The Government of Sierra Leone, through the Ministry of Health and the National Public Health Agency (NPHA), convened a comprehensive two-day Intra-Action Review (IAR) for the Mpox response from July 25 to 26, 2025. The exercise was carried out across three strategic regions: South-Eastern, North and North west, and North west and Western regions, gathering district teams, national facilitators, and technical partners to collectively reflect on the country’s Mpox response and strengthen future preparedness.
Preceding the regional reviews, a national orientation was held on July 22 at the Sierra Palms Hotel in Freetown. This gathering brought together representatives from all 16 districts to establish a shared understanding of the IAR methodology and outbreak timeline. Incident Manager Dr. James Squire underscored the non-blaming nature of the exercise, while Facilitator Dr. John Kanu guided cross-district comparisons and integrated reflection to promote actionable learning.
An Intra-Action Review is a critical WHO-recommended mechanism for evaluating outbreak response performance during an active public health emergency. It allows stakeholders to identify what is working, where gaps exist, and how operations can be improved while the response is still ongoing. By facilitating real-time course correction, promoting team ownership, and spotlighting field-level innovations, the IAR helps ensure that national responses are agile, evidence-driven, and resilient.
The IAR also produces a nationally consolidated document that captures best practices, challenges, and priority recommendations from across participating districts. This document serves as both an accountability and learning tool. It informs decision-makers, guides simulation and preparedness planning, strengthens future outbreak responses, and ensures alignment with international health regulations. For Sierra Leone, it further reinforces the country’s leadership in embracing transparency, collaboration, and continuous improvement in public health.
The South-Eastern IAR, held in Bo, brought together district response teams from Bo, Bonthe, Kailahun, Kenema, Moyamba, and Pujehun. Discussions focused on coordination mechanisms, surveillance outcomes, vaccine deployment strategies, and RCCE efforts tailored to diverse community landscapes. District teams shared insights on rapid activation, adaptation of response protocols, and the integration of local leadership in community engagement.
In Makeni, at Wusum Hotel, the North and Northwest regional IAR convened health teams from Kono, Bombali, Falaba, Tonkolili, Kerene, and Koinadugu districts. Facilitated by Operations Lead Dr. Mustapha Jalloh, this session began with a comprehensive response overview and transitioned into deep dives across all response pillars. Reflections emphasized early case detection, cold chain maintenance, and innovations in point-of-entry screening.
The Northwest and Western Region review was held at Lakka Resort, Western Area Rural, and brought together teams from Kambia, Port Loko, Western Area Urban, and Western Area Rural. Led by facilitators Mr. Mohammed Boie-Jalloh and Mr. Sahr Gbandeh, this session highlighted urban, rural interface challenges, adaptive RCCE strategies, and innovations in surveillance and IPC implementation. Teams presented adjustments made in real time during the outbreak, emphasizing logistical agility and strengthened field coordination.
Across all locations, district teams were joined by key technical partners including GOAL, Jhpiego, UNICEF, WHO, Africa CDC, and Institut National de Développement de la Santé Publique. Each session culminated in a plenary, where pillar groups consolidated findings, assessed both enabling and limiting factors, and shared lessons across districts. The reviews captured achievements such as enhanced contact tracing systems, expanded community trust through culturally sensitive messaging, and improved multisectoral coordination.
At a continental and global level, Sierra Leone’s Mpox IAR provides a timely model for how structured reflection, documentation, and mid-response adaptation can transform outbreak management. After past health emergencies such as Ebola and COVID-19, the value of IARs has become increasingly evident not only in improving operational capacity but also in sustaining public trust and institutional credibility. These lessons now inform global health security frameworks and guide coordinated preparedness efforts across the African region.
The IAR reaffirmed Sierra Leone’s commitment to applying global best practices for outbreak evaluation. It demonstrated the value of collective reflection and empowered district teams to shape recommendations grounded in their lived experience. Through its final report, the IAR will serve as a cornerstone document for strengthening preparedness, guiding future simulations, and reinforcing trust in national public health systems.
Public Information Officer
Mpox Response
Public Relations Unit, NPHA-SL