National Health Promotion Strategy of Sierra Leone (2017–2021)

1.1.2 Review, Finalize and Disseminate the Communications Pillar TOR 1.1.3 Hold Monthly (More as Necessary) National SM Pillar Meetings 1.1.4 Hold National Communications Pillar Meetings (PHNEOC) Every Two Weeks 1.1.5 Participate in Inter-pillar Meetings at National Level Called by PHNEOC for Improved Coordination

1.1.6 Conduct Periodic Capacity Assessment for Strengthening National SM and Communication Pillars and Provide Support SO 1.2: Rejuvenate the Social Mobilization Pillar at District Level and Strengthen Coordination Mechanisms The HED will also revitalize and strengthen district pillars – key to coordinating health promotion activities and messages, and ensuring a functioning feedback loop between the district and national level. As such, strategic priorities will include conducting a stakeholder mapping meeting to identify the gaps in information flows and develop a plan to address them, ensuring that roles and responsibilities of the key health promotion structures at all levels are defined, including how they share information. 5 Informal structures include traditional healers, traditional birth attendants, unlicensed drug peddlers and pharmacies. During the Ebola outbreak, a ban on using unlicensed health providers was enacted; however, evidence suggests this drove practices underground, so it is important to understand how to work with them in a safe and effective way. National Health Promotion Strategy (2017–2021) 21 Importantly, there is a need for on-going training in health promotion leadership for the DHMT so they can provide greater guidance to partners, including civil society at the local level. During emergencies, it is critical that a trained health promotion officer is stationed at the district level. Multiple organizations will be conducting district-level health-promotion-related training. As these trainings roll out, care will be taken to not duplicate efforts – combining efforts wherever possible – and to ensure that trainings are complementary to each other. Major activities for this SO: 1.2.1 Review, Update and Disseminate District Level SM Pillar TOR 1.2.2 Map Active SM Pillar Partners and Identify Dormant SM Pillars 1.2.3 Hold a Revitalization Meeting to Present Mapping Landscape with Recommendations, TOR and Roles/Responsibilities 1.2.4 Conduct Two-Day Capacity Assessment Meetings and Support (e.g., Training) for All District SM Pillars 1.2.5 Hold Monthly District-level SM Pillar Meetings (More Frequently as Needed) and Circulate Meeting Minutes 1.2.6 Attend Monthly District Coordination Meetings in Person and Include HP on the Agenda, While Serving as Health Advocates 1.2.7 Map and Develop MOUs with Functional Community Radio Stations in Each District for Message Dissemination

1.2.1 Review, Update and Disseminate District Level SM Pillar TOR SO 1.3: Strengthen Community-level Actors and Foster Community Ownership of Health One of the primary lessons learned from the 2014-2015 Ebola outbreak was the power communities have to lead the change toward improved health and wellness. Structures to oversee and manage certain aspects of health communication continue to exist in communities. Each PHU has a CHW serving as the link between the facility and the community. HMCs, also known as the FMCs, oversee the functioning and supply of the PHUs. VDCs oversee all development initiatives in communities, including health services and health promotion. Representatives from community groups are attached to each VDC and regularly promote health and sanitation issues. Community groups are instrumental for a variety of health promotion roles. As such, strategic priorities include rolling out integrated health promotion training and guidelines to these community-level structures and groups. For instance, conducting trainings to clarify the VDCs’ and associated community groups’ health promotion roles and strengthening them in this role or holding a series of community stakeholders meetings to develop a system for feedback between the community and appropriate district and national structures (this could be based on the mapping exercise noted above). DHMTs will be held accountable for ensuring the feedback loop system is in place and functioning as planned. Major activities for this SO: 1.3.1 Develop and Disseminate Guidance on HP Roles and Responsibilities for Community Structures (e.g., VDCs, HMCs/FMCs, CHWs, Community Groups, etc.)

1.3.2 Support Integrated Training on HP Roles/Responsibilities for VDCs/HMCs/FMCs and Community Structures National Health Promotion Strategy (2017–2021) 22 OBJECTIVE 2. STRENGTHEN NATIONAL HEALTH PROMOTION INTERVENTIONS One of the benefits of creating a national strategy for health promotion is that it can add value to the work of individual actors and agencies, and ensure linkages to national health priorities. The following “areas for common action,” validated by national stakeholders during a series of consultations, represent opportunities to increase national programme impact and quality: 1. Models for implementation 2. Intended audiences for our programmes 3. Key change agents 4. Typical health promotion interventions 5. Key behavioural determinants 6. Collaboration with all technical units of the Ministry on their priorities for health promotion 7. A national umbrella campaign 8. An emergency communication plan 9. Amultisectoral response In each of these nine areas, if several implementers coordinate with each other, the whole of our national effort will truly be greater than the sum of its parts. To inspire broad “buy in” and increase programme quality, national health promotion efforts will adopt proven models to guide programme implementation. Two models that have been field tested in many settings similar to Sierra Leone are the P-Process™ and the Social Ecological Approach to Change. The P-Process describes the crucial steps in programme implementation that are required to guide strategy development (see Figure 1 at right). This step-by-step road map leads communication professionals from a loosely defined concept about changing behaviour to a strategic and participatory programme with a measurable impact on the intended audience. As programme managers proceed through the project cycle, they must reflect on how much participation – from both implementation partners and the audience themselves – they are inspiring. In addition, programme managers need to understand what capacity building needs are apparent in order to be able to follow the process productively and ensure that efforts are strategically designed, resonate with intended audiences and Figure 1: P-Process have the necessary impact. As part of the P-Process, implementers first analyse the programme environment and public health situation. They then work on the strategic design of the programme, including making key decisions about the intended audience and the channels to reach that audience. The next step is to develop programme elements, testing them with the intended audience and then retesting them after incorporating feedback. In the implementation and monitoring phase, adequate real-time monitoring is often neglected and its value needs to be emphasised. Finally, in evaluation and re-planning, National Health Promotion Strategy (2017–2021) 23 programme managers uncover whether their efforts have achieved their objectives, explain why (or why not) objectives were not reached and use their conclusions to re-plan the next phase of action. Another programming model that will be helpful to those implementing the National Health Promotion Strategy is built on the Social Ecological Approach to Change. It is a reminder that comprehensive programming operates in the enabling environment, the service delivery system and the community and individual domains. Figure 2 (below) is an example of a framework that was developed by CCP for a malaria communication campaign. By depicting the three levels of intervention, all actors in a coalition of organizations can understand where they fit in the national campaign strategy. By populating the model with specific indicators in the third and fourth columns, it can be useful to monitor programme progress and track ultimate impact. Figure 2: Sample Pathways to Improved Health Outcome National Health Promotion Strategy (2017–2021) 24 SO 2.1: Disseminate and Provide Guidelines on the Use of Health Promotion Models Given the health promotion models described above, strategic priorities will include creating information materials about effective health promotion models; consistently adopting and adapting evidence-based models for health promotion programming; and orienting partners toward using these models in their programming. Activities should address accountability of partners and programmes adopting these models, either through the service-level agreement (SLA) process or some other mechanism. Major activities for this SO: 2.1.1 Develop and Disseminate HP Model/Pathway Brochure and Orient Partners on HP Model/Pathway and Other Guidance through Standing Pillar Meetings

2.1.2 Hold Regular MOHS Stakeholders Meetings to Include a Mandate in the SLA for Partners to Base Programming on Approved HP Model/Pathway, and Other Guidance Documents (e.g., SM TOR) SO 2.2: Support National Integrated Efforts to Reach Adolescents with Health Promotion Based on a review of national issues and priority audiences among the technical experts (see the Background section), the national priority audience for this Strategy is older adolescents (ages 15 to 19) with younger adolescents following close behind in second place. Targeting this group alone, however, will be insufficient as they are the most vulnerable and disenfranchised. Imploring them directly to change their behaviour will likely be unproductive without simultaneously mobilizing all audiences that support young people as they strive to make the healthiest choices they can. Given that many players are undertaking efforts to reach adolescents, the coordination role of the Ministry, pillars and coordinating committees will be crucial in pursuing the national priority to reach this audience. Therefore, to support an integrated effort to reach older adolescents and secondary audiences with health promotion, national strategic priorities include identifying and filling gaps in evidence, supporting and strengthening adolescent-focused campaigns and supporting advocacy to gain buy-in at the national and district levels. Major activities for this SO: 2.2.1 Gather and Share Existing Evidence with National and District Partners on Adolescent Health Behaviors through HED Knowledge Gateway

2.2.2 Conduct Bi-annual Meetings between HED and the National School Adolescent Health Program/Secretariat of Teenage Pregnancy to Strengthen Collaboration

2.2.3 Support Adolescent Campaign Design and Implementation 2.2.4 Support Advocacy on the Need to Reach Adolescents (e.g., Religious and Community Leaders)

2.2.5 Facilitate Community-level Adolescent-Focused Program Activities National Health Promotion Strategy (2017–2021) 25 SO 2.3: Strengthen Community-level Actors in Health Promotion Another area for common action is to improve the health promotion role of key community change agents. Key change agents within the community and health infrastructure in clued CHWs, health promotion coordinators, healthcare workers, committees and organizations (such as the VDCs and FMCs), drivers’ unions, market women’s associations and others. Importantly, they also include community leaders such as traditional leaders, market women, women’s group leaders, youth group leaders, social heads, bike riders, traditional healers and teachers. Given the Ministry’s prioritization of the development of CHWs, and the trust local communities have in them, these change agents are critical health promoters at the community level. To strengthen the role of community change agents, national strategic priorities include surveying available materials and orientation schemes for key change agents, reproducing quality existing materials and creating new materials and programmes where necessary, while also providing training on using job aids and tools. It is also recommended to do this activity for in-service healthcare workers for strengthened interpersonal communication skills, providing training on interpersonal communication and how to use job aids and tools, and providing follow-up support. Major activities for this SO: 2.3.1 Conduct Mapping of Materials/Job Aids for Community-level Actors and Supporting Partners to Identify Gaps 2.3.2 Develop Health Promotion Materials/Job Aids for Community-level Actors Based on Mapping/Review 2.3.3 Provide Opportunities (Training) for Community-level Actors to Use Health Promotion Materials and Become Health Promotion Advocates 2.3.4 Conduct Mapping of Materials/Job Aids for In-service Healthcare Workers to Identify Gaps 2.3.5 Develop Health Promotion Materials/Job Aids for Interpersonal Communication Skills for In- service Healthcare Workers

2.3.6 Provide Training for In-service Healthcare Workers on Interpersonal Communication Skills and Using Job Aids/Materials and Provide Follow-up Support (Incentives, Mentoring, Supportive Supervision) SO 2.4: Establish Evidence-base on Behaviours and Communication Channels to Guide Programming Strategic priorities will focus on identifying, assessing, gaining and sharing evidence on behavioural determinants and communication channels and investing in those that work. However, in the meantime, the HED and all health promotion partners must consider the key behavioural determinants, for example: National Health Promotion Strategy (2017–2021) 26 Priority Behavioural Determinants Secondary Behavioural Determinants Perceived “traditional religious values” and “value of Traditional views regarding gender norms that hamper health services” as being particularly influential. health promotion – for instance, that men generally have overriding decision-making power. The influence of grandmothers and mothers-in-laws, even though they are not often the most knowledgeable about health information. Strategic priorities will include assessing and selecting a few platforms that can serve multiple health needs and multiple partners, and investing in those select interventions. It also includes investing in or advocating for additional research on key behavioural determinants related to priority audiences and health areas to validate or strengthen the evidence that exists in this area, and to document and share that evidence with other key partners. Further, the HED will lead the coordination ofNGOs, broadcast partners and national production partners around communication channels via the communications pillar and to share data and broadcast feedback. Using donor organizations as influential champions, the HED will mobilize resources to co-finance the production of a national radio and TV show that collaborates with local partners for local content. Major activities for this SO: 2.4.1 Conduct Desktop Analysis to Identify Evidence Gaps on Knowledge, Attitudes, Practices and Behaviors Related to Priority Health Areas and Audiences 2.4.2 Support the Design, Implementation and Dissemination of Studies to Fill Gaps in Evidence (See 2.4.1) 2.4.3 Orient Government Agencies and Partners on Using Evidence in SBCC Programming 2.4.4 Facilitate National Communication Channels Assessment to Map Existing Approaches and Effectiveness, Selecting Key Channels/Approaches (e.g., Radio, Mobile, TV, Community Engagement)

2.4.5 Based on Assessment, Invest in Select Communication Channels for Health Promotion (See 2.4.4) SO 2.5: Develop and Launch a National Health Promotion Campaign Currently, no consistent or sustained national health promotion campaigns are taking place in the country. There are occasional event-based days, usually driven by recognition of UN days. Sierra Leone needs a broader, well-planned and coalition-based platform from which to address public health. Those participating in May 2016 stakeholder consultations felt it was time to develop a plan for such a sustained campaign. One feature of such a campaign, for example, might be a national logo and/or slogan to symbolize health that can be adopted by the MOHS and all of its partners. Major activities for this SO: 2.5.1 Develop a National Health Promotion Campaign that Includes a National Logo 2.5.2 Hold National- and District-level Campaign Launches 2.5.3 Roll Out National Campaign (e.g., Broadcast, Print Distribution)

2.5.4 Monitor and Evaluate National Campaign Outcomes National Health Promotion Strategy (2017–2021) 27 SO 2.6: Facilitate Development of an Emergency Communication Plan Given Sierra Leone’s recent history, its ability to respond to public health emergencies, such as disease outbreaks, must be central to its national health promotion strategy. Indeed, this component of the Strategy is so important that the MOHS has dedicated a separate volume to elaborate on its emergency communication strategy. A brief mention of that component of national health promotion efforts is included here to make the point that pursuing that agenda represents one of the nine key areas for common action in health promotion in the country. Some features of the public health emergency response system will include: • a continued emphasis on coordinating committees and taskforces at all levels; • capacity building in emergency and risk communication; • a use of media that has already proven effective, such as a toll free hotline, use of SMS messages, radio programming in local dialects and mobile PA systems; • an expansion of community surveillance efforts; • community engagement, group discussions, drama groups and local celebrities; and • continued use of community bye-laws to create the enabling environment for action. Major activities include: 2.6.1 Contribute to Emergency Communication Plan and Training Curriculum

2.6.2 Support Emergency Communication Training at District-level SO 2.7: Strengthen Integration of Health Promotion Activities with Activities in Other Sectors – e.g., Education, Agriculture, Youth – to Achieve Health and Development Gains It will be important for the HED to explore deepening the integration of public health promotion within the broader national development agenda. Benefits of a more integrated approach could include improving community ownership and satisfaction, reach, equity, sustainability, operations, value for money and impact. Below are just a few of the opportunities that could be further explored: • Linking family planning with promoting girls’ empowerment and education issues through the Ministry of Education, Science and Technology • Reaching women and children with health promotion activities through the Ministry of Social Welfare, Gender and Children’s Affairs • Exploring or strengthening integrated nutrition programming with the Ministry of Agriculture, Food Security and Forestry • Strengthening coordination of health messages with the Ministry of Youth Affairs • Coordinating health promotion activities and messages with sports celebrities and activities through the Ministry of Sports • Strengthening relationships with the Ministry of Information and Communication to attain greater press access and information services National Health Promotion Strategy (2017–2021) 28 • Strengthening partnerships with the Ministry of Local Governments and Rural Development and the Ministry of Internal Affairs, Local Government and Rural Affairs to gain access to and influence regional- and local-level leaders The immediate aim of this SO is to identify mutual benefits of integrating health promotion with other government development areas where it makes sense. An assessment of the costs and benefits of this approach in Sierra Leone will be an important first step toward this end. Other agenda items can include roles/responsibilities related to integration efforts, support needs to operationalize integration and appointing health promotion point people for each collaborating Ministry. Stakeholders will meet regularly to review progress on health promotion activities and identify and address problems. Major activities include: 2.7.1 Convene Multi-stakeholder Meetings with Relevant Ministries to Integrate Health Promotion

