Intra-Action Review of Sierra Leone’s 2025 Mpox Outbreak Response: Insights for Advancing Decentralized Public Health Systems

Abstract

In complying with the International Health Regulations Monitoring and Evaluation Framework (IHR-MEF), the National Public Health Agency (NPHA) mounted a phased Intra-Action Review (IAR), beginning at the regional level and proceeding to the national level, to assess response activities, identify best practices, and recommend corrective actions. The paper aims to report on Sierra Leone’s decentralized response to the 2025 mpox outbreak through the lens of a structured IAR process. The IAR employed an interactive approach, using a user-friendly approach and systematic facilitation techniques. The focus was not on the individual performance of the mpox response but rather on the health system's overall performance.

The IAR revealed that operationalization of the Incident Management System, decentralization of response structures, and engagement of community and partner institutions strengthened response capacity across districts. These approaches contributed to improved coordination, expanded access to services, and enhanced collaboration among stakeholders at national and subnational levels. At the same time, the review shows persistent systemic weaknesses that limited operational efficiency. Delays in funding disbursement, logistical constraints, data management challenges, and gaps in community engagement affected the timeliness and consistency of interventions.

Improving emergency preparedness requires more efficient and reliable financing systems so that response activities can begin quickly at both the national and district levels. Funds should be released on time, and districts should have greater control over resources. This will improve response speed and reduce delays in carrying out important interventions.

Keywords: Intra Action Review (IAR); Incident management system; Incident Action Plan (IAP); mpox