Title : Testing one health preparedness in practice: Lessons from multi-sectoral zoonotic disease simulation exercises in Sierra Leone (Kambia Kailahun & Pujehun

Zoonotic disease preparedness requires more than the existence of policies, standard operating procedures (SOPs), and coordination structures; these systems must function effectively during an unfolding outbreak. Sierra Leone has adopted a One Health approach linking human, animal and environmental health actors across national, district and community levels. To assess practical readiness, the National Public Health Agency (NPHA), in collaboration with GIZ through the Health Systems Strengthening and Epidemic Prevention III programme, conducted a multi-sectoral tabletop simulation exercise in Kambia, Kailahun and Pujehun Districts using a realistic Lassa Fever outbreak scenario.

Methods: The same Master Scenario Events List, scenario and Exercise Evaluation Guides were used across the three districts. Approximately 150 participants from national, district and community levels, including health, agriculture, environment, local government, community leadership, civil society and One Health Chiefdom Committees (OHCCs), participated. Progressive injects, guided discussions and role-play tested detection and notification, coordination and communication, decision-making and risk communication, resource mobilization, community engagement, recovery and resilience, gender considerations, and One Health integration. Observer scores and qualitative observations were reviewed through hotwash discussions and After-Action Reviews, followed by district improvement planning.

Results: Overall performance ranged from moderate to good, with average scores of 2–4 out of 5 across the assessed capabilities. Detection and notification were the strongest domain, scoring 3.7/5, supported by functional DHMT notification pathways, laboratory confirmation procedures and Rapid Response Team activation. Moderate performance was observed for coordination and communication (2.7/5), decision-making and risk communication (2.7/5), recovery and resilience (2.7/5), and One Health coordination (2.7/5). Resource management scored 2.3/5, reflecting gaps in timely access to IPC supplies, fuel and emergency financing. Gender considerations were assessed within epidemic response activities, particularly in relation to gender-sensitive isolation and case-management practices and the protection of female caregivers. However, these considerations were not consistently translated into targeted response measures, with Gender and Protection recording the lowest score (2.0/5). Other critical gaps included integration of community-based surveillance, rumour management, information flow between sectors and communities, and the routine operationalization of existing OHCC roles and feedback mechanisms. Participants demonstrated awareness of One Health linkages, including the relationship between rodent control and Lassa Fever, but translating this knowledge into coordinated action remained inconsistent.

I recommend using this version because it answers the supervisor's question more directly without claiming that specific gender-targeted activities were developed when the report does not provide enough evidence to make that claim. It also keeps the gender finding connected to the broader theme of testing practical epidemic preparedness.

Conclusion: The exercise demonstrated that tabletop simulation can reveal operational gaps that may not be evident from preparedness plans and SOPs alone. Strengthening epidemic preparedness and readiness in Sierra Leone requires regular simulation, stronger implementation of established One Health governance arrangements and SOPs, routine operationalization of OHCC roles and feedback mechanisms, integrated community surveillance, stronger multi-sectoral information sharing, dedicated emergency financing, and systematic integration of gender and protection considerations. Simulation should therefore be regularly and frequently repeated as a practical mechanism for testing readiness and converting lessons into corrective actions before future zoonotic disease emergencies.

Aminata Saccoh is a Public Health Specialist and Technical Advisor with GIZ Sierra Leone, specializing in infectious disease preparedness, outbreak response, and One Health. With a background in clinical nursing and frontline epidemiology, she has led and supported multi-sectoral initiatives to strengthen surveillance, coordination, and community engagement for priority zoonotic diseases across Sierra Leone. Her work focuses on building resilient health systems through capacity strengthening, simulation exercises, and evidence-based approaches that bridge human, animal, and environmental health. She is passionate about advancing global collaboration to improve health security and epidemic preparedness.