2.7.2 Assign HP Role (e.g., Seconded, Focal Point) to Support HP Activities in Four Ministries (e.g., Education, Agriculture, Youth, Gender) SO 2.8 Launch in Full Effect a National Public Health Information Line This SO aims to equip HED and the national SM Pillar with an additional tool that is readily available as a channel for public interaction and communication. The aim is to strengthen nationwide strategies, which can benefit from one-on-one interaction with individuals within a framework for behaviour change modification. A sustainable public health line has proven effective and useful in connecting targeted demographics (such as teenagers and pregnant and lactating mothers, etc.) with the information they need. The public will be encouraged to call into a public health line at any point in time and access health information at no cost. A call centre tool also provides a platform for easy analytics on health promotion activities and its impact on public awareness. The number of health information calls received can be tagged as directly proportional to the increase or decrease in public knowledge about key public health issues and the options they have to prevent and resolve them. Major activities include: 2.8.1 Conduct Resource Mobilization Activities and Secure Funding from Stakeholders

2.8.2 Set-up a Toll-free Hotline Number or Repurpose an Existing Line, such as the Ministry of Health's 117 2.8.3 Conduct Activities to Educate the Public on Using the Public Health Line 2.8.4 Integrate the Call Centre Approach to Health Promotion in all MOHS Strategic Plans as Part of Strengthening a Continuous National level Method of Health Promotion

2.8.5 Conduct Trainings for Call Centre Health Promotion and Information with Staff National Health Promotion Strategy (2017–2021) 29 OBJECTIVE 3. IMPROVEHUMAN RESOURCES AND CAPACITY STRENGTHENING FOR HEALTH PROMOTION The constraints on human resources for health promotion in Sierra Leone are a major barrier to the implementation of consistently high-quality programming at the scale that is required. While these constraints cannot be fully addressed in one five-year strategy, the MOHS can establish a foundation for health promotion human resources – including for logistical support – on which future programmes can build. Broadly, approaches in this area will fall into two categories of action: training and workforce policy. SO 3.1: Develop Training Programme for Pre-service and In-service Health Promotion Professionals The development of pre-service training partnerships with one or more postgraduate training colleges is a particular priority for this Strategy. Three possibilities for exploration include University of Makeni (UNIMAK), a private Catholic university, the College of Medicine and Allied Health Sciences (COMAHS) and the Postgraduate Training institution the MOHS is planning. The priority beneficiaries of health promotion capacity strengthening should be: • At the national level, HED staff (including those seconded to Disease Prevention and Control and Malaria Control) and the national SM Pillar members • At the district level, the district SM coordinators, the DHMT members, the members of the SM committee and relevant government ministries department and agencies • At the community level, local council and VDC members and influential members of secret societies Capacity strengthening work will be guided by the understanding that learners, particularly adult learners, exhibit various learning styles. So to be effective, efforts to build human resources will interact with those learners through a blended learning approach that mixes methods: • Providing face-to-face and virtual learning opportunities through experiential/workplace learning programmes, mentoring and coaching relationships and embedded advisors • Facilitating access to and encouraging uptake and application of resources by providing job aids and resources, connecting to external resources including and developing resources, case studies and best practices • Facilitating participation in learning and exchange events such as internships or professional exchange opportunities; TWGs/SBCC communities of practice; formal learning programmes including provision of scholarships; and conferences and meetings As a priority for this Strategy, the HED will develop a health promotion pre-service training programme with one or more local training institutions, and tailor that training programme to develop specific competencies required by public and voluntary sector employers. In-service training curricula will also be developed so methods, participants and activities are planned and comprehensive. For example, it might include a basic programme on health promotion principles and practices and brief refreshers on technical areas such as health topics, risk communication, use of media and use of data, all rolled out through an annual nationwide plan. National Health Promotion Strategy (2017–2021) 30 Major activities for this SO: 3.1.1 Develop National Training Plan of In-service Training Opportunities for HP Professionals 3.1.2 Assign HED Staff to Attend International Health Conference (e.g., ASTMH, SBCC Conference) and Health Communication Study Tour (e.g., WHO) 3.1.3 Hold at Least One HP-focused Capacity Building TOT Per Year for HED and Partners at National/District Level (e.g., DSMCs) – As Per Training Plan (3.1.1) 3.1.4 Hold a Strategic Health Communication Training in Sierra Leone (Repeated Every Three Years) – As Per Training Plan (3.1.1) 3.1.5 For Pre-service Training, Assess and Finalize Potential Partnership with Training Institution(s) 3.1.6 Develop Curriculum with Selected Training Institution(s)

3.1.7 Provide Annual General Support to Institution to Implement Training, (e.g., Support for Faculty, Materials) SO 3.2: Review and Update Human Resources for Health Policy to Include Health Promotion In addition to capacity building, the Strategy will also collaborate with the office of the Chief Medical Officer (CMO)and the Human Resources Directorate of the MOHS to clarify and elevate the standing of the health promotion function within the health sector hierarchy by: • clarifying the career path of health promotion practitioners; • placing a greater number of specialists in full time dedicated positions; • providing input to and endorsing the final form of the pre-service and in-service training strategies; • clarifying job descriptions and remuneration packages for all necessary Health Promotion functions, both at national and district levels; and • in concert with the Advocacy for Strengthened Health Promotion component of this Strategy, advocating for increased resources to fund improved health promotion human resources. The priorities for this SO are advocating for the strengthening of the HED workforce and meeting with the MOHS Human Resources for Health to review policy to ensure it leads to a strengthened workforce for HED. Major activities for this SO: 3.2.1 Update and Clarify HP Roles/Responsibilities, Terms of Service and Professional Development to Guide MOHS Leadership (Annually)

3.2.2 Advocate with MOHS Human Resources for Health and Partners to Influence Strengthening the HED Workforce National Health Promotion Strategy (2017–2021) 31 OBJECTIVE 4. RAISE AWARENESS AND MOBILIZE RESOURCES FOR STRENGTHENED HEALTH PROMOTION To shift the norm away from being the “spare tyre” in the health system, the HED will develop a series of advocacy activities so that new and higher expectations of the HED and health promotion activities can take root. Ultimately, the aim will be to create opportunities to influence key public and private sector decision-makers to increase resources to support the HED and health promotion interventions. A number of implementing partners have a strong experience in advocacy – such as Health for All, Save the Children, Mama Ye, World Vision and Inter-Religious Council – and will, along with other partners, be called on to support the HED to achieve this objective. SO 4.1: Advocate for Increased Funding, Operational Support and Human Resources for Health Promotion Activities Health promotion contributes to core performance indicators by addressing knowledge, attitudes and efficacy, encouraging care-seeking positive health behaviours and removing barriers to practicing them. The priority for this SO amounts to ensuring the HED and partners are speaking with one voice to raise the visibility of health promotion to government decision-makers, the private sector and donors. Key government decision-makers include, but are not limited to, Parliamentary Health Committee, Minister of Finance and Economic Development, Minister of Health and Sanitation, CMO and district councils. It will be critical for the HED to have a technical advisor working with them to help lead these efforts and equip partners with the evidence, messages and materials they need to encourage investments in health promotion. Talking points will articulate the message that investing in health promotion leads to healthier populations and supports the priority health systems strengthening efforts stated in the MOHS’ recovery plans.6 Recruiting influential health promotion champions – such as donor organizations and business leaders – and gaining media attention on the impact of health promotion will be key. Major activities for this SO: 4.1.1 Develop Advocacy Plan to Identify Objectives, Key Audiences, Messages and Opportunities to Raise the Profile of HP and Mobilize Resources 4.1.2 Develop and Disseminate Evidence Briefs on Impact and Importance of HP in Sierra Leone 4.1.3 Hold Training for Journalists to Orient Press on Covering Health Promotion Stories

4.1.4 Hold National Event to Launch Evidence Briefs and Raise Visibility of Health Promotion 4.1.5 Orient District-level Decision-makers (e.g., District Council, VDCs, FMCs/HMCs) on Impact of HP via Advocacy “Road Shows”

4.1.6 Hold Advocacy Meeting with Parliamentary Health Committee to Showcase HP Successes and Advocate for Increased Funding for Health Promotion 6 According to the MOFED’s 2016 budget speech, priorities for the country highlight key areas of the Ebola recovery strategy and the Sustainable Development Goals (SDGs). It will be important for advocates to draw on these priorities in their advocacy messages. DRAFT Health Promotion Strategy (2017–2022) 32 SO 4.2: Recruit at Least Five New Private Sector Institutions to Invest in National Health Promotion Activities Advocating for increased resources from the government alone will not be enough. The MOHS HED will look toward additional private sector funding to help support health promotion activities and fill critical operational gaps. This means offering a menu of options for the private sector to support, including printing, dissemination, volunteer employee mobilizers, events and other options. Options will also include radio, TV or billboard advertising for the national health campaign (see SO 2.5) that the private sector will want to get behind and sponsor. Social events with celebrities will make joining this initiative more desirable, and business leaders will have opportunities to meet and be photographed at health promotion events. Activities within this SO will provide national visibility to private sector partners and help foster a norm of investing in health. Private sector leaders are also perfectly situated to ensure the government is investing its own resources in promoting health. Major activities for this SO: 4.2.1 Develop Private Sector Brochure Outlining Options for Investing in HP in Sierra Leone, with a Business Case for Investing in HP

4.2.2 Hold Annual Business Networking Forums to Encourage Investments in Health Promotion National Health Promotion Strategy (2017–2021) 33 OBJECTIVE 5. IMPROVE MONITORING AND EVALUATION SYSTEMS FOR HEALTH PROMOTION M&E allows for an in-depth understanding of the impact that health communication initiatives have on people’s attitudes, behaviours and other psychosocial factors, which ultimately affect health outcomes. Having a solid evidence base on health promotion activities in the country will not only inform the MOHS and partners of what approaches and messages are working and which are not, but will also build a case for the importance of health promotion to overall national health priorities. A priority of this objective will be to develop a standard M&E framework for both the management and implementation of health promotion activities. This framework will be used at the national, district and community levels. For example, data collection will be standardized to allow for monitoring of inputs, outputs and the reach of health promotion activities, considering elements such as the socio-demographic characteristics of people reached, audience reactions and feedback to health promotion interventions and positive trends in behaviour change, where possible. Importantly, in collaboration with the Directorate of Policy, Planning and Information (DPPI), the HED will receive M&E support and training, strengthen indicators for health promotion and ensure indicators are aligned with overall national health indicators. See attached Annex B for a description of methods, indicators and targets that will be used to assess the implementation of this Strategy as well as health promotion’s impact on key public health indicators. To support this effort, the HED will establishan M&E subcommittee within the SM Pillar, linking it to the existing MOHS M&E TWG, when appropriate, to address data on knowledge, attitudes, practices and behaviours, and to facilitate the sharing of data and resources and the use of existing data and surveys for making decisions. Major activities for this objective: 5.1.1 Hold Stakeholder Meeting to Agree on HP Monitoring Indicators and M&E Priorities for HP 5.1.2 Create M&E Subcommittee with a TOR within the SM Pillar, and Facilitate the Incorporation of M&E in the Implementation of All Health Promotion Activities 5.1.3 Identify an HP Staff Person to Focus on M&E and Represent HED in M&E Steering Committee Meetings

5.1.4 Develop M&E Framework with DPPI and Partner Support 5.1.5 Review and Incorporate Behavioral Indicators into Existing Monitoring Systems, e.g., the Health Management Information System (HMIS)

5.1.6 Ensure HP M&E Framework Is Included in MOHS M&E Trainings to Districts National Health Promotion Strategy (2017–2021) 34 OBJECTIVE 6. STRENGTHEN KNOWLEDGE SHARING AND MANAGEMENT Functioning knowledge management systems are crucial to the success of this Strategy and the impact of national health promotion activities. It is essential that the HED has a strong documentation, filing and sharing system. Broadly speaking, beginning with the simplest and highest priority and continuing to the more complex later priorities, the following initiatives will be pursued over the life-span of this Strategy: • Develop a functional library of health promotion materials and resources in a venue that is easily accessible to the widest array of programme partners • Establish a consistent, long-term plan for meetings and events that can be used as opportunities for information exchange • Create a health promotion newsletter to share information on tools, partners and programmes • Establish standard, intuitive and consistently-applied electronic filing systems in directories accessible to a number of HED staff • Create a system of health-promotion-related listservs for members of the health promotion and communication pillars to share information with each other Given the relatively low access to internet connectivity, a priority for this Strategy will be to invest in improving internet access at the national and district level. In the meantime, face-to-face knowledge sharing systems are being emphasised. A functioning knowledge management system will share critical data, best practices, guidelines and other important documents to improve overall efficiency, coordination and leadership. Major activities for this objective: 6.1.1 Develop a Knowledge Management Plan Based on 2016 Knowledge Management Assessment 6.1.2 Provide Technical Assistance to Districts to Implement Knowledge Management Plan

6.1.3 Ensure the HED and District SM Coordinators Have Internet Connectivity and an IT Person at the National Level 6.1.4 Organize Electronic Files at HED (Maintaining the Knowledge Gateway) 6.1.5 Organize Hardcopy Files at HED (Completing Filing System) 6.1.6 Create Tailored Email Listservs that Include Relevant Partners 6.1.7 Create Electronic and Hardcopy Versions of Health Promotion Newsletter Quarterly for Nationwide Distribution 6.1.8 Ensure HED Page is on MOHS Website, Linking to Knowledge Gateway

