Abstract :
The impact of the 2013–2016 Ebola virus disease outbreak in the Mano River union region, which includes Liberia, Sierra Leone and Guinea,1 is a direct indicator of the acute limitations in national healthcare systems and the critical role played by diagnostic and public health laboratories. Despite having a Central Public Health Reference Laboratory, Sierra Leone lacked the capacity to provide the Biosafety Level 3 laboratory support that is required to effectively direct responses and that could have offset such a prolonged and costly health systems war against the outbreak.
Before the outbreak, Sierra Leone had in place both a national Medical Laboratory Policy and a five-year strategic plan for 2010–2015,2,3 and had achieved some notable successes. These included the establishment of the first Laboratory Medicine/Science undergraduate degree course to increase the human resource pool of laboratorians, the development of national norms and standards to inform laboratory support for the national health package, and the activation of the Central Public Health Reference Laboratory. The Central Public Health Reference Laboratory formed the apex to institute a public health laboratory network to diagnose key national priority diseases, such as influenza, yellow fever and measles, support the restructuring of laboratory tier systems, and support the integration of surveillance activities, especially for HIV molecular testing and the national health demographics health survey. However, during the implementation of the strategic plan, the country experienced two major disease outbreaks – cholera in 20124 and Ebola virus disease in 20131 – that crippled the implementation of other key interventions.
Sierra Leone is now focused on building a resilient healthcare delivery system. This will require major changes to improve routine services at clinical and public health laboratories throughout the country. The strategy is to develop comprehensive multi-programme integration, including tuberculosis, malaria and HIV, as well as disease surveillance and preparedness combined with best practices for successful healthcare delivery adapted to suit the country’s infrastructure, capability and environment.
