Past Projects & Initiatives

  • District Health Systems
  • Ebola
  • IRMNH Programme
  • National AIDS
  • National Food and Nutrition Policy
  • Packaged Water
  • Preventing Malnutrition
  • Rotavirus Vaccine
  • SMAC
  • Transmission of HIV
  • Diaspora Engagement

Project Completion Report and Evaluation of Strengthening District Health Systems

District Health Systems

The Ministry of Health and Sanitation contracted FOCUS 1000 to conduct an evaluation of Strengthening District Health Systems (SDHS)– a five year, $27 million project funded by the African Development Bank and Government of Sierra Leone to strengthen: health systems, the maternal and child health programme, and programme management. The evaluation consisted of:

  • Assessment of the civil works in 27 peripheral health units in 5 districts
  • In-depth interviews with District Health Management Teams
  • Survey with health professionals who benefited from short and long term trainings
  • Focus group discussions with traditional leaders and community members

The evaluation report has been shared with the Ministry of Health and Sanitation, African Development Bank, and other development partners/stakeholders.

Ebola KAP Study

Medical Staff Engagement

As of May 25, 2015, Sierra Leone has recorded a total of 8,608 confirmed cases of Ebola Virus Disease (EVD) with 4,014 cumulative survivors and 3,542 laboratory confirmed deaths [1]. The epidemic which has ravaged Sierra Leone, Guinea and Liberia has been characterized by the World Health Organization (WHO) as one of the most challenging Ebola outbreaks to date.

FOCUS 1000 is supporting the efforts of the Government of Sierra Leone, development partners, and civil society in addressing the current Ebola Virus Disease (EVD) epidemic. CDC supported FOCUS 1000 to conduct the Knowledge, Attitude and Practice (KAP) studies on Ebola Virus Disease (EVD) and Medical Care in Sierra Leone, in collaboration with UNICEF and Catholic Relief Services (CRS). The findings are now informing the national social mobilization efforts.

Knowledge Attitudes and Practice studies drive Ebola response

In May 2014, Ebola Virus Disease (EVD) struck Sierra Leone bringing progress in health and development to a halt. At its onset some of the messages were not too clear and even lead to confusion and fear.. As the months progressed it became evident that their efforts were being met with resistance as the number of deaths and infection rates increased. These incidences highlighted the need for a better understanding of the situation on the ground to develop a strategic approach to this deadly virus that informed and created opportunities for behaviour and social change.

Recognizing the importance of using data to drive evidence based strategies and interventions in the fight against Ebola, the US Centers for Disease Control and Prevention (CDC) joined forces with FOCUS 1000 with UNICEF and CRS to conduct a series of studies to determine the Knowledge Attitude and Practice (KAP) on Ebola Virus Disease Prevention and Medical Care in Sierra Leone. The first study was conducted in August 2014, and provided the Government and partners a baseline on the knowledge, perception and behaviour of the public to Ebola. This informed and guided government and partners in developing a strategic approach for social mobilization and communication.

A follow up KAP 2 study covering all four regions and fourteen districts in Sierra Leone was conducted in October 2014. The objective of the follow up study was mainly to assess changes in knowledge, attitudes, and practices as compared to the KAP 1 baseline in August 2014 so as to identify gaps and prioritize areas of urgent need.

With more technical support from CDC and UNICEF, the recently completed KAP 3 in February 2015, showed comprehensive knowledge on Ebola, however, this was much lower in the North (47%) compared to the South (57%); with continued resistance to shifting traditional burial rites in identified hotspots; and highlighting boosters that have helped to change traditional practices particularly in relation to burials. This study also showed the impact of social mobilization in stemming the spread of the virus and has indicated areas for intervention as government develops plans with partners post Ebola.

Multi-Year Annual Survey to Monitor Program Effectiveness of the Improving Reproductive, Maternal and Newborn Health (IRMNH) Programme in Sierra Leone

IRMNH Programme

HERA has partnered with FOCUS 1000 to establish a baseline and monitor the effectiveness of DFID´s supported programme Improving Reproductive, Maternal and Newborn Health (IRMNH) in Sierra Leone, particularly the two outputs for which UNFPA is responsible for:

  • Increased awareness of information and services for SRH services including modern family planning, antenatal care, skilled birth attendants, post-natal care and the prevention and treatment of malaria and STI, with specific focus on adolescents and young people.
  • Increased uptake of modern family planning services including sexually transmitted infections diagnosis and treatment, particularly by under-25s.

National AIDS Spending Assessment

Sierra Leone has a stabilized HIV epidemic of 1.5% prevalence, and is on track to meet the targets of the Millennium Development Goals on HIV and AIDS. The Government and development partners have instituted two National Strategic Plans aiming to put Sierra Leone on a path to zero new infections by 2015. In order to achieve this goal, it is vital to track national spending on the multi-sectorial response on HIV/AIDs against the national priorities.