6.1.9 Hold Best Practices Exchange Semi-annually through SM Pillar Meeting National Health Promotion Strategy (2017–2021) 35 APPENDIX A. ADDITIONAL HEALTH LANDSCAPE IN SIERRA LEONE This section provides additional information on the health landscape in Sierra Leone, as indicated in the Situation Analysis. Immunizations The number of children fully vaccinated by age 12 months increased in the five years between the 2008 DHS and 2013 DHS, from 31percent to 58percent, and more than half of children were fully vaccinated by the age of five years old. In addition, the number of children who received no vaccinations decreased to just 4percent in 2013. Reports about vaccination rates during the Ebola outbreak are conflicted, with some reporting rates declined due to vaccination campaigns being cancelled along with fear of becoming infected by Ebola either by the vaccines or by attending a facility (Takahashi et al., 2016). The drop in vaccination rates manifested in outbreaks of measles and other diseases (Patel, 2016), but toward the end of the Ebola epidemic, the children of Sierra Leone were again benefiting from mass vaccination campaigns. However, 19.7 percent of mothers are unaware that they need to bring children back to repeat immunizations (Expanded Programme on Immunization[EPI] Report, 2013). Further, 31.9 percent of mothers are not aware of the need to return for the tetanus vaccine (EPI Report, 2013). Care-seeking Barriers Many external and internal factors influence care-seeking practices, which are important to understand in order to increase utilization of services, such as: • Infrastructure In Sierra Leone, the overall infrastructure of the health system is inadequate to serve the population’s health needs, and the limited facilities that do exist are often under-staffed and lacking the proper equipment and supplies (Amnesty International, 2009; UNICEF, 2014). • Transportation Another frequently cited barrier to seeking care is the challenge of going to a facility. Patients considering seeking care at a lower-level facility may be discouraged from even doing that due to the possibility of being referred for a higher level of care and then facing poor roads and long distances with potentially high costs for transportation (Amnesty International, 2009; Oyerinde et al., 2012). • Financial Patients often have to pay out of pocket and on the spot for basic medical supplies and medicines (Amnesty International, 2009; Oyerinde et al., 2012). Two-thirds of respondents in the 2013 DHS identified having enough money for treatment as a barrier to accessing care. Malaria Malaria is the biggest health threat and leading cause of death in Sierra Leone, accounting for one quarter of deaths every year, which amounts to more deaths per year than during the entire Ebola outbreak (2013, DHS). Knowledge of malaria and that it is transmitted by mosquitos is high, but awareness about malaria prevention and treatment-seeking practices, particularly for young children and pregnant women, is lower. National Health Promotion Strategy (2017–2021) 36 The 2013 Malaria Indicator Survey (MIS) found that almost two-thirds of households own a mosquito net, with net ownership being more prevalent in rural areas compared to urban areas; however, very few (17 percent) households had an adequate number of nets (one for every two people) and living in a house with a mosquito net does not guarantee use (MIS 2014). Overall, pregnant women and children under five years are more likely than the general population to sleep under a mosquito net, but the incidence of malaria and malaria-related illness among these vulnerable groups indicates a greater need for further emphasis on sleeping under a net every night and intermittent preventative treatment in pregnancy (IPTp).According to the 2013 MIS, 53 percent of pregnant women and 55 percent of children under five do not sleep under an ITN. When it comes to treatment of malaria in children, according to the 2013 DHS report, nearly two-thirds of children with a fever were taken to a health facility, provider or pharmacy for treatment. Of those children taken to a facility with a fever, 37 percent took artemisin in-based combination therapies (ACTs) for treatment, with most of them taking an ACT within 24 hours of the onset of their fever (DHS 2013). Unfortunately, according to UNICEF (2014), the number of children under five years treated for malaria fell 39 percent during the Ebola epidemic. A number of other studies and experts have expressed concern about the full extent of the impact of the Ebola outbreak on malaria in Sierra Leone, with predictions of a significant rise in the number of cases and a decline in treatment seeking. HIV/AIDS The HIV prevalence rate in Sierra Leone has remained stable (at 1.5 percent) for about a decade, and the country has made significant strides in testing, prevention and treatment, especially among key populations and vulnerable populations such as pregnant women; however, much work remains to be done to reach the national goals of zero new infections and zero AIDS-related deaths. Awareness of HIV/AIDS in the general population is nearly universal and most people are aware of a place they could be tested for HIV, but only 38 percent of women and 14 percent of men reported in the 2013 DHS that they had ever been tested for HIV and received their results. Further, 75 percent of women and 69 percent of men do not have comprehensive knowledge on HIV AIDS prevention and transmission (DHS, 2013). Even among pregnant women, a vulnerable population, rates of testing remain low, with nearly two-thirds of pregnant women receiving HIV counseling during an ANC visit, but only 43 percent being tested for HIV (2013 DHS). Despite low levels of testing among pregnant women, there is very high coverage of prevention of mother-to-child transmission (PMTCT). In the general population, ART coverage has increased in recent years, yet it remains low among adults at 39 percent. Commercial sex workers and their clients contribute to 40 percent of new HIV infections, so there has been a major focus on this population. Just between 2013 and 2014, a significant increase was seen in the percentage of sex workers who had been tested for HIV within the past 12 months and those who reported using a condom with their most recent client (UNAIDS, 2014); however, the Ebola outbreak hindered the national AIDS response as resources previously dedicated to HIV prevention and treatment were redirected to the Ebola epidemic. In addition, with fear of contracting Ebola keeping people from going to health facilities, the number of people being tested and treated for HIV undoubtedly decreased. National Health Promotion Strategy (2017–2021) 37 Tuberculosis Very limited data is publicly available about tuberculosis (TB) in Sierra Leone, including precise figures about the current incidence rate of TB; however, recent statistics indicate that TB remains a significant health issue in Sierra Leone. Between 2004 and 2007 the number of registered cases almost doubled, although during that same period the detection rate also increased slightly (MOHS, 2010). The TB treatment success rate did increase between 2000 and 2009, but in 2010 it dropped to the level it was in 2000 (79 percent) (MOHS, 2010). This could have been simply an anomaly or an indication of a larger issue, including possibly being related to the emergence of multi-drug resistant TB (WHO, 2015). No data or reports were located which address the effect of the Ebola outbreak on TB, yet given the closure of facilities and diversion of resources to the Ebola crisis, it is likely that the situation related to TB worsened during the Ebola outbreak. Diarrhea The prevalence of diarrhoea went down from 15 per cent in 2010 (MICS) to 11 percent in 2013 (DHS). As is the case in many other developing countries, however, diarrhoea is still a leading cause of death among children in Sierra Leone, accounting for 12percentof the deaths of children under five years old (Liu et al., 2012). A combination of not seeking treatment at a facility and low knowledge of home treatment measures increases the danger of diarrhoea for children in Sierra Leone. Reports have revealed varying levels of knowledge of causes of and appropriate courses of action for diarrhea. Studies in Sierra Leone have found that people often correctly identify the cause of diarrhea as poor hygiene conditions and practices, but when probed, respondents also identified other causes, some of which were rooted in myths and superstitions (Kanu et al., 2014; McMahon et al., 2013). In terms of treatment, 15 percent of children with diarrhea had not been treated with oral rehydration salts (ORS).Furthermore, the 2013 DHS revealed inappropriate home treatment measures, with four in 10children with a diarrhea episode given less to drink and six in 10children given less or no food. This combination of not seeking treatment at a facility and low knowledge of home treatment measures increases the danger of diarrhea for children in Sierra Leone. Childhood Nutrition The prevalence of global acute malnutrition decreased from 9.6 percent for boys and 7.4 per cent for girls in 2010 (MICS) to 5.7 per cent for boys and 3.8 percent for girls in 2014 (Sierra Leone National Nutrition Survey, 2014). The 2014 Sierra Leone National Nutrition Survey further states that little more than one quarter of all children under five years of age are stunted in Sierra Leone (28.8 percent with a higher percentage of boys [32 percent] than in girls [25 percent]), showing a slight improvement since the 2013 DHS,7 but suggesting that children in Sierra Leone are still not being properly nourished. Another indication of poor childhood nutrition is that four out of five children are anemic, with over half of those being moderately or severely anemic (DHS, 2013). In addition, 41 percent of children up to six months of age are not exclusively breastfed and 63.6 percent of children under two years of age do not have the minimum dietary diversity (SMART Survey 2014). Moreover, according to UNICEF, more than half of children under age two are not appropriately fed with complementary foods and a majority are not getting a variety of foods often enough (UNICEF Sierra Leone). 7 According to the 2013 DHS report, only seven percent of babies were considered to have a low birth weight; however, for children under five years old 38 percent were stunted and 16 percent were underweight. National Health Promotion Strategy (2017–2021) 38 In addition to improper feeding practices, malnutrition among children who are breastfeeding also is affected by the mother’s size and her likely nutritional status. The 2013 DHS found that if a mother’s body mass index (BMI) was considered to be in the range of thin or underweight, her child was more likely to be underweight than mothers with higher BMIs. In Sierra Leone, just over half of infants were breastfed within the first hour of birth. A study by Save the Children (2012) revealed the belief that water, not breastmilk, should be the first meal for a newborn, and the same study also found that mothers typically thought that colostrum was bad and should be discarded. Prior to the Ebola outbreak the government recognized the promotion of exclusive breastfeeding as a priority and was also working on adopting a Code on Marketing of Breast Milk Substitutes to reduce the amount of promotion of breast milk substitutes and encourage breastfeeding. Water, Sanitation and Hygiene Steady progress has been made in improving water and sanitation conditions in Sierra Leone, leading to the 2013 DHS report finding that three out of five households obtain drinking water from an improved source. Unfortunately, there is a significant urban-rural disparity (89 percent compared to 48 percent of households). Only ten percent of households use an improved, unshared toilet facility, and again there is a significant urban-rural disparity (20 percent compared to five percent). In households where a place for hand washing was observed, nearly half had no water, soap or other cleaning agent (2013 DHS), but with the focus on hand washing and hygiene during the Ebola outbreak it is likely that more households are practicing proper hygiene behaviours. Further, 60 percent of households do not wash hands after cleaning a child who defecated, and 14 percent of households do not wash hands after defecating (SLNNS, 2014). Handwashing areas were observed in 22 percent of households (DHS, 2013). Gender-based Violence and Domestic Violence Gender-based violence, including forced marriage and rape, was widespread during Sierra Leone’s civil war, and unfortunately remains commonplace in the post-conflict context with more than half of women having experienced physical violence and 11percentexperiencing sexual violence at some point in their adult lives (2013, DHS). In addition to domestic violence, females in Sierra Leone are subject to gender-based violence at young ages through female genital mutilation (FGM), early marriage, rape and school-related sexual abuse. According to the 2013 DHS, nine out of ten women have experienced some form of circumcision. Furthermore, girls reported that they faced a greater risk of sexual exploitation or assault during the Ebola outbreak. Other girls reported that some girls turned to transactional sex to support themselves after their family members lost their lives to Ebola (Risso-Gill & Finnegan, 2015). Non-communicable Diseases Information on non-communicable diseases (NCDs) in Sierra Leone is scarce. The little that is known points to NCDs such as cardiovascular diseases, cancers and diabetes being health issues needing more attention. According to the WHO (2015), NCDs accounted for around one quarter of deaths in Sierra Leone, with cardiovascular diseases being the most common NCD cause of death. Women’s Participation in Decision Making Examining women’s participation in making decisions about their family’s health care reveals that women in Sierra Leone have very limited autonomy. Tellingly, even when it comes to their own National Health Promotion Strategy (2017–2021) 39 healthcare, only one in 10women can make a decision on their own, without consulting anyone else (2013, DHS). For the healthcare of children, women typically share decision-making authority but play a more prominent role. According to a recent study (Wittels, 2016), this greater role for women is due to their ability to identify symptoms and act quickly in emergencies because they spend more time with the children. Influences on Healthcare Decision Making and Care-seeking • Trust in Services and Providers A recent study (Wittels, 2016) found that people typically trust health workers to provide information on health, but when it comes to providing services that improve health conditions, people have more doubt in the personal and medical treatment provided by nurses and doctors. There are indications that trust in the health system diminished due to rumours and misconceptions about the role of health facilities and providers in the outbreak. • Family Involvement Male involvement can motivate women to seek services at facilities and, as such, men can be an important catalyst for improved care-seeking practices. Female relatives and friends can also have a strong influence on health decisions and care-seeking. Generally, Sierra Leoneans also turn to friends and relatives who have experience with the problem (Wittels, 2016). National Health Promotion Strategy (2017–2021) 40 APPENDIX B. REVIEW OF NATIONAL POLICY AND GUIDANCE Below is a very brief summary of the key points made in the 2010 Policy, and the participants’ observations. Leadership for Coordination and Impact • This section of the 2010 Policy called for the establishment of a Health Promotion Directorate; using the term “Health Promotion” rather than “Health Education”; re- examining the qualifications, staffing and professional progression of health promotion staff; and ensuring adequate health promotion funding. • Participants in the May 2016 review discussion felt that, while there had been some progress made on the staffing issue, there was still substantial work to do. Funding remains inadequate and budgets need to be drafted for local council consideration. Implementation Plan • This section of the 2010 Policy called for the establishment of district health promotion units; health promotion becoming a core function of all ministries/departments; broadened health promotion partnerships; health promotion becoming central to development agenda; and coordination in materials development. • Participants in the May 2016 review discussion felt that materials development was well coordinated during the Ebola outbreak response. Materials were presented to the SM subcommittee and vetted. During the Ebola response, the district SM committees and their coordinators also helped coordinate materials development and distribution and other SM activities. However, the district SM committees are not as structured as they would like them to be. For example, some districts do not have an office for their SM coordinator. In addition, there is more work to do to position health promotion across the development agenda in various ministries. Some progress was made during the Ebola response, and some efforts made to link health promotion in agriculture and social welfare, but more work is needed to ensure it is truly crosscutting. Capacity Building • This section of the 2010 Policy called for multiple channels of instruction to build health promotion skills; a health promotion “human resource development plan” to promote career opportunities; training opportunities at degree level, including fellowships/scholarships; pre-service training programmes with public and private universities within Sierra Leone; and continuing education workshops, seminars and conferences. • Participants in the May 2016 review discussion felt people were eager for capacity building opportunities, but those options were not available. While occasional as-needed continuing education workshops do take place, there are no formal plans or annual strategies outlining minimum offerings. Fellowships are hard to come by. Although specific technical courses may not be available, some general public health trainings are available, including a bachelor degree programme that will soon start at the University of Makeni. National Health Promotion Strategy (2017–2021) 41 Health Promotion Practice • This section of the 2010 Policy called for use of participation and empowerment approaches; mainstreaming health promotion across development sectors; broadening partnerships (civil society, academic, public and private sectors); using local/preferred languages with beneficiaries; strengthening health promotion skills; sustainable financing through government budget; and documenting and sharing evidence of effectiveness. • Participants in the May 2016 review discussion felt some progress has been made on this agenda: partnerships for health promotion are expanding; most radio programming and some print materials are available in local languages; and participation and empowerment through district social mobilizers, CHWs, women’s groups and religious and traditional leaders is improved. WHO and UNICEF have also supplemented the district health education structures. Priority Public Health Issues • This section of the 2010 Policy called for an integrated approach to disease based on primary health care principles; addressing inequities and inequalities; addressing new threats (e.g., Avian Influenza [AI], Swine Flu [H1N1], disasters and urbanization); and population-specific health promotion. • Participants in the May 2016 review discussion felt this agenda had been partially accomplished, but substantial work still remains. Policy for Healthy Settings • This section of the 2010 Policy called for health promotion at all levels of the health care system; implementation of the Health Promoting School Concept or Child Friendly Schools; educating parents on communicable and non-communicable health issues; integrating health promotion; and preventing harmful products in recreational settings. • Participants in the May 2016 review discussion felt some progress had been made on this agenda, particularly with some parental education and school-based programming, but much work still remains. Health Communication • This section of the 2010 Policy states that health communication should involve both public and private mass media; emphasise radio; utilize various interpersonal approaches; include locally produced print materials; and include beneficiary involvement in media/material development. • Participants in the May 2016 review discussion felt those goals were partially accomplished. Health promotion staff have developed a healthy collaboration with a network of newspapers and radio stations. While some printing is done outside of Sierra Leone, most materials are locally developed and produced. Generally, beneficiaries are involved in media and programme development. For instance, Sight Savers did a good job involving beneficiaries in recent eye care work. However, beneficiary involvement is not done consistently or thoroughly. Participants felt there was much more that could be done to encourage the use of social media, which is very popular among young people. National Health Promotion Strategy (2017–2021) 42 Building Healthy Public Policies • This section of the 2010 Policy states that health promotion should be integrated into all Government of Sierra Leone policies; a national advocacy committee for health promotion should be established; programmes should focus on reducing the health equity gap; health promotion should address risk factors and social determinants of health; Sierra Leone should use regulations and legislation as a health promotion tool; and the health sector should partner widely. • Participants in the May 2016 review discussion felt some progress had been made building healthy public policies. Perhaps the best evidence was the use of district-level bye-laws during the Ebola outbreak. Sierra Leone also has a national tobacco control taskforce, and tobacco control legislation was in progress at the time of the review. District-level bye-laws have also been used to support bed net distribution and use and address gender-based violence. Sierra Leone has seen a reduction in home deliveries and the Free Health Care Initiative (FHCI) has helped to reduce the health care equity gap. But more can be done in the policy domain related to risk factors, such as during pregnancy, and to address drug and alcohol use among youth. Supportive Structures for Health Promotion • This section of the 2010 Policy states that MOHS should establish an Advisory Council to a Health Promotion Directorate; local health committees at district and community levels with a “functioning multisectoral health promotion team”; health information centres in collaboration with the National Library and various Ministries; an intersectoral task force on health promotion; a Sierra Leone Health Promotion Network; a Sierra Leone health promotion association; and a Sierra Leone health promotion society. The Directorate should work with all NGOs and development partners involved in health promotion. • Participants in the May 2016 review discussion felt some accomplishments had been achieved in developing these supportive structures. For example, during the Ebola outbreak, the Social Mobilization and Advocacy Consortium (SMAC) was a good example of intersectoral collaboration and partnership with NGOs. District SM committees and local health committees are generally established. The national SM pillar is intersectoral. Financing Health Promotion • This section of the 2010 policy called for increased government allocations to health promotion across all Government of Sierra Leone Ministries and Departments; adequate funding of the Health Promotion Directorate by MOHS; the government to tax harmful products, and establish a health promotion foundation to programme that revenue; partner with private sector, civil society and international organizations to mobilize more resources for health promotion; and the Health Promotion Directorate to be characterized by transparency, accountability and efficiency. • Participants all agreed that significant progress still needs to be made at all levels on the health promotion financing agenda. Monitoring • This section of the 2010 Policy called for a national consultation to assess progress and monitor policy implementation; the development of guidelines to monitor policy progress National Health Promotion Strategy (2017–2021) 43 including indicators and targets; documentation and sharing of monitoring findings; and revisions to the 2010 Policy based on findings • Participants in the May 2016 review discussion felt some investments had been made in health promotion M&E by individual programmes and donors, but work remains to be done to put in place a national health promotion monitoring system. National Health Promotion Strategy (2017–2021) 44 APPENDIX C. PRIORITIZED HEALTH PROMOTION NEEDS ACROSS MOHS UNITS During consultations, a number of MOHS directorates and programmes have identified their strategic priorities for health promotion for 2017-2021. By addressing these priorities first, the MOHS will likely achieve the biggest impact on health outcomes in the immediate term, and reinforce the value of health promotion to the various units of the Ministry. These priorities are included below. Directorate of Food and Nutrition: Includes maternal infant and young child nutrition (MIYCN), integrated management of acute malnutrition (IMAM), micronutrients, clinical nutrition and nutrition surveillance and research. • Priority Areas for Health Promotion: According to the Directorate, the priority health promotion issue to address focuses on misuse of ready-to-use therapeutic foods by health workers and community members (e.g., selling the foods in the market and not providing them to the malnourished children). The Directorate found high rates of misuse across the country. Ready-to-use therapeutic food (RUTF) is for children from six to 59 months old who are severely malnourished. Another priority is preventative behaviours, such as promoting growing and eating nutritious foods, especially for pregnant women and children under five. Directorate of Primary Health Care (DPHC): Supports interventions focusing on CHWs and health promotion, including supervising and monitoring CHWs. • Priority Areas for Health Promotion: With more than 20 catchment communities, the number one priority for the DPHC is ensuring CHWs are recognized for playing a key role in promoting health in communities and conducting community-based surveillance. The CHW Hub is represented in each DHMT. The DPHC is working with NGO partners in all the districts and is appealing to all partners to work with them and the CHWs. Directorate of Reproductive and Child Health: Includes the Child Health/Expanded Programme on Immunization (EPI), the Reproductive Health and Family Planning Program and the School and Adolescent Health Program. Each programme has technical and support staff. • Priority Areas for Health Promotion: The top priority is reducing teenage pregnancy, which is the third highest cause for school dropouts. According to the Secretariat for Teenage Pregnancy and as stated earlier, 8 percent of teenagers are impregnated by peers, 35 percent by men 10 years older than them (DHS, 2008). Other priorities include reducing fistula, reducing unsafe abortions and discouraging child marriage. Directorate of Disease Prevention and Control: Includes the following programmes: National Malaria Control Programme (NMCP); National HIV/AIDS Control Programme (NACP); Maternal and Child Health (MCH)/EPI Programme (links to NMCP and NACP); TB/Leprosy Control Programme; Neglected Tropical Diseases Programme; and Disease Surveillance. • Priority Areas for Health Promotion: Priority health promotion issues for the NMCP is increasing bed net usage, especially among pregnant women and children under five, and to use the bed nets all year round, not just during the rainy season. Relatedly, a priority is also to discourage the misuse of bed nets (e.g., using them for fishing). The second priority is to encourage pregnant women to go to ANC for intermittent preventative treatment in pregnancy with National Health Promotion Strategy (2017–2021) 45 sulfadoxine-pyrimethamine (IPTp-SP). For the Expanded Programme on Immunization (EPI) programme, the priority is to use messages to promote getting routine immunizations – which are more sustainable than regularly scheduled mass immunization campaigns – in nearby facilities in order to increase uptake. CHWs need training so they can encourage community members go for routine immunizations, especially now that a second dose of the measles vaccine is required. Another priority is increasing usage of the under five cards, which should be seen as a “passport” to enter school. Directorate of Non-Communicable Diseases: In 2013, with support from the WHO, the Directorate launched its National NCDs Policy and Strategic Plan 2013–2017. The Directorate noted that the four major NCDs are cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. • Priority Areas for Health Promotion: During the launch of the 2013-2017 plan, the Directorate highlighted four behavioural risk factors for NCDs: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol. National Health Promotion Strategy (2017–2021) 46 APPENDIX D. BUDGET FOR NATIONAL HEALTH PROMOTION STRATEGY (2017-2021) Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4 IMPLEMENTATION PHASE

