In June 2021, the Sierra Leone National NTD Program (NNTDP), with support from USAID’s Act to End NTDs | West (Act | West) program, convened key stakeholders to develop a five-year NTD Sustainability Plan to mainstream NTDs into routine health service delivery, national policies, and financing for sustainable NTD programming. The workshop took place at a pivotal moment in Sierra Leone for policy integration and alignment, as the NTD Master Plan (2021 -2025), National Health Sector Strategy (2021 - 2025), Community Health Worker (CHW) curriculum (2021-2025), and Universal Health Care (UHC) policy are under development. The NNTDP acknowledges the importance of leveraging national reforms to advance NTD sustainability and as stated by Hon. Ibrahim Sesay, a member of the Sierra Leone Technical Advisory Committee (TAC) on NTDs, there is a need to prioritize ownership at the national level, as well as the community level, by engaging with trusted networks such as chiefs, religious leaders, traditional healers, and civil society organizations (CSOs) to advance objectives in the Sustainability Plan
The NNTDP has made great strides to date, with support from Helen Keller Intl, in the control and elimination of NTDs, whereby progress has been made in onchocerciasis (OV), schistosomiasis (SCH), and soil transmitted helminths (STH) control and 12 of 16 districts have stopped MDA for lymphatic filariasis (LF) and projected to stop treatment nationwide as early as 2022 and full elimination possibly as early as 2027. In 2020, a rapid assessment was conducted using community listening to determine barriers to mass drug administration (MDA), which identified that using existing trusted networks, such as traditional healers, religious leaders, and civil society organizations (CSOs) can support community engagement, dispel rumors around MDAs, and build trust in NTD services--- strategies the country is now using to overcome challenges in treatment for LF in hard-to-reach communities that have impacted the country’s path to LF elimination. “Ownership will be realized when communities are engaged – we should be working with the communities, not for them.”
The NNTDP included non-traditional stakeholders in the development of the Sustainability Plan, such as the Director of Traditional Healers and the Ministry of Gender and Social Welfare to provide perspectives on the challenges faced at the community level. Involving non-traditional stakeholders is an approach that was informed by lessons learned during the Ebola epidemic, where the priority for community-based interventions and understanding origins of distrust in healthcare originated. One critical lesson learned from the Ebola response that contributed to its control was the engagement of existing trusted community networks such as facility and ward development committees, civil society organizations, traditional healers, and religious leaders. This approach was highly effective and contributed to reaching unmet populations that were previously not being reached by the national health system.
Dr. Abdul Bangura, Director for Traditional Medicine, noted at the workshop that traditional healers were essential frontline workers in the Ebola response, working to support community-based surveillance, distribute drugs, conduct trust-building sessions, and assist with sensitization as trusted leaders in the community that speak the local dialect. In many communities, traditional healers are “the first port of call” for health services due to systematic barriers in reaching health care facilities. In the aftermath of Ebola in Sierra Leone, the Ministry of Health and Sanitation (MoHS) has renewed an emphasis on engaging communities in strengthening the health system and improving access to a package of services at the community level, including the elimination and control of NTDs.
The Sustainability Plan development centered around sustainable approaches to mainstreaming NTDs into national health services and opportunities for community ownership. The Plan identifies national policies and service delivery platforms that can be owned at the community level to advance sustainability objectives. The renewal of national policies allows the NNTDP and the Partners Network Forum (PNF), a cross-sectoral coalition for NTDs, to engage with national policy makers to advocate for the inclusion of NTDs into school health services, include morbidity management and post-MDA surveillance for OV, SCH, and STH into the national health system, and prioritize NTDs into the revised CHW curriculum. This will provide a leverage point to transition the delivery of NTD programs from community drug distributors (CDD), which are a volunteer-based position, to a more sustainable national-salaried CHW. The transition would not only be a more sustainable platform for NTD service delivery but would also support national priorities for integrated community based primary healthcare. The Sustainability Plan also outlines that through engagement of trusted community leaders in NTD activities, trust can be built in the NTD services. In addition, these leaders can raise awareness about stigma around NTDs to increase treatment seeking behavior and enable community-based programs to identify LF cases and refer them to the appropriate facility for morbidity management.
The next stage of the Sustainability Plan development process will include consultations and reviews with the multi-sectoral Ministries that have been involved in the development process over the next few months before advancing to political validation by the MoHS in January 2022. Once the Plan has been politically validated, the NNTDP will lead its’ implementation with support from Act | West. The 5 year plan will be a roadmap to sustainable control and elimination of NTDs in Sierra Leone.
 Sierra Leone NTD Sustainability Plan workshop participants included: the Ministry of Health and Sanitation (MoHS) - Directorate of Food and Nutrition, National School and Adolescence Health Program, Directorate of Environmental Health, WASH, President of the Council for Traditional Healers, Ministry of Gender and Social Welfare, WHO, Helen Keller Intl, World Vision, national NGOs (FOCUS1000, Pikin-to-Pikin), NTD TAC members, and Sightsavers.
 Bedson J, Jalloh MF, et al. Community engagement in outbreak response: lessons from the 2014–2016 Ebola outbreak in Sierra Leone. BMJ Global Health 2020;5:e002145.
 Informal Interview: Pratt, S. Director of Focus1000. (2021, Jun 9, 2021