FOCUS 1000 provided technical expertise and assistance to the National AIDS Secretariat in conducting the most recent National HIV/AIDS Spending Assessment in 2013 covering the period of 2010-2011. The NASA methodology developed by UNAIDS was employed in undertaking the assessment. It tracks the flow of resources from financing sources to financing agents and service providers who render specific HIV/AIDS goods and services targeting various beneficiary populations. Findings from the assessment are now informing Government efforts to align national spending with the priorities in the National Strategic Plan.

Alignment of Implementation Plan on National Food and Nutrition Policy

The government of Sierra Leone has given high priority to the issue of nutrition and food security, as part of its commitment to the Agenda for Prosperity, and to strengthen efforts to accelerate the achievement of the MDGs. A national nutrition policy has been developed to address malnutrition and food insecurity in Sierra Leone, with an accompanying implementation plan and budget. FOCUS 1000 was contracted by the MoHS and UNICEF to align the proposed budget with the implementation plan, as well as develop a logical framework for measuring results and performance.

Improving the Regulation, Monitoring, and Quality of the Packaged Water Industry in Sierra Leone; And Sensitizing the Consumer-base

Water Sachets

Households in Sierra Leone face a serious challenge in having access to safe drinking water. In the past few years, the packaged water industry has seen dramatic boom in production in response to consumers’ demand for safer, alternative sources of drinking water. With more than 100 packaged water businesses in the country, the Government is taking action to put in place mechanisms for the effective regulation and monitoring of the packaged water industry in order to safeguard public health, and prevent outbreak of waterborne illnesses such as cholera.

With funding from DFID and by working closely with government regulators, FOCUS 1000 and the UNC Water Institute have:

  • Assessed the baseline situation of the industry (including rigorous testing of the quality of packaged water products);
  • Clarified roles and responsibilities of regulatory entities, developed comprehensive regulations for the packaged water industry; and
  • Sensitized consumers on the safety, consumption and handling of packaged water.

Developing Capacity to Prevent Malnutrition in Sierra Leone

Weighing Newborns

The Overseas Development Institute (ODI), through the Secure Livelihoods Research Consortium (SLRC), has partnered with FOCUS 1000 in conducting research on capacity development for the prevention of malnutrition in Sierra Leone. Malnutrition rates remain persistently high in Sierra Leone, despite numerous efforts by Government and development partners to improve the situation. The aim of the project is to generate useful evidence to inform policy making on the issue of nutrition. As part of the evidence generation activities, FOCUS 1000 and Valid International recently conducted a Semi Qualitative Evaluation of Access and Coverage (SQUEAC) focusing on the issue of stunting in Kambia District.

Communication Strategy for the Introduction of Rotavirus Vaccine in Sierra Leone

Communication Strategy for the Introduction of Rotavirus Vaccine in Sierra Leone
The Government of Sierra Leone, UNICEF, and the World Health Organization are introducing the rotavirus vaccine in Sierra Leone for the first time to contribute to the EPI goal of increasing the percentage of under-one children fully immunised against vaccine preventable diseases including rotavirus diarrhoea.  FOCUS 1000 provided technical expertise and assistance in developing a comprehensive communication strategy for the introduction of the rotavirus vaccine, launched in March 2014.


SMAC logo

GOAL the leading organization, Centers for Disease Control (CDC) gives technical input, BBC Media Action produces radio programming, Restless Development works with social mobilizers, and FOCUS 1000 with religious and traditional healers, formed the Social Mobilization Action Consortium (SMAC) in order to support and strengthen the National Social Mobilization Pillar. Simultaneously activate multiple channels to provide EVD information which addresses the principle transmission modes; and work with and through existing local community structures capable of leading and role-modelling behaviour change, in order to reduce EVD infections. On the 15th October 2014, with funding from the Department for International Development (DFID), SMAC launched a six-month project, Community-based Action against Ebola. Under the project, SMAC is delivering Radio, Religious Leader, and Community Mobilization activities in every district of the country and aims to achieve tangible behaviour change around safe burials, early treatment, and social acceptance of Ebola survivors. SMAC Community Mobilisers are trained and work with 10,052 communities nationwide using the Community-Led Ebola Action approach. Religious Leaders from the Islamic Action Group (ISLAG) and Christian Action Group (CHRISTAG) use faith-based frameworks to engage over 2,000 congregations across the country on Ebola issues. While our Partner Radio Stations produce and broadcast relevant Ebola programming in local languages in all districts. SMAC has now been awarded funding from the Bill and Melinda Gates Foundation to launch a four-month project on ‘Enhancing the Impact of the SMAC Action Against Ebola Initiative’, which aims to enhance existing activities, introduce mobile phone data collection, and improve coordination of activities at both the national and district levels.