0.1 Launch the Health Promotion Strategy 6,000 - - - - - - - 6,000

0.2 Orient District Teams on the Health Promotion Strategy - 3,000 - - - - - - 3,000

0.3 Meet with at Least 10 Partners/Donors to Secure 200 - - - - - - - 200 Commitments to Support Individual Activities

0.4 Develop Detailed TOR for Proposed Technical Advisor - - - - - - - - -

0.5 Recruit Technical Advisor to Support the HED - 10,000 10,000 10,000 40,000 40,000 40,000 40,000 190,000 Subtotal - 6,200 13,000 10,000 10,000 40,000 40,000 40,000 199,200 Inception Phase Total - 6,200 13,000 10,000 10,000 40,000 40,000 40,000 199,200 OBJECTIVE 1: STRENGTHEN HEALTH PROMOTION STRUCTURES SO 1.1: Rejuvenate the Social Mobilization and Communication Pillars at National Level and Strengthen Coordination Mechanisms Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

1.1.1 Review, Update and Disseminate SM Pillar TOR - - - - - - - - -

1.1.2 Support the Finalization and Dissemination of the - - - - - - - - - Communications Pillar TOR

1.1.3 Hold Monthly (More as Necessary) National SM Pillar 150 150 150 150 600 600 600 600 3,000 Meetings 1.1.4 Hold National Communications Pillar Meetings (PHNEOC) 150 150 150 150 600 600 600 600 3,000 Every Two Weeks

1.1.5 Participate in Inter-Pillar Meetings at National Level - - - - - - - - - Called by PHNEOC for Improved Coordination

1.1.6 Conduct Periodic Capacity Assessment for Strengthening - - - - 500 - 500 - 1,000 DRAFT Health Promotion Strategy (2017–2022) 47 National SM Pillar and Provide Support Subtotal 300 300 300 300 1,700 1,200 1,700 1,200 7,000 SO 1.2: Rejuvenate the Social Mobilization Pillar at District Level and Strengthen Coordination Mechanisms Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4 1.2.1 Review, Update and Disseminate District Level SM Pillar - - - - - - - - - TOR 1.2.2 Map Active SM Pillar Partners and Identify Dormant SM - - 5,330 - - - - - 5,330 Pillars

1.2.3 Hold a Revitalization Meeting to Present Mapping - - - 1,000 - - - - 1,000 Landscape with Recommendations, TOR and Roles/Responsibilities

1.2.4 Conduct Two-day Capacity Assessment Meetings and - - - 30,000 - 30,000 - - 60,000 Support (e.g., Training) for all District SM Pillars

1.2.5 Hold Monthly District-level SM Pillar Meetings (More 100 100 100 100 400 400 400 400 2,000 Frequently as Needed) and Circulate Meeting Minutes

1.2.6 Attend Monthly District Coordination Meetings in person - - - - - - - - - and include HP on the agenda, while serving as health advocates

1.2.7 Map and Develop MOUs with Functional Community - 500 500 - - - - - 1,000 Radio Stations in Each District for Message Dissemination Subtotal 100 100 5,930 31,100 400 30,400 400 400 68,830 SO 1.3: Strengthen Community-level Actors and Foster Community Ownership of Health Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4 National Health Promotion Strategy (2017–2021) 48

1.3.1 Develop and Disseminate Guidance on HP Roles and - 45,000 20,000 15,000 5,000 2,000 2,000 2,000 91,000 Responsibilities for Community Structures (e.g., VDCs, HMCs/FMCs, CHWs, Community Groups, etc.)

1.3.2 Support Integrated Training on HP Roles/Responsibilities - - 10,000 10,000 5,000 5,000 3,000 3,000 36,000 for VDCs/HMCs/FMCs and Community Structures Subtotal - 45,000 30,000 25,000 10,000 7,000 5,000 5,000 127,000 Objective 1 Total 400 45,400 36,230 56,400 12,100 38,600 7,100 6,600 202,830 OBJECTIVE 2: STRENGTHEN NATIONAL HEALTH PROMOTION INTERVENTIONS SO 2.1 Disseminate and Provide Guidelines on Use of Health Promotion Models Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

2.1.1 Develop and Disseminate HP Model/Pathway Brochure - - 1,000 - - - - - 1,000 and Orient Partners on HP Model/Pathway and Other Guidance through Standing Pillar Meetings

2.1.2 Hold Regular MOHS Stakeholders Meetings to Include a - - 50 50 50 50 50 50 300 Mandate in the SLA for Partners to Base Programming on Approved HP Model/Pathway, and Other Guidance Documents (e.g., SM TOR) Subtotal - - 1,050 50 50 50 50 50 1,300 SO 2.2: Support National Integrated Efforts to Reach Adolescents with Health Promotion Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4 National Health Promotion Strategy (2017–2021) 49

2.2.1 Gather and Share Existing Evidence with National and - - - - - - - - - District Partners on Adolescent Health Behaviors through HED Knowledge Gateway

2.2.2 Conduct Biannual Meetings between HED and the School - 100 - 100 200 200 200 200 1,000 Health Program/Secretariat of Teenage Pregnancy to Strengthen Collaboration

2.2.3 Support Adolescent Campaign Design and - - 10,000 45,000 55,000 40,000 30,000 25,000 205,000 Implementation

2.2.4 Support Advocacy on the Need to Reach Adolescents - - - - 25,000 - - - 25,000 (e.g., Religious and Community Leaders)

2.2.5 Facilitate Community-level Adolescent-focused Program - - - - 16,000 30,000 25,000 25,000 96,000 Activities Subtotal - 100 10,000 45,100 96,200 70,200 55,200 50,200 327,000 SO 2.3: Strengthen Community-level Actors in Health Promotion Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

2.3.1 Conduct Mapping of Materials/Job Aids for Community- - - 14,000 - - 1,000 - 1,000 16,000 level Actors and Supporting Partners to Identify Gaps

2.3.2 Develop Health Promotion Materials/Job Aids for - - - - 51,500 55,000 - - 106,000 Community-level Actors Based on Mapping/Review

2.3.3 Provide Opportunities (Training) for Community-level - - - - - - 75,000 25,000 100,000 Actors to Use Health Promotion Materials and Become Health Promotion Advocates

2.3.4 Conduct Mapping of Materials/Job Aids for In-service - - 7,500 - - 3,000 - 3,000 13,500 Healthcare Workers to Identify Gaps

2.3.5 Develop Health Promotion Materials/Job Aids for - - - - 51,000 55,000 - - 106,000 Interpersonal Communication Skills for In-service Healthcare Workers

2.3.6 Provide Training for In-service Healthcare Workers on - - - - - - 100,000 80,000 180,000 National Health Promotion Strategy (2017–2021) 50 Interpersonal Communication Skills and Using Job Aids/Materials and Provide Follow-up Support (Incentives, Mentoring, Supportive Supervision) Subtotal - - 21,500 - 102,500 114,000 175,000 109,000 522,000 SO 2.4: Establish Evidence-base on Behaviours and Communication Channels to Guide Programming Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

2.4.1 Conduct Desktop Analysis to Identify Evidence Gaps on - - - 3,100 - - - - 3,100 Knowledge, Attitudes, Practices and Behaviors Related to Priority Health Areas and Audiences

2.4.2 Support the Design, Implementation and Dissemination - - - - 5,000 55,000 5,000 55,000 120,000 of Studies to Fill Gaps in Evidence (See 2.4.1)

2.4.3 Orient Government Agencies and Partners on Using - - - - 6,500 - - 6,500 13,000 Evidence in SBCC Programming

2.4.4 Facilitate National Communication Channels Assessment - - - - - - 24,720 - - to Map Existing Approaches and Effectiveness, Selecting Key Channels/Approaches (e.g., Radio, Mobile, TV, Community Engagement)

2.4.5 Based on Assessment, Invest in Select Communication - - - - - 10,200 113,200 - 123,400 Channels for Health Promotion (See 2.4.4) Subtotal - - - 3,100 11,500 65,200 142,920 61,500 284,220 SO 2.5 Develop and Launch a National Health Promotion Campaign Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

2.5.1 Develop a National Health Promotion Campaign that - - - - 125,000 - - - 125,000 National Health Promotion Strategy (2017–2021) 51 Includes a National Logo

2.5.2 Hold National- and District-level Campaign Launches - - - - 21,000 - - - 21,000

2.5.3 Roll Out National Campaign (e.g., Broadcast, Print - - - - 60,000 - - - 60,000 Distribution)

2.5.4 Monitor and Evaluate National Campaign Outcomes - - - - - 20,000 20,000 20,000 60,000 Subtotal - - - - 206,000 20,000 20,000 20,000 266,000 SO 2.6 Facilitate Development of an Emergency Communication Plan Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

2.6.1 Contribute to Emergency Communication Plan and - - - - - - - - - Training Curriculum

2.6.2 Support Emergency Communication Training at District- - - - - 10,000 - - - 10,000 level Subtotal - - - - 10,000 - - - 10,000 Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4 SO 2.7 Strengthen Integration of Health Promotion Activities with Activities in Other Sectors – e.g., Education, Agriculture, Youth – to Achieve Health and Development Gains

2.7.1 Convene Multi-stakeholder Meetings with Relevant - - - 2,000 - 2,000 - 2,000 6,000 Ministries to Integrate Health Promotion

2.7.2 Assign HP Role (e.g., Seconded, Focal Point) to Support - - - - - - - - - HP Activities in Four Ministries (e.g., Education, Agriculture, Youth, Gender) National Health Promotion Strategy (2017–2021) 52 Subtotal 2,000 2,000 2,000 6,000 SO 2.8 Launch in Full Effect a National Public Health Information Line Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

2.8.1 Conduct Resource Mobilization Activities and Secure - - 20,700 38,700 154,800 140,400 140,400 140,400 635,400 Funding from Stakeholders

2.8.2 Set-up a Toll-free Hotline Number or - - - - 57,900 27,900 57,900 27,900 171,600 Operationalize/Broaden the Scope of the Existing Ministry of Health’s 117 Call Centre Line 2.8.3 Conduct Activities to Educate the Public on Using the - - - - - - - - - Public Health Line

2.8.4 Integrate the Call Centre Approach to Health Promotion - - 1,500 - - - - - 1,500 in all MOHS Strategic Plans as Part of Strengthening a Continuous National level Method of Health Promotion

2.8.5 Conduct Trainings for Call Centre Health Promotion and - 1,500 1,500 1,500 6,000 6,000 6,000 6,000 28,500 Information with Staff Subtotal - 1,500 22,200 41,700 218,700 174,300 204,300 174,300 837,000 Objective 2 Total - 1,600 54,750 91,950 644,950 445,750 597,470 417,050 2,253,520 OBJECTIVE 3: IMPROVE HUMAN RESOURCES AND CAPACITY STRENGTHENING FOR HEALTH PROMOTION SO 3.1 Develop Training Program for Pre-service and In-service Health Promotion Professionals Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4 National Health Promotion Strategy (2017–2021) 53

3.1.1 Develop National Training Plan of In-service Training - - 15,000 - - - - - 15,000 Opportunities for HP Professionals

3.1.2 Assign HED Staff to Attend International Health - - - - 4,500 - - 4,440 8,940 Conference (e.g., ASTMH, SBCC Conference) and Health Communication Study Tour (e.g., WHO)

3.1.3 Hold At Least One HP-focused Capacity Building TOT Per - - - - 25,000 25,000 25,000 15,000 90,000 Year for HED and Partners at National/District Level (e.g., DSMCs ) – As Per Training Plan

3.1.4 Hold a Strategic Health Communication Training in Sierra - - - - - 45,000 - - 45,000 Leone (Repeated Every Three Years) – As Per Training Plan

3.1.5 For Pre-service Training, Assess and Finalize Potential - - - - 2,500 2,500 - - 5,000 Partnership with Training Institution(s) 3.1.6 Develop Curriculum with Selected Training Institution(s) - - - - - - 30,000 - 30,000

3.1.7 Provide Annual General Support to Institution to - - - - - - 25,000 25,000 50,000 Implement Training, (e.g., Support for Faculty, Materials) Subtotal - - 15,000 - 32,000 72,500 80,000 44,440 243,940 SO 3.2 Review and Update Human Resources for Health Policy to Include Health Promotion Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

3.2.1 Update and Clarify HP Roles/Responsibilities, Terms of - - - - - - - - - Service and Professional Development to Guide MOHS Leadership (Annually)

3.2.2 Advocate with MOHS Human Resources for Health and - - - - - - - - - Partners to Influence Strengthening HED Workforce Subtotal - - - - - - - - - National Health Promotion Strategy (2017–2021) 54 Objective 3 Total - - 15,000 - 32,000 72,500 80,000 44,440 243,940 OBJECTIVE 4: RAISE AWARENESS AND MOBILIZE RESOURCES FOR STRENGTHENED HEALTH PROMOTION SO 4.1 Advocate for Increased Funding, Operational Support and Human Resources for Health Promotion Activities Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

4.1.1 Develop Advocacy Plan to Identify Objectives, Key - - - - - 11,000 - - 11,000 Audiences, Messages and Opportunities to Raise the Profile of HP and Mobilize Resources 4.1.2 Develop and Disseminate Evidence Briefs on Impact and - - - - - 2,750 - 2,750 5,500 Importance of HP in Sierra Leone 4.1.3 Hold Training for Journalists to Orient Press on Covering - - - - - - 16,000 - 16,000 Health Promotion Stories

4.1.4 Hold National Media Event to Launch Evidence Briefs - - - - - - 7,500 - 7,500 and Raise Visibility of Health Promotion

4.1.5 Orient District-level Decision-makers (e.g., District - - - - - - - 20,000 20,000 Council, VDCs, FMCs/HMCs) on Impact of HP via Advocacy “Road Shows”

4.1.6 Hold Advocacy Meeting with Parliamentary Health - - - - - - - - - Committee to Showcase HP Successes and Advocate for Increased Funding for Health Promotion Subtotal - - - - - 13,750 23,500 22,750 60,000 SO 4.2 Engage at Least Five New Private Sector Institutions to Invest in National Health Promotion Activities Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

4.2.1 Develop Private Sector Brochure Outlining Options for - - - - - 5,000 - - 5,000 National Health Promotion Strategy (2017–2021) 55 Investing in HP in Sierra Leone, with a Business Case for Investing in HP

4.2.2 Hold Annual Business Networking Forums to Encourage - - - - - 13,400 4,850 4,850 23,100 Investments in Health Promotion Subtotal - - - - - 18,400 4,850 4,850 28,100 Objective 4 Total - - - - - 32,150 28,350 27,600 88,100 OBJECTIVE 5: IMPROVE MONITORING AND EVALUATION SYSTEMS FOR HEALTH PROMOTION Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

5.1.1 Hold Stakeholder Meeting to Agree on HP Monitoring - - - 500 - - - - 500 Indicators and M&E Priorities for HP

5.1.2 Create M&E Subcommittee with a TOR within the SM - - - - 2,000 2,000 2,000 2,000 8,000 Pillar, and Facilitate the Incorporation of M&E in the Implementation of All Health Promotion Activities

5.1.3 Identify an HP Staff Person to Focus on M&E and - - - 5,500 22,000 22,000 22,000 22,000 93,500 Represent HED in M&E Steering Committee Meetings

5.1.4 Develop M&E Framework with DPPI and Partner - - - - - - - - - Support

5.1.5 Review and Incorporate Behavioral Indicators into - - - - - - - - - Existing Monitoring Systems (e.g., HMIS)

5.1.6 Ensure HP M&E Framework is Included in MOHS M&E - - - - - - - - - Trainings to Districts Subtotal - - - 6,000 - 24,000 24,000 24,000 78,000 Objective 5 Total - - - 6,000 - 24,000 24,000 24,000 78,000 National Health Promotion Strategy (2017–2021) 56 OBJECTIVE 6: STRENGTHEN KNOWLEDGE SHARING AND MANAGEMENT Year 1 Year 2 Year 3 Year 4 Year 5 Total Q1 Q2 Q3 Q4

6.1.1 Develop a Knowledge Management Plan Based on 2016 - - - - - - - - - Knowledge Management Assessment 6.1.2 Provide Technical Assistance to Districts to Implement - 1,000 1,000 - 2,000 2,000 2,000 2,000 10,000 Knowledge Management Plan

6.1.3 Ensure HED and District SM Coordinators Have Internet 10,000 10,000 40,000 40,000 40,000 40,000 180,000 Connectivity and IT person at the National Level

6.1.4 Organize Electronic Files at HED (Maintaining the - - - - - - - - - Knowledge Gateway)

6.1.5 Organize Hardcopy Files at HED (Completing Filing - - - - - - - - - System) 6.1.6 Create Tailored Email Listservs that Include Relevant - - - - - - - - - Partners

6.1.7 Create Electronic and Hardcopy Versions of Health - - - - 1,000 1,000 1,000 1,000 4,000 Promotion Newsletter Quarterly for Nationwide Distribution

6.1.8 Ensure HED Page is on MOHS Website, Linking to - - - - - - - - - Knowledge Gateway

6.1.9 Hold Best Practices Exchange Semi-annually through SM - - - - 3,500 3,500 3,500 3,500 14,000 Pillar Meeting Subtotal - 11,000 1,000 10,000 46,500 46,500 46,500 46,500 208,000 Objective 6 Total - 11,000 1,000 10,000 46,500 46,500 46,500 46,500 208.000 Quarterly Total 6,,600 71,000 116,980 174,350 775,550 699,500 823,420 606,190 3,273,590 National Health Promotion Strategy (2017–2021) 57 APPENDIX E. BUDGET NOTES FOR THE NATIONAL HEALTH PROMOTION STRATEGY (2017-2021) This document provides the assumptions and estimating parameters used to develop the projected expenditures for a 5-year budget (January 2017- December 2021) in sufficient detail to permit analysis of proposed costs. We have presented supporting detail by cost element, and in cases where vendor estimates are not available, projections are based on our experience with projects of similar size and scope. INCEPTION PHASE

0.1 Q1, Y1: Launch the Health Promotion Strategy: A national launch event with a press release and media will be held to raise awareness of the new strategy to MOHS officials and partners. Copies of the Strategy will be printed and disseminated to guests. Cost for the launch, which includes printing and refreshments, is estimated at $2,000.

0.2 Q1, Y1: Orient District Teams on the Health Promotion Strategy: Following the national launch, an orientation for representatives from all 14 districts will take place in Freetown. Costs will include travel expenses to Freetown for 26 district representatives, in addition to refreshments. Total cost is $6,000.

0.3 Q1, Y1: Meet with at Least 10 Partners / Donors to Secure Commitments to Support Individual Activities: In order to fund activities in this strategy, the HED will meet on several occasions with partners to determine which activity or set of activities they want to adopt or financially support. This activity will take place in the first quarter of 2017, and costs for this exercise include transportation, for a total amount of $200.

0.4 Q1, Y1: Develop Detailed TOR for Proposed Technical Advisor: The HED will develop a TOR defining the scope of work to recruit a technical advisor (see below). There are no costs associated with this activity.

0.5 Q2, Y1: Recruit Technical Advisor to Support the HED: Given the staff shortages within the HED, a technical advisor will be recruited to support the HED in implementing activities in this strategy. The HED will develop a TOR in the first quarter of 2017 but it is expected that this person will be primarily in charge of resource mobilization, M&E systems development, and capacity strengthening. This technical advisor could be seconded staff from partner organization. This person will be recruited in the second quarter of 2017, to be sustained through the five years. Estimated costs for this person is $40,000 per year ($10,000 per quarter), for a total for the five years of $190,000. DRAFT Health Promotion Strategy (2017–2022) 58 OBJECTIVE 1: STRENGTHEN HEALTH PROMOTION STRUCTURES SO 1.1: Rejuvenate the Social Mobilization and Communication pillars at National level and Strengthen Coordination Mechanisms

1.1.1 Q1, Y1: Review, Update and Disseminate SM Pillar TOR: HED developed a TOR for the SM Pillar, describing how it will function, the development of which partners supported. This TOR will be disseminated to government officials and key partners at the national level by email listservs and in-person during an SM Pillar meeting and the NGO forum, and will be maintained on the HED’s Knowledge Gateway. The TOR will be reviewed yearly and updated as needed. There are no costs associated with this activity.

1.1.2 Q2, Q3, Yi: Support the Finalization and Dissemination of the Communications Pillar TOR: HED is supporting the finalization of the TOR for the Communications Pillar. Similar to the SM Pillar TOR, this TOR will be disseminated to government officials and key partners at the national level by email listservs and in-person during a Communications Pillar meeting and the NGO forum, and will be maintained on the HED’s Knowledge Gateway. The TOR will be reviewed yearly and updated as needed. There are no costs associated with this activity.

1.1.3 Y1-Y5: Hold Monthly (more as necessary) National SM Pillar Meetings: SM Pillar chairs HED with UNICEF will host these meetings every month, with additional meetings called as needed. Meeting minutes will be taken and circulated to inform other partners and district level representatives of key outcomes. At least one HED representative from the SM Pillar will also attend the Communications Pillar, and report to the respective Pillars on activities to ensure coordination. Estimated costs are $600 per year refreshments, printing, etc. ($50/two meetings per month). Estimated total cost for the five years is$3,000.

1.1.4 Y1-Y5: Hold Regular National Communications Pillar Meetings (PHNEOC) Every Two Weeks: The HED has seconded a staff member to help lead the Communications Pillar, which the CDC is also supporting. At lest one HED representative from the Communications Pillar will also attend the SM Pillar, and report to the respective Pillars on activities to ensure coordination. Estimated costs are $600 per year refreshments, printing, etc. ($50/two meetings per month). Estimated total costs for the five years is $3,000. National Health Promotion Strategy (2017–2021) 59

1.1.5 Y1-Y5: Participate in Inter-Pillar Meetings at National Level Called by PHNEOC for Improved Coordination: One HED representative will participate in Inter- Pillar meetings, which are scheduled on an as needed basis to ensure coordination with other national efforts, including the SM and Communications Pillars. There are no costs associated with this activity.

1.1.6 Y2 & Y4: Conduct Periodic Capacity Assessment for Strengthening National SM Pillar and Provide Support: A health promotion capacity assessment of SM Pillar members will occur once every two years (Y2 and Y4). Based on those results, additional support will be provided through SM Pillar meetings and other partners based on their technical expertise. This activity will involves: ● Y2 & Y4: Using capacity assessment tools and facilitating two, 2-day meetings with key partners in the SM Pillar. A technical support person will guide participants through filling out the survey tools during the meetings. Estimated costs are $350 for lunch and refreshments (30 people at $11.67 per person), plus $150 for local transportation ($5 per person for 30 people) for an estimated total of $1,000 ($500 per year). ● Y2 & Y4: Technical support will be provided based on results. The Pillar can address and recruit partners to help provide that support during special sessions in SM Pillar meetings and other channels. Estimated total cost for this activity is $1,000. SO 1.2: Rejuvenate the Social Mobilization pillar at District Level and Strengthen Coordination Mechanisms

1.2.1 Q1, Y1: Review, Update and Disseminate District Level SM Pillar TOR: Similar to the national level SM Pillar TOR, the HED is developing a TOR for the district-level SM Pillars. This TOR will be disseminated to government officials and key partners at the district and national level by email listservs and in-person during national and district-level SM Pillar meetings, and will be maintained on the HED’s Knowledge Gateway. The TOR will be reviewed yearly and updated as needed. There are no costs associated with this activity. National Health Promotion Strategy (2017–2021) 60

1.2.2 Q2-Q3, Y1: Map Active SM Pillar Partners and Identify Dormant SM Pillars: A stakeholder mapping meeting will be held to identify which district SM Pillars are dormant, and determine who will be responsible for certain roles within the pillar (e.g., inviting partners, chairing meetings, meeting minutes, etc.), and to determine additional support needs to rejuvenate and sustain them. Assuming the venue will be the district offices, estimated costs to conduct the mapping include sending two people from Freetown to 13 Districts, totaling $2,180 ($15 for 2 people for transportation totaling $390, $15 for 2 people for meals totaling $390, $54 for lodging for 2 people totaling $1,400) and lunch during the stakeholder meeting for $3,150 (approx. $15 per person for 210 people [15 per district) x 14 districts). Estimated total cost for this activity is $5,330.

1.2.3 Q4, Y1: Hold a Revitalization Meeting to Present Mapping Landscape with Recommendations, TOR and Roles/Responsibilities: Revitalization meetings will be held in each of the 14 districts following the mapping exercises, where district HP coordinators and district pillar leads will present the findings from the mapping exercises, along with the district-level TORs, and clarified roles and responsibilities. Estimated costs for these meetings are for refreshments for 14 districts (approx. 15-20 people per district for $74 per district). Estimated total cost for this activity is $1,000.

