Authors:
Eleeza O, Barrera-Cancedda AE, Mutebi RR, Njenga A, Vandi MA, Mearns S, Yakubu A, Toure M, Michaels-Strasser S.

Abstract:
The COVID-19 pandemic exposed vulnerabilities in health systems’ abilities to detect, report, and respond to threats. Inadequate preparedness led to healthcare worker infections, essential service disruptions, and impacts on communities. Primary healthcare (PHC) is often overlooked in health security initiatives. Epidemic Ready Primary Health Care (ERPHC) is an initiative that strengthens PHC facilities to prevent, detect, and respond to outbreaks, while maintaining essential services. ICAP at Columbia University, the Sierra Leone Ministry of Health, and Resolve to Save Lives is implementing a multiyear ERPHC project in Sierra Leone. We conducted a retrospective data review of 52 confirmed measles cases across 4 PHC facilities from January to March 2024. Data are presented using an adapted 7-1-7 quality improvement approach for detection and notification to evaluate the key tenants of ERPHC: speed, safety, and surge. Out of the 52 confirmed cases, 98% and 100% met the first “7” and “1” for detection and notification. Immediate case management and safety actions were completed for all 52 cases. None of the facilities were able to implement 2 readiness parameters for surge: sufficient supplies and referral pathways. Key bottlenecks included patient late presentation to health facilities, delayed notification via the electronic case-based surveillance system, inadequate personal protective equipment availability, and no updated referral pathways. These results underscore the need to scale and implement ERPHC in PHC facilities using adapted 7-1-7 metrics. Healthcare worker safety, increased community engagement, national supply chain mechanism strengthening, and established patient referral pathways need to be the foci of further health security investment in Sierra Leone.