Community-based Digital Data Collection and Surveillance System Background

With support from the Bill and Melinda Gates Foundation, FOCUS 1000 is working through the Social Mobilization Action Consortium (SMAC) to rapidly collect relevant community-based EVD surveillance data from a network of over 1000 community mobilisers, 500+ mosques/churches, and 100 radio station managers in Kambia, Port Loko, Bombali, Moyamba, Kono, and Western Area. The SMAC Consortium consists of the following partner organizations/agencies: BBC Media Action FOCUS 1000 GOAL Restless Development US Centers for Disease Control and Prevention (CDC)


Overview of Data Collection Mechanisms

SMAC logo

The SMAC Digital Data Collection System (DDCS) comprises two key components: (i) daily SMS alerts on deaths and suspected cases (ii) weekly Open Data Kit (ODK) submissions on a range of social mobilization activities and EVD surveillance indicators.

Daily SMAC SMS SMAC has integrated with Airtel to allow the RapidPro platform to interact with its network of social mobilisers via SMS. The platform allows social mobilisers to send alerts for specific events such as death, suspected case, quarantine issues, survivors, and orphans. Once an alert is sent, the respective SMAC District Liaison Office (DLO) would then follow-up with the phone user to get more detailed information about the reported event. The DLOs would subsequently follow-up with the District Ebola Response Center (DERC) to facilitate a prompt response. All follow-up information collected by the DLOs regarding the alert are then inputted into the SMAC SMS Management System wherein each alert is automatically geo-coded and mapped for monitoring and tracking purposes. Similarly, SMAC uses the platform to rapidly conduct polls/surveys with the network of social mobilisers on any given issue relevant to the present context in the national Ebola response. An example of such use was during the Three Days Zero Ebola campaign wherein SMAC conducted a rapid survey on each of the campaign and shared the results with the National Ebola Response Center (NERC) in order to assess the following: (i) number of households reached (ii) number of deaths identified (iii) number of sick people identified (iv) community acceptance of visiting teams (iv) challenges faced by visiting teams.

Weekly ODK Reports SMAC has also integrated with Airtel to enable its network of social mobilisers to use basic Android-smart phones to submit weekly reports using Open Data Kit (ODK). The ODK mobile application has been customized to collect a range of indicators on the following: (i) social mobilization activities by each partner organization (ii) deaths and associated events (iii) suspected cases and associated events (iv) survivors. ODK allows for offline data collection, which makes it possible for social mobilisers to collect and store the weekly report without Internet connection. However, once the report has been finalized offline, the social mobilisers would then use the Airtel data network to electronically submit their weekly report. The weekly data are then analyzed by the FOCUS 1000 team, and key performance and surveillance indicators shared with SMAC partners and other decision-makers in the national Ebola response in Sierra Leone.

Study on Prevention of Mother to Child Transmission of HIV

Study on Prevention of Mother to Child Transmission of HIV

Sierra Leone has made remarkable progress in increasing access to antenatal care (ANC) and PMTCT services, especially since the introduction of the Free Health Care Initiative by His Excellency President Ernest Bai Koroma in 2010. Despite the gains, the country has not attained universal ANC and PMTCT coverage. Supported by the National AIDS Control Programme within the Ministry of Health and Sanitation, FOCUS 1000 conducted a national study to:

  • Determine the availability and accessibility of ANC and PMTCT services
  • Assess mothers’ and male partners’ awareness, knowledge and attitudes (vis-à-vis quality and adequacy) of ANC and PMTCT services in the health facilities
  • Identify bottlenecks and facilitating factors for service delivery
  • The assessment spanned across 40 health facilities (17 from urban areas and 23 from rural areas), with a sample of 400 pregnant/lactating women and 386 men/partners.

The findings of the study are now informing NACP’s initiatives to enhance the utilization and quality of ANC and PMTCT services.

Diaspora Engagement Strategy for the Health Sector

Sierra Leone faces a massive shortage of professionals in the health sector. Following the protracted civil conflict, many Sierra Leonean health professionals migrated out of the country to Europe and North America – leading to a “brain drain” in the health sector. The Office of Diaspora Affairs (ODA) and the International Organization for Migration (IOM) are now working to turn the “brain drain” into a “brain gain.”
FOCUS 1000 provided consultative services to the IOM and ODA in developing a Diaspora Engagement Strategy for the Health Sector to facilitate the return of Sierra Leonean health professionals in the diaspora to serve in health care delivery and learning institutions on a sustainable basis.

Evaluation of the WASH-Village Savings and Loans (VS&L) Linking Project

Plan International has contracted FOCUS 1000 to conduct an endline assessment of the WASH-VS&L Linking Project in Port Loko and Moyamba Districts, a pilot project funded by the UK Department for International Development through Adams Smith International. The main objective of the project was to ensure sustainability of WASH outcomes for beneficiary communities through improved access to finance using VS&L methodologies. A total of 34 VS&L groups were to be trained in effective management of their realized savings. Furthermore, 68 VS&L members were also to be trained on proper maintenance and repair of water supply facilities such as pumps and wells. The trainings were then infused with sector learning in order to facilitate the scaling up of WASH-VSL linkages.

The evaluation aimed to:

  • Assess progress towards achieving the overall aims and objectives of the project;
  • Reflect and learn from what has worked well and what has not, and the reasons why, so as to inform future initiatives; and
  • Identify lessons learned and provide recommendations for replication and scale-up for future similar projects