1.2.4 Q4, Y1: Conduct Two-Day Capacity Assessment Meeting and Provide Support (e.g., Training) for all District SM Pillars: Using a similar process to the national level health promotion capacity assessment (above), district-level assessments will be held with district representatives and partners. Similar to the process described for the national level assessment, a 2-day facilitated capacity assessment meeting will guide participants in filling out the survey tools. Based on results, an action plan will be developed to fill in gaps with technical assistance (TA). TA will not necessarily be the same each time. The cost for the assessment is estimated at $2,800 for the 2-day meetings in all districts ($200 per meeting x 14 districts), and $5,600 for travel experiences for two HED staff from Freetown to each of 14 districts ($200 x 2 people x 14 districts). At a minimum, estimated costs for providing additional TA will be approximately $12,000 ($3,000 per year starting in Y2) to cover local travel, partner assistance, tools, training, supervision, or many things together. Estimated total costs for this activity is $20,000.

1.2.5 Y1-Y5: Hold Monthly District-level SM Pillar Meetings (more frequently as needed), and Circulate Meeting Minutes: As part of the rejuvenation process, the district-level SM Pillar meetings will be supported with refreshments. Meeting minutes will be taken and circulated to inform other partners and National Health Promotion Strategy (2017–2021) 61 national level representatives of key outcomes. Costs for refreshments will be approx. $400 per year ($16.70 x 12 monthly meetings for 14 districts). Estimated total costs for this activity for the five years are $2,000.

1.2.6 Y1-Y5: Participate in Monthly District Coordination Meetings: One district-level Health Promotion (HP) Coordinator will participate in monthly district coordination meetings, scheduled on an as needed basis, to ensure coordination with other efforts, such as surveillance, and will report back to the national office. There are no costs associated with this activity.

1.2.7 Q2-Q3, Y1: Map and Develop MOUs with Functional Community Radio Stations in Each District for Message Dissemination: The HED will support this activity, which UNICEF is conducting. It is likely that the MOUs will be between UNICEF and the stations, but will be shared with MOHS. Estimated costs for this activity include two trips from Freetown to the 14 districts, at approximately $500 per first round of visits. Estimated total costs for the 2 visits are approximately$1,000. SO 1.3: Strengthen Community-level Actors and Foster Community Ownership of Health

1.3.1 Y1 (Q2-Q4)-Y5: Develop and Disseminate Guidance on HP Roles and Responsibilities for Community Structures (e.g., VDCs, HMCs/FMCs, CHWs, Community Groups, etc.): Integrated health promotion guidelines will be rolled out to these community-level structures and groups. This will involve the following: ● Y1: Community stakeholder meetings at district level to develop a system for feedback between the community and appropriate district and national structures (this could be based on the mapping exercise noted above). This would include roles/responsibilities with accountability mechanisms for addressing community concerns. Estimated costs for the first year total $80,000 ($45,000 for consultant fees and community meetings, $20,000 to support focus group discussions at the district and community level in select regional centers to develop guidance, additional stakeholder meetings to review FDG findings with community-level validation, and $15,000 for printing and dissemination). ● Y2-5: Remaining years--$5,000 for year 2, and $2,000 every year afterward—Include follow-up and re-printing, where needed. Total estimated total costs for this activity is$91,000. National Health Promotion Strategy (2017–2021) 62

1.3.2 Y1 (Q3-Q4)-Y5: Support Integrated Training on HP Roles/Responsibilities for VDCs/HMCs/FMCs and Community Structures: This activity supports training that UNICEF or others are conducting with community groups, to ensure HP in on the agenda. Trainings will be conducted to clarify the VDCs’ and associated community groups’ health promotion roles and to strengthen them in this role. This includes orienting national, district and community stakeholders on the guidance developed above (233 meetings including 218 wards/ meetings, 14 district meetings and 1 national meeting). Estimated costs for cascade training from national to district level include approx. $4,600 per district with an additional $5,000 for national coordination. These estimates are based on 1 PHU staff and 1 VDC member attending trainings held at district level (e.g., 5 trainings per district). Trainings could be simultaneous, meaning there would need to be multiple trainers of district and national teams. Additional coordination costs cover fees, fuel, travel, coordination, communication, etc. Estimated costs for refreshments and printing are included in year 5. Total estimated costs for support for this activity is$36,000. National Health Promotion Strategy (2017–2021) 63 OBJECTIVE 2: STRENGTHEN NATIONAL HEALTH PROMOTION INTERVENTIONS SO 2.1: Disseminate and Provide Guidelines on Use of Health Promotion Models

2.1.1 Q3, Y1: Develop and Disseminate HP Model/Pathway Brochure and Orient Partners on HP Model/Pathway and other Guidance through Standing Pillar Meetings: Shortly after the launch of the HP Strategy, an HP model brochure will be developed and disseminated to partners, who will be oriented on the models and other guidance documents (e.g., SM TOR, etc.) through standing Pillar meetings, Knowledge Gateway, listservs, etc. Estimated costs for this activity are for color printing of a 1-page brochure totaling approximately $100. Estimated total costs for this activity are $100.

2.1.2 Y1 (Q3-Q4)-Y5: Hold Regular MOHS Stakeholders Meetings to Include a Mandate in the SLA for Partner to Base Programming on Approved HP Model/Pathway and Other Guidance Documents (e.g., SM TORs): These meetings will begin in Y1, starting in Q3 and repeated in Q4. For the remaining years, there will be one annual meeting for follow-up as needed. Estimated costs cover refreshments $300 ($50 x 2 in Y1 plus $50 x 3 for Y3-5). Estimated total costs for this activity are $300. SO 2.2: Support National Integrated Efforts to Reach Adolescents with Health Promotion

2.2.1 Y1 (Q3-Q4)-Y5: Gather and Share Existing Evidence with National and District Partners on Adolescent Health Behaviors through HED Knowledge Gateway: This activity involves gathering existing adolescent health-related evidence, adding it to the HED Knowledge Gateway, promoting and disseminating the link to these resources to national/district partners, and ensuring Knowledge Gateway point person within the HED leads efforts to ensure new evidence is uploaded as it is developed. There are no costs associated with this activity.

2.2.2 Y1 (Q2 & Q4)-Y5: Conduct Bi-annual Meetings between HED and the School Health Program / Secretariat of Teenage Pregnancy to Strengthen Collaboration: These bi-annual meetings ensure health promotion is strengthened and coordinated for adolescents in schools and communities. Each meeting will have an agenda and objectives, along with meeting minutes. Estimated costs for these meetings are $1,000 ($100/per meeting x 2 per year x 5 years). Estimated total cost for the five years is$1,000.

2.2.3 Y1 (Q2 & Q4)-Y5: Support Adolescent Campaign Design and Implementation: Technical and financial support will be provided to the Secretariat of Teenage National Health Promotion Strategy (2017–2021) 64 Pregnancy and other partners as needed to carry out an adolescent-focused campaign. This activity will complement activities the Secretariat of Teenage Pregnancy is already leading, broadening them where necessary. Estimated costs for this activity will include technical and financial support to scale up a national adolescent campaign, which may include filling research gaps, strategy and messaging development, campaign materials, national/district advocacy events, and multi-media programming including mobile platforms focused on adolescents. At a minimum, it is estimated that this support would be approximately $50,000 ($10,000 per year starting in Y1). Total estimated costs for this activity, which will also serve as an investment in mass media for health promotion, is$50,000.

2.2.5 Y2: Support Advocacy on the Need to Reach Adolescents (e.g., Religious & Community Leaders): HED will also provide support to the Secretariat of Teenage Pregnancy and others working on adolescent health by conducting advocacy on the need to reach adolescents. Estimated costs include a one-day orientation meeting for the media to cover adolescent health issues and the adolescent-focused campaign (see 2.2.3), totaling $7,000 (e.g., costs for transportation, lunch, venue and printing for approx. 50 journalists) and a one- day orientation to community and religious leaders through formal structures (e.g., Inter-Religious Council) at the national level, to be rolled out to the district level through cascade trainings, totaling $18,000 (e.g., costs for transportation, lodging, meals, printing for 14 districts at $1,285 per district). Estimated total costs for this activity is$25,000.

2.2.6 Y2-Y5: Facilitate Community-level Adolescent-focused Program Activities: Adolescent-focused community engagement activities will also be supported through the Secretariat of Teenage Pregnancy. Estimated costs include the following: ● Y2: Consultant to adapt an existing community engagement (CE) platform (e.g., CLEA, Journey of Hope) to focus on adolescent health issues, totaling an estimated $10,000 ($500/day for 10 days totaling $5,000, and 5 days travel at approximately $5,000). ● Y2: Pretest CE platform for an estimated cost of $6,000. ● Y3: Printing of CE materials for an estimated cost of $10,000. ● Y3: Cascade trainings in select districts for an estimated cost of $20,000. ● Y4 and Y5: Implementation in select communities, with costs to include oversight/supervision and monitoring (approx. $25,000 each in Y4 & Y5). Estimated total costs for this activity is$96,000. SO 2.3: Strengthen Community-level Actors in Health Promotion National Health Promotion Strategy (2017–2021) 65

2.3.1 Y1 (Q3), Y3, Y5: Conduct Mapping of Materials/Job Aids for Community-level Actors and Supporting Partners to Identify Gaps: A request will be made at the national and district levels and through existing forums such as the NGO forum to collect all health promotion materials for community-level actors8, followed by a series of review meetings to review and catalogue all materials/job aids (e.g., good, bad, friendly, outdated, etc.), where the good ones are uploaded to the HED Knowledge Gateway. Additional reviews will occur in Y3 and Y5, with sessions taking place through existing channels and meetings (e.g., SM Pillar meetings). Estimated costs for this activity include approximately $6,500 for the initial mapping exercise in Q3,Y1, which includes travel costs to bring materials from the 14 districts, and refreshments for review meetings, followed by $1,000 every two years to review and catalogue additional materials. Partners will be reached to update outdated materials. Estimated total cost for this activity is$7,500.

2.3.2 Y2-Y3: Develop Health Promotion Materials/Job Aids for Community-level Actors Based on Mapping/Review: Where there are gaps identified in the review above, additional materials/job aids will be developed. Estimated costs for this activity, spread out across Y2 and Y3, involves hiring a consultant to lead development efforts (20 days @ $500/day and travel and other expenses, $20,000), starting with identifying materials/job aids that need updating or developing, holding a 2-day workshop with key district and national level stakeholders to agree on messages and images for the new materials/job aids ($6,500), developing a scope of work and hiring an advertising firm/graphic designers to produce the materials ($25,000), pretesting the materials in at least two districts ($5,000), and printing and distributing the materials to all of the 14 districts for wider community-level distribution among partners ($50,000). Estimated total cost for this activity is $106,500.

2.3.3 Y4-Y5: Provide Opportunities (Training) for Community-level Actors to Use Health Promotion Materials and Become Health Promotion Advocates: Cascade training rolled out across the districts in Y4 and Y5 will orient community agents to harmonize messages, use the job aids/materials, gain effective communication skills, and understand the appropriate role they play in a national system of health promotion. This activity includes developing a cascade training curriculum, identifying facilitators, selecting participants (see example change agents above in 2.3.1), conducting community entry activities, and supervising the roll out of the orientations. Estimated costs for these 8 Community level actors, or change agents, include but are not limited to CHWs, TBAs, VDCs, and community groups such as traditional healers, market women’s associations, community leaders such as traditional leaders, women’s and youth group leaders, social heads, drivers’ unions, bike riders, and teachers. National Health Promotion Strategy (2017–2021) 66 activities include a 3-day TOT workshop ($30,000), printing ($8,000), and implementation of the orientations communities throughout the 14 districts ($25,000). Estimated total cost for this activity is $63,000.

2.3.4 Y1 (Q3), Y3, Y5: Conduct Mapping of Materials/Job Aids for In-service Healthcare Workers to Identify Gaps: Similar to the mapping exercise above, a request will be made to collect materials and job aids (e.g., counseling aids, interpersonal communication materials) for in-service healthcare workers, followed by a series of review meetings to review and catalogue all materials/job aids (e.g., good, bad, friendly, outdated, etc.), where the good are uploaded to the Knowledge Gateway. Reviews will occur annually, with sessions taking place through existing channels and meetings. Estimated costs for this activity include approximately $7,500 for the initial mapping exercise in Q3, Y1, which includes travel costs to bring any hardcopy materials from the 14 districts, support to partners and venue/refreshments for the review meetings, followed by $6,000 ($3,000 every two years) to review additional materials in Y2 & Y5. Partners will be reached to update outdated materials. Estimated total cost for this activity is $13,500.

2.3.5 Y2-Y3: Develop Health Promotion Materials/Job Aids for Interpersonal Communication Skills for In-service Healthcare Workers: Where there are gaps identified in the review above, additional materials/job aids will be developed. Estimated costs for this activity, spread out across Y2 and Y3, involves hiring a consultant to lead development efforts (e.g., 20 days @ $500/day and travel and other expenses, $20,000), starting with identifying materials/job aids that need updating or developing, holding a 2-day workshop with key district and national level stakeholders to agree on messages and images for the new materials/job aids ($6,500), hiring graphic designers to produce the materials ($25,000), pretesting the materials ($5,000), and printing and distributing the materials to all of the 14 districts for wider community-level distribution among partners ($50,000). Estimated total cost for this activity is $106,500.

2.3.6 Y4-Y5: Provide Training for In-service Healthcare Workers on Interpersonal Communication Skills and Using Job Aids/Materials and Provide Follow-up Support (Incentives, Mentoring, Supportive Supervision): Cascade training in Y4 and Y5 rolled out to multiple staff from each facility will harmonize messages, use the job aids/materials and to gain effective interpersonal communication skills. This activity includes developing a cascade training curriculum, identifying facilitators, selecting participants (see example change agents above in 2.3.1), and supervising the roll out of the trainings. Estimated costs for these activities include a 3-day TOT workshop ($30,000), travel to the districts with lodging and National Health Promotion Strategy (2017–2021) 67 meals ($10,000), printing ($5,000), and refreshments and incentives for trainings throughout the 14 districts ($25,000). Estimated total cost for this activity is $180,000. SO 2.4: Establish Evidence-base on Behaviours and Communication Channels to Guide Programming

2.4.1 Q4, Y1: Conduct Desktop Analysis to Identify Evidence Gaps on Knowledge, Attitudes, Practices and Behaviors Related to Priority Health Areas and Audiences: Estimated costs for this activity include these activities: ● Develop a schedule of visits to MOHS programmes, key partners, anthropologists, donors and others, and gather information from them on what evidence exists. There are no costs associated with this activity. ● Hold a desktop review workshop as part of the M&E technical working group’s health promotion sub-ground formed under Objective 5 ($3,000 for the 2-day desktop review workshop [ideally this will be one of the first tasks of the newly formed M&E subcommittee within the SM Pillar—see Objective 5). ● Present results to partners. There are no costs associated with this activity. Estimated total cost for this activity is $3,000.

2.4.2 Y2-Y5: Support the Design, Implementation and Dissemination of Studies to Fill Gaps in Evidence (see 2.4.1): Following the desktop review, the following will occur: ● Y2: Conduct meetings with MOHS programmes, partners and donors to encourage them to design and conduct studies to fill gaps in KAP and behavioral evidence related to priority audiences and health areas. There are no costs associated with this activity. ● Y2: Develop a research plan based on the outcomes of those discussions, and updated each year as needed. This can be done through support from the M&E technical working group or the HED staff. There are no costs associated with this activity. ● Y3 & Y5: Conduct research based on the research plan, including designing the study and tools, selecting locations, training data collectors, and conducting the study. It is anticipated that based on the research plan, partners will conduct these studies and assume these costs ($50,000 for Y3 & Y5). ● Y2-5: Provide technical support to these partners through the M&E technical working group and district coordinators to ensure studies are coordinated, complementary and not duplicative, and reflect national health promotion priorities according to this Strategy. There are no costs National Health Promotion Strategy (2017–2021) 68 associated with this activity. ● Y2-5: Add all evidence and reports to the HED Knowledge Gateway and disseminated via NGO forums, listservs, SM and Communication Pillar meetings, HED newsletter (see Objective 6) and other channels. There are no costs associated with this activity. ● Y2-5: Starting in Q4 of Y2, convene partners to share evidence once a year in health communication evidence-sharing forums, which can be hosted by the M&E subcommittee of the SM Pillar (see Objective 5). Estimated total cost for this activity is $100,000.

2.4.3 Y2 & Y5: Orient Government Agencies and Partners on Using Evidence in SBCC Programming: Through orientation meetings at the national level, national and district government representatives and partners will be briefed on how to use evidence in programming. These orientations will occur through existing channels and meetings once every two years. Estimated costs for this activity include travel for district representatives to Freetown, printing and refreshments, for $3,500 per meeting. Estimated total cost for this activity is $7,000.

2.4.4 Y4: Facilitate National Communication Channels Assessment to Map Existing Approaches and Effectiveness, Selecting Key Channels/Approaches (e.g., Radio, Mobile, TV, Community Engagement): With the support of technical partners (e.g., BBC Media, CDC), the HED will facilitate an assessment of communication channels used by the government and partners—such as radio, TV, mobile platforms and community engagement—to rate their effectiveness and select key channels that can serve multiple health needs and multiple partners. Estimated costs for this activity include the following: ● Y4: Develop a TOR and recruit a technical support person from a partner organization (or hire a consultant) to conduct consultations and a 2-day stakeholders meeting with key partners engaged in health promotion to map their communication channels—such as radio, TV, mobile platforms and community engagement—and rate their effectiveness. Estimated costs for this activity include a consultant for 10 days at $500/day for $5,000 plus travel expenses (if regional/international) for 5 days at $3,720, and a 2-day stakeholder meeting for $7,000, which includes travel expenses, venue and meals, totaling $12,000. ● Y4: Based on results from the meeting and existing evidence (e.g., 2016 BBC media report), develop an assessment report with recommendations describing the selection of key channels that can serve multiple health needs and partners—this will be used to guide investments in those channels. Validate the assessment with stakeholders in a one-day validation meeting, after which modifications will be made to the National Health Promotion Strategy (2017–2021) 69 assessment/recommendations. Estimated costs for this activity include a consultant for 5 days at $500/day for $2,500 and a one-day validation meeting for $3,500, totaling $6,000. Estimated total cost for this activity is $21,720.

2.4.5 Y3-Y4: Based on Assessment, Invest in Select Communication Channels for Health Promotion (see 2.4.4): Estimated costs for this activity include these activities. ● Y3: Hire consultant to facilitate stakeholder consultations among partners implementing mobile platform programming (e.g., UReport, RapidPro, WhatsApp, GeoPoll) and develop recommendations for partnership, integration, development of mobile platform guidelines for adolescent health. Estimated cost for this activity is $10,000 ($500/day for 10 days totaling $5,000 plus 5 days travel at approximately $5,000). ● Y4: Present mobile platform guidelines and results of consultations to partners through existing channels and meetings—e.g., SM Pillar, Communications Pillar, listserves, the Knowledge Gateway—and advocate to partners to use mobile platforms in their health promotion programming. There are no costs associated with this activity. ● Y3-Y4: With technical support from a partner, HED will convene MOHS health programmes once a year to facilitate the coordination of key mass media and community engagement programmes to expanded impact so more programmes can benefit. Estimated cost of this activity is $400 ($200 per year for meeting refreshments). ● Y4: With technical support from a partner, hold a 2-day workshop to develop a plan and budget for the production of a national radio/TV show, using local content from local partners. Estimated cost is $16,000 ($11,000 for media consultant to facilitate - $600/day for 10 days including 5 days travel for approximately $5,000 - and a 2-day workshop, including travel, lodging for district representatives). ● Y4: Conduct meetings with donor organizations and partners to request financial and coordination support for the production of the national radio/TV show, using local content from local partners. Estimated cost for the production and broadcast of a radio/TV show is approximately $92,000 ($3,000 per episode x 24, and $20,000 for broadcast for a total of $92,000). Estimated total cost for this activity is $118,400. SO 2.5: Develop and Launch a National Health Promotion Campaign National Health Promotion Strategy (2017–2021) 70

2.5.1 Y2: Develop a National Health Promotion Campaign that Includes a National Logo: A well-planned coalition-based national platform from which to address public health will be developed. One feature of such a campaign will be a national logo and/or slogan to symbolize health that can be adopted by the MOHS and all of its partners. This activity will include the following costs: ● Y2: Conduct a stakeholder meeting to develop creative brief for campaign, during which existing evidence will be reviewed for an estimated $15,000 (3-day meeting, which includes bringing in district representatives and beneficiaries). ● Y2: Hire an ad agency and design and develop campaign based on creative brief for an estimated $50,000 (ad agency to develop campaign design, jingle, radio spot, poster, and logo) ● Y2: Pretest campaign concept and campaign products for an estimated $10,000 ● Y2: Produce key campaign products – e.g., print, media, etc. for an estimated $50,000. ● Y2: Disseminate campaign products via HED Knowledge Gateway, list serves, and existing channels and meetings at the national and district level. There are no costs associated with this activity. Estimated total cost for this activity is $125,000.

2.5.2 Y2: Hold National- and District-level Campaign Launches: Awareness of the national campaigned will be raise through national and district level launches, which will include: ● Y2: Media briefing at the national level for an estimated $1,000 ● Y2: National launch in a hall with refreshments and media for an estimated $7,000. ● Y2: Local launches in each of the 14 districts for an estimated $13,000 (approx. $930 per district) Estimated total cost for this activity is $21,000.

2.5.3 Y2: Roll Out National Campaign (e.g., Broadcast, Print Distribution): Campaign print materials will be distributed to the districts for the PHUs, community centers and other appropriate areas and jingles and radio spots will be broadcast nationwide. ● Y2: Set agreements with radio stations to broadcast radio jingles and radio spots on a schedule ($50,000 for community and national broadcasts) National Health Promotion Strategy (2017–2021) 71 ● Y2: Distribute print materials to the districts ($10,000 for print distribution) Estimated total cost for this activity is $60,000.

2.5.4 Y2-Y5: Monitor and Evaluate National Campaign Outcomes: The national campaign implementation will be monitored through surveys at the district level. This involves developing indicators, survey questions and a monitoring form and conducting periodic surveys on a random sample of beneficiaries (e.g., campaign message awareness, motivated to change behavior, etc.). Routine health promotion monitoring surveys or other mechanisms can also be tapped into via the M&E technical working group ($20,000 each year for three years [$1,400 per district] from Y3 to Y5 - incudes contracting local partner/data collectors to collect the data). Estimated total cost for this activity is $60,000. SO 2.6: Facilitate Development of an Emergency Communication Plan

2.6.1 Y1: Contribute to Emergency Communication Plan and Training Curriculum: An Emergency Communication Plan started by the Communication Pillar in 2016 will be finalized. This will involve HED participation in stakeholders meeting to identify roles and responsibilities for Emergency Communication implementation, attending the launch and dissemination of the Emergency Communication Plan, and contributing to the development of a training curriculum in emergency communication for district level. There are no costs associated with this activity.

2.6.2 Y2: Support Emergency Communication Training at District-level: The Emergency Communication training will be rolled out to the district level, requiring support. Support will be provided in terms of printing and recruiting district-level trainers. Estimated total cost for this activity is $10,000. SO 2.7: Strengthen Integration of Health Promotion Activities with Activities in Other Sectors – e.g., Education, Agriculture, Youth – to Achieve Health and Development Gains

2.7.1 Y1, Y3, Y5: Convene Multi-stakeholder Meetings with Relevant Ministries to Integrate Health Promotion: Meetings with various Ministries within the Government of Sierra Leone—such as those focusing on education, agriculture, youth, gender, and others—every two years to integrate health promotion with other development areas where it makes sense, and review progress over time. These will also result in consensus on roles and responsibilities, and ensuring there are adequate and capable health promotion point people in each of the collaborating Ministries. Each meeting will have an agenda and objectives; National Health Promotion Strategy (2017–2021) 72 meeting minutes will be taken and shared. Estimated costs for this activity are $6,000 (3 meetings at $2,000 per meeting, which includes printing, materials, travel expenses for select representatives from the districts and lunch). Estimated total cost for this activity is $6,000.

2.7.2 Y3-Y5: Assign HP Role (e.g., Seconded, Focal Point) to Support HP Activities in Four Ministries (e.g., Education, Agriculture, Youth, Gender): The MOHS will assign a health promotion role to support these Ministries with health promotion training and resources, and this person will providing technical support for health promotion activities, including providing training to staff, identify and address issues, and identify opportunities for harmonized communication, where needed.

2.8 Full Launch of a National Public Health Information Line

2.8.1 Y1-Y5, Set up a Toll-free Hotline Number or Repurpose an Existing Line, such as the Ministry of Health's 117: Depending on whether a new toll-free number is launched, the cost for call centre set -up will include leasing E1 lines, an information and communications technology (ICT) infrastructure and power set-up, operators, workstations, and software. The below costings are based on the model of using an already existing system. For this, there will no initial set-up costs, but rather monthly operational costs. • Y1 (Q3-4)–Y2: Software maintenance and upgrades is $1,200/mo x 18 months totaling $21,600 • Y1 (Q3-4)–Y5: ICT and network equipment maintenance = $1,500/mo x 54 months totaling $81,000 • Y1 (Q3-4)–Y5: Management fees, including monitoring and robust analysis= $3,500/mo x 54 totaling $189,000 • Y1 (Q3-4)–Y5: Call centre manager system(Cisco or DigiumExlastix) = $500/mo x 54 months totaling $27,000 • Y1 (Q3-4)–Y5: Stationery = $200/mo x 54 months totaling $10,800 • Y1 (Q4)–Y5: 15 operators at $6,000/mo (15 x $400 per operator) x 51 months totaling $306,000 Estimated total monthly cost for the entire activity from Y1, Q3-4 to Y5 is $635,400.

2.8.2 Y2 - Y5 Conduct Activities to Educate the Public on the Use of the Public Health Line:Public awareness is an integral component of setting up a public health line. Regular media engagement, community engagement and other form of social mobilization are to be used. • Y2-Y5: Media Engagement (radio discussions, etc. :$2,400/year ($200/mo x 12) for four years, totaling $9,600. • Y2 & Y4: Community Engagement conducted once every two years for a cost of $30,000 per year (Transportation, DSA, Miscellaneous) totaling $60,000 • Y2-Y5: Annual training for social mobilizers at $7,500 per annual training for four years totaling $30,000 National Health Promotion Strategy (2017–2021) 73 • Y2-Y5: Posters, flyers, bill boards/ banners and other display material and printing for a cost of $18,000 per year for four years totaling $72,000 Estimated total cost for this activity from Y2 to Y5 is $171,600.

2.8.3 Y2 - Y5 Integrate a Call Centre Approach in all National level Strategic Plans as Part of Strengthening Health Promotion: HED will need to prioritize the functioning of the national public health line, by ensuring that its activities are a part of all strategic efforts toward health promotion and behavior change modification. Government released planning documents will include this initiative. There are no costs associated with this activity.

2.8.4 Y1 (Q4) - Y5 Conduct Trainings for Staff on Promoting Optimal Health Behaviors via the Call Centre: An initial full training will be done for call centre staff with regular ad hoc refresher trainings that have no added costs. HED will provide the knowledge base materials for health promotion overarching topics and eHealth (or other partner) will support in facilitating the trainings. Estimated total cost for the initial training is $1,500.

2.8.5 Y1-Y5 Advocate for Funding and other Revenue Generating Activities with Stakeholders: The public health line can be funded by a number of partners who focus on different types of public health issues. MoHS along with HED will engage with the health NGO community to incite interest in the use of such a system. Partners can then in turn contribute towards call centre activities and keep it operational. Regular stakeholder meetings and workshops will be an instrumental component of this activity. HED to potentially hire a public health line focal person at $6,000 a year ($500 x 12), starting in Y1 and continuing into Y5. Estimated costs for this activity from Y1 to Y5 is $30,000. National Health Promotion Strategy (2017–2021) 74 OBJECTIVE 3: IMPROVE HUMAN RESOURCES AND CAPACITY STRENGTHENING FOR HEALTH PROMOTION SO 3.1: Develop Training Program for Pre-service and In-service Health Promotion Professionals

3.1.1 Q2, Y1: Develop National Training Plan of In-service Training Opportunities for HP Professionals: A budgeted plan for in-service training will ensure that curricula, methods, participants and activities are planned and comprehensive. The nationwide plan, which will be updated every two years, will include the following: ● Basic programme on health promotion principles and practices, ● Brief refreshers on technical areas such as health topics, risk communication, use of media and use of data ● Use of a blended learning approach to include o face-to-face and virtual learning opportunities, o resources such as job aids and best practices, o learning opportunities such as “internships,” mentoring opportunities for staff, and o participation in technical working groups and conferences. The plan will need to be costed and invested in by donor organizations and partners. Developing this plan will require technical support to lead a 2-day workshop with national and district level stakeholders who will identify priority health topics and training gaps, with travel expenses for district level representatives, and technical assistance to develop the plan. Estimated total cost for this activity is $15,000.

3.1.2 Y2-Y5: Assign HED Staff to Attend International Health Conference (e.g., ASTMH, SBCC Conference) and Health Communication Study Tour (e.g., WHO): Financial support will be provided for HED staff to attend an international health conference featuring SBCC topics per year, and to attend a study tour to learn best practices from other countries. The staff member will present learnings to the national and district level staff. This activity includes: ● One study tour organized by a partner (e.g., WHO) to learn best practices in health communication for 2 people within the HED for an estimated $4,440 ($3,000 for regional airfare [2 x $1,500], and approx. $1,440 for per diem [approx. $240 x 2 people x 3 days]). ● One international health conference for 1 HED staff person per year totaling $4,500 ($2,500 for airfare, $2,000 for per diem [approx. $400 for lodging/per diem for 5 days]). National Health Promotion Strategy (2017–2021) 75 Estimated total cost for this activity is $8,940.

3.1.3 Y2-Y5: As Per Training Plan, Hold At Least One HP-focused Capacity Building TOT Per Year for HED and Partners at National/District Level (e.g., DSMCs): A technical support person from a partner organization will help develop, lead and support the trainings, which will include health topics such as compassionate communication, risk communication, etc. Prior to the workshop, training modules will be developed (including an advocacy module with budgeting exercises). Estimated costs for a five-day training is $25,000 per workshop for Y2- Y4, which includes travel expenses for district level staff, and $15,000 for Y5, for a shorter, refresher course. Estimated total cost for this activity is $90,000.

