilience, preparedness, and overall health outcomes.
“Kenema District is endemic for Lassa fever,” said Oliver Eleeza, ICAP’s ERPHC technical lead, reflecting on applications of the approach, “and, despite ongoing efforts to combat the disease, its persistent presence continues to challenge health care resilience in the area. The Epidemic-Ready Primary Healthcare model provided critical support to health facilities, strengthening their capacity to detect, manage, and respond to Lassa fever cases – and other diseases of epidemic potential – more effectively.”
Through the ERPHC model, ICAP trained and mentored health care workers on Integrated Disease Surveillance and Response (IDSR), IPC, and early disease detection, and supported each health facility in developing customized improvement plans to enhance epidemic preparedness. ICAP also distributed IPC materials, job aids, and standard operating procedures to strengthen health care delivery. In collaboration with the district health management teams, ICAP conducted regular supervision visits to track progress and address challenges related to the model.
A major component of this supervision was reinforcement of IPC best practices through practical, on-site training sessions on topics such as hand hygiene, personal protective equipment use, and isolation protocols. In addition, health care facilities were supported with stock tracking systems, allowing them to anticipate and prevent supply gaps. Health workers were also mentored on digital surveillance systems, specifically the Community-Based Disease Surveillance (eCBDS) system. The training focused on improving data accuracy and ensuring timely disease reporting, enhancing a facility’s ability to detect and respond to potential outbreaks efficiently.
From December 2023 to December 2024, significant progress was recorded across the Kenema district. After evaluation of key indicators, IDSR performance improved from 65 percent to 100 percent, IPC from 42 percent to 87 percent, and health facility preparedness from 34 percent to 61 percent. Overall, the ERPHC score – which factors in health facility preparedness, IPC, and IDSR – rose from 50 percent to 92 percent.
Some of the major outcomes of these improvements included health care workers’ ability to establish screening and isolation areas, manage case surges, and maintain functional communication systems for disease reporting. Mentorship and training improved early disease detection, timely reporting, and rapid outbreak response, ensuring health facilities were better equipped to manage public health emergencies.
“The ERPHC model has transformed how we approach primary health care in Kenema District,” said the Kenema district medical officer, who leads all health care services in the district. “By equipping health care workers and engaging communities, we have strengthened epidemic response and improved overall health care services. Seeing the progress in just one year, we are committed to expanding this initiative to ensure comprehensive and resilient health care for all.”
Encouraged by results, the Kenema district medical officer expanded ERPHC implementation beyond the initial 20 health facilities, adding 20 more across the district. In addition to providing further training to district staff to support this expansion, ICAP supplied electronic tablets preloaded with ERPHC data collection tools to enhance disease surveillance, reporting, and decision-making at both at health facilities and at the district level.
The Kenema district is now leading efforts to scale up the ERPHC model across all health facilities in the district while advocating for its integration into national health strategies.
About ICAP
A major global health organization that has been improving public health in countries around the world for two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 40 countries, working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies. Online at icap.columbia.edu
