Background: Sierra Leone adopted the Integrated Disease Surveillance and Response (IDSR) strategy to enhance epidemic detection and control. Despite nationwide electronic reporting, major outbreaks like Ebola and COVID-19 revealed persistent systemic weaknesses, necessitating a comprehensive evaluation to identify gaps and prioritise corrective actions.
Methods: Using a mixed-methods design aligned with the World Health Organisation (WHO) monitoring and evaluation framework, this study collected data in 2021 272 national, district, and health facility respondents visited 93 health facilities. Tools included validated questionnaires (Cronbach’s α = 0.70–0.80), key informant interviews, and direct observation. Quantitative data from District Health Information System (DHIS-2) and facility assessments were analysed using regression models to identify predictors of performance, and the qualitative data were thematically analysed using a deductive approach.
Results: Core IDSR functions were inadequately implemented at the health facility level. Only case detection and registration showed a significant association with reporting timeliness (β=108.989, p=0.017), yet just 76% of facilities performed it adequately. Case confirmation was the strongest operational predictor but critically weak, with only 8% of facilities equipped for laboratory confirmation due to resource deficits. Outbreak investigation, preparedness, and feedback were consistently deficient. Among support functions, minimum resource availability was the strongest performance predictor, but severely lacking, only 42% of facilities met basic standards. Training and guideline availability significantly predicted district-level performance, but coverage was suboptimal. DHIS-2 data showed strong timeliness (85%) and completeness (90%), exceeding national targets and indicating high system acceptance, though data quality and private facility engagement remained concerns. Structurally, IDSR is integrated into the health system but suffers from insecure funding and a lack of legal mandate.
Conclusion: IDSR performance in Sierra Leone is hindered not by the strategy’s design but by uneven implementation. Prioritising laboratory-based case confirmation, and outbreak investigation ensuring minimum operational resources at facilities, and strengthening district-level training and guidelines constitute the most strategic pathway to improve epidemic preparedness and response outcomes.