3.1.4 Y3: Hold a Strategic Health Communication Training in Sierra Leone (Repeated Every Three Years): Following the success of the Johns Hopkins Center for Communication Programs (CCP) Leadership Training in Strategic Communication training in 2016, these certificate training programmes will continue to be held every three years for HED staff at the national and district level and partners. Estimated costs include all expenses for the 2-week training course for approximately 30 people, including venue, travel, lodging, and meals, and international travel expenses and consulting expenses for regional facilitators (e.g., CCPN, Nigeria). Estimated total cost for this activity is $45,000.

3.1.5 Y2-Y3: For Pre-service Training, Assess and Finalize Potential Partnership with Training Institution(s): Pre-service training partnerships will be developed with one or more postgraduate training colleges. This activity is a particular priority for this strategy. The HED will set up meetings with the University of Makeni (UNIMAK), a private Catholic university, the College of Medicine and Allied Health Sciences (COMAHS) and the Postgraduate Training institution that the MOHS is planning to explore partnerships and pre-service training options. This activity will start in Y2 and continue through Y3 and will require the HED and a technical support person from a partner organization (or consultant) to gather information and develop an assessment of the potential partnerships. Estimated costs will include transportation and consultation fees for developing an assessment report with recommendations, estimated at $2,500 per year. Estimated total cost for this activity is $5,000.

3.1.6 Y4: Develop Curriculum with Selected Training Institution(s): A resulting pre- service training programme—with one or more local training institutions, tailored for developing specific competencies—will be required for public and voluntary sector employers. WHO will be contacted to provide support/technical assistance to hire a consultant to develop the curriculum. Estimated expenses for National Health Promotion Strategy (2017–2021) 76 this activity include two, one-week visits to these institutions to develop the curriculum. Estimated total cost for this activity is $30,000.

3.1.7 Y4-Y5: Provide Annual General Support to Institution to Implement Training, (e.g., Support for Faculty, Materials): To sustain these institutional programmes over time, the HED will provide support to these institutions, such as lecture space, furniture, faculty support, materials, and other operational and technical support, as required. While these costs may change or vary depending on the results of the partnership, estimated costs are $25,000 per year, starting in Y4. Estimated total cost for this activity is $50,000. SO 3.2: Review and Update Human Resources for Health Policy to Include Health Promotion

3.2.1 Y1-Y5: Update and Clarify HP Roles/Responsibilities, Terms of Service and Professional Development to Guide MOHS Leadership (Annually): HED will meet with the HR office to clarify these roles, terms of services, etc., on a yearly basis.There are no costs associated with this activity.

3.2.2 Y1-Y5: Advocate with MOHS Human Resources for Health and Partners to Influence Strengthening HED Workforce: HED will meet with MOHS HRH and partners through existing forums such as the NGO forums, meetings with MOHS officials and individual meetings to strengthen the workforce. Examples include asks for additional staff, trainings, internships, mentorship programs, seconding staff, hiring consultants, and other areas for improvement, as required. This activity will be ongoing, starting in Y1 and continuing each year. There are no costs associated with this activity. National Health Promotion Strategy (2017–2021) 77 OBJECTIVE 4: RAISE AWARENESS AND MOBILIZE RESOURCES FOR STRENGTHENED HEALTH PROMOTION SO 4.1: Advocate for Increased Funding, Operational Support and Human Resources for Health Promotion Activities

4.1.1 Y3: Develop Advocacy Plan to Identify Objectives, Key Audiences, Messages, and Opportunities to Raise the Profile of HP and Mobilize Resources: With technical support from a partner organization (or consultant), a resource mobilization plan will be developed that identifies regular available resources and gaps for strengthened health promotion. It is recommended that the technical advisor (referenced in the inception phase) is already onboard for this activity. This activity will include the following: ● Y3: Conduct a resource mobilization workshop to identify public and private target audiences, opportunities and messages to raise visibility of the health promotion/HED and secure sustainable funding. This will explore businesses, donors and others already contributing to health promotion and those who aren’t but are promising, along with key influencers. Results will form the foundation of a resource mobilization plan. Estimated costs for a 3-day advocacy workshop, which include venue, materials, printing, travel from the districts, etc., are $10,000. ● Y3: Develop an advocacy workplan based on the workshop. The plan will include target audiences for advocacy (including names of specific decision-makers), messages, opportunities, etc. This includes a consultant to support the plan development for an estimated $1,000 ($250/day for four days). ● Y3: National and district staff and partners will be oriented on the plan through existing meetings and through listservs, the HED Knowledge Gateway, NGO forums, pillar meetings, and other existing mechanisms. Estimated total cost for this activity is $11,000.

4.1.2 Y2-Y5: Develop and Distribute Evidence Briefs on Impact and Importance of HP in Sierra Leone: The HED will require all partners working in health promotion to develop and share evidence briefs on their health promotion activities that show the impact of health promotion on health outcomes. Over time, a package of materials will highlight global, national, and, wherever possible, district data to inform conversations with political leaders and other decision makers about the benefits of health promotion. Briefs that highlight the benefits of health on businesses and the economy will also be developed and distributed. Estimated costs include: ● Y2-Y5: With technical support from a partner, the HED will develop and disseminate an evidence brief template through existing forums (NGO National Health Promotion Strategy (2017–2021) 78 forums, SM & Communication pillars, etc.), requesting partners to fill them out for all health promotion projects, to show impact of activities. HED will consider making this a requirement through the SLA process. This will be disseminated to partners yearly and provided to all new projects starting up in Sierra Leone. ● Y3 & Y5: HED will hire a consultant to compile evidence and develop a health promotion evidence packet that can be used for advocacy. The consultant will augment local data with global evidence while also linking health promotion to other development goals and outcomes (e.g., economy, business). Consultant will be hired to gather data, write and format the information into a packet of evidence briefs. Costs for this consultant are estimated at $5,000 ($2,500 x 2 [Y3 & Y5]). ● Y3 & Y5: HED will disseminate the briefs through a launch (below) and through existing mechanisms (e.g., Knowledge Gateway, listservs, NGO forums, etc.), encouraging partners to use them to advocate for more resources for health promotion. This involves developing a PPT to use in these forums. Dissemination will occur in Y3 and Y5. Estimated costs include $500 for printing ($250 x 2 [Y3 & Y5]). Estimated total cost for this activity is $5,500.

4.1.3 Y4: Hold Training for Journalists to Orient Press on Covering Health Promotion Stories: With technical support from partners (e.g., BBC Media, CDC), a 2-day training programme designed to teach and motivate journalists to cover health promotion stories more accurately will be held. As part of the training, the MOHS can announce a contest for the best story on health promotion covered during the year. Estimated costs for this event will include travel expenses for approximately 30 journalists and workshop expenses such as venue, materials and meals and an award for the best journalist (e.g., mobile phone), to be awarded later in the year, totaling approximately $16,000. Estimated total cost for this activity is $16,000.

4.1.4 Y4: Hold National Media Event to Launch Evidence Briefs and Raise Visibility of Health Promotion: This event will involve the following: ● Develop invitation list with public and private decision-makers, donors, media and partner organizations, then develop and send invitations. These are no costs for this activity. ● Develop and distribute press release about the evidence briefs. These are no costs for this activity. ● Hold media/launch event distribute evidence briefs. Estimated costs are $7,500 (venue with lunch for up to 50 people, photographers, small token awards [e.g., desk item, plaque]). Activity involves these actions: o Recruit high-level health promotion champions within donor National Health Promotion Strategy (2017–2021) 79 organizations, the government, and businesses to speak about health promotion benefits, asking participants to invest in HP. o Present awards to government officials and businesses that have invested or contributed to HP in a promising way. Estimated total cost for this activity is $7,500. Y5: Orient District-level Decision-makers (e.g., District Council, VDCs,

4.1.5 FMCs/HMCs) on Impact of HP via Advocacy “Road Shows”: Similar to the launch above, smaller-scale advocacy “road shows” will highlight the benefits of health promotion in each of the 14 districts, with a presentation of the evidence package to district decision-makers (e.g., District Council member[s], Member of Parliament, etc.). Community radio, media, health provider staff, CHWS, etc., will be invited to attend, and awards will be given to champions and health promoters. This event could be combined with national campaign roll out activities (see Objective 2). Estimated costs for road shows include banners, printing, refreshments, awards, venue, and incentives for approx. $1,430 per district for a total cost of $20,000 for all 14 districts. Estimated total cost for this activity is $20,000.

4.1.6 Y5: Hold Advocacy Meeting with Parliamentary Health Committee to Showcase HP Successes and Advocate for Increased Funding for Health Promotion: The HED with influential stakeholders will organize a committee room meeting in the House of Parliament and meet with the Parliamentary Health Committee and other key stakeholders such as the Minister of Finance and Economic Development, Minister of Health and Sanitation, CMO, and others to advocate for increased resources for health promotion, using evidence to demonstrate cost-effectiveness. Talking points should include clear asks for funding with a clear rationale for the funding (e.g., based on the advocacy plan) and include how health affects development issues (e.g., all of the SDGs). There are no costs associated with this activity. SO 4.2: Engage at Least Five New Private Sector Institutions to Invest in National Health Promotion Activities

4.2.1 Y3: Develop Private Sector Brochure Outlining Options for Investing in HP in Sierra Leone, with a Business Case for Investing in HP: This activity will require the following: ● With technical support from a partner organization (or consultant), meet with MOHS programme stakeholders and develop a list of HP investment options and potential benefits with costs. For example, investment options might include radio or TV spots or billboards promoting optional behaviors related to adolescent health, with estimated prices and National Health Promotion Strategy (2017–2021) 80 benefits, such as including the company logo and acknowledgement on the ad, etc. Estimated costs include consultant fee at $500/day for four days for a total of $2,000. ● Pay a consultant to develop a brochure, which includes the options, benefits and estimated costs described above along with a short business case outlining the business and economic value of investing in health in a presentable package. Estimated costs include consultant fees of $500/day for five days for a total of $2,500. ● Print the brochure. Estimated costs for printing is $500. Estimated total cost for this activity is $5,000.

4.2.2 Y3-Y5: Hold Annual Business Networking Forums to Encourage Investments in Health Promotion: With both public and private sector partners, the MOHS will hold a networking forum each year to recognize business investing in health promotion and encourage others to invest. These are opportunities to showcase private sector contributions that have occurred in the past (e.g., during EVD), and to identify actions they can take through the Investing in Health: A Private Sector Playbook. Media will be invited to cover the events. Estimated costs for these forums include: ● Y3-Y5: Develop an agenda for the forums, an invitation list of public and private sector partners and send official letters of invitation. There are no costs associated with this activity. ● Y3-Y5: Recruit media to cover the event, and ask businesses to talk about the benefits of a healthy workforce and population. Estimated costs of $100 to cover photographer and media to attend and cover event for Y3. ● Y3-Y5: Facilitate forums with approximately 50 people in Y3, approximately 15 people in Y4 and Y5. Estimated costs are $10,000 for Y3, $6,000 for Y4 and Y5 (it is estimated that some private sector partners can cover some of these costs). ● Printing the agenda, brochure, other materials as needed. Estimated costs are about $300 per event for a total of $1,000 the three events. ● Developing and distributing a press release. There are no costs associated with this activity. Estimated total cost for this activity is $23,100. National Health Promotion Strategy (2017–2021) 81 OBJECTIVE 5: IMPROVE MONITORING AND EVALUATION SYSTEMS FOR HEALTH PROMOTION

5.1.1 Q4, Y1: Hold Stakeholder Meeting to Agree on HP Monitoring Indicators, and M&E Priorities for HP: A stakeholder meeting with the DPPI and partners (e.g., M&E staff within partner organizations) will be held to agree on priorities for health promotion M&E. Specifically, the objectives will be to strengthen indicators for health promotion, and ensure they are aligned with overall national health indicators. See attached Annex B of the Strategy for a description of methods, indicators and targets for the Strategy and a sample of health promotion’s impact on key public health indicators to be used in the discussion. Estimated costs for this activity include refreshments for stakeholder meeting. Estimated total cost for this activity is $500.

5.1.2 Y2-Y5: Create an M&E subcommittee with a TOR within the SM Pillar, and Facilitate the Incorporation of M&E in the Implementation of All Health Promotion Activities: An M&E subcommittee will be developed within the SM Pillar to discuss a broad array of health promotion M&E topic areas, including discussions on indicators. This subcommittee will link with ongoing conversations within the M&E technical working group involved CHW health promotion. Estimated costs for this activity include refreshments for quarterly meetings at $500 per meeting totaling $2,000 per year starting in Y2. Estimated total cost for this activity is $8,000.

5.1.3 Y1 (Q3), Y2-Y5: Identify an HP Staff Person to Focus on M&E and Represent HED in M&E Steering Committee Meetings: This activity will involve the following steps: ● Q4, Y1: HED will hire or reach out to other partners, such as the UNFP, for a dedicated M&E support person with an annual salary of approximately $22,000 per year. This HED staff person will focus on M&E and represent HED in M&E technical working group meetings. ● Y2-Y5: With partners in the M&E TWG’s HP subgroup, these M&E staff and support will be responsible for the following: o developing standards guides for M&E o creating monitoring tools and collecting information to report on indicators o developing a training plan on new M&E framework Ultimately there will be a sustainable, supported and structured monitoring National Health Promotion Strategy (2017–2021) 82 system in place to collect data on the health promotion indicators. Estimated total costs for one M&E staff person at $22,000 per year, from Y1 (Q4) to Y5 is $93,500.

5.1.3 Y1 (Q3), Y2-Y5: Develop M&E Framework with DPPI and Partner Support: This activity will involve the following steps: ● Q3, Y1: Meeting with DPPI to have them second an M&E officer to the HED, which the DPPI will train. ● Q3-Q4, Y1: HED will reach out to other partners, such as the UNFP, for M&E support. ● Q3, Y1: HED to dedicate an HP staff person to focus on M&E and represent HED in M&E technical working group meetings. ● Y2-Y5: With partners in the M&E TWG’s HP subgroup, these M&E staff and support will be responsible for the following: o developing standards guides for M&E o creating monitoring tools and collecting information to report on indicators o developing a training plan on new M&E framework Ultimately there will be a sustainable, supported and structured monitoring system in place to collect data on the health promotion indicators. There are no costs associated with this activity.

5.1.4 Y2-Y5: Review and Incorporate Behavioral Indicators into Existing Monitoring Systems (e.g., HMIS): An M&E staff person will meet with the DPPI to complete forms for adding approved indicators to the monitoring system. This will involve ongoing meetings within the M&E steering committee. There are no costs associated with this activity.

5.1.5 Y2-Y5: Ensure HP M&E Framework is Included in MOHS M&E Trainings to Districts: HED will meet with the DPPI to ensure that the HED M&E framework is integrated into DPPI trainings. There are no costs associated with this activity. National Health Promotion Strategy (2017–2021) 83 OBJECTIVE 6: STRENGTHEN KNOWLEDGE SHARING AND MANAGEMENT

6.1.1 Q1, Y1: Develop a Knowledge Management Plan Based on 2016 Knowledge Management Assessment:HC3’s project will provide support to the HED on developing a knowledge management (KM) plan based on the assessment that was developed and shared in 2016. This plan will provide guidance to the dedicated HED staff on maintaining the KM system. There are no costs associated with this activity.

6.1.2 Q2, Q3, Y1, Y2-Y5: Provide Technical Assistance to Districts to Implement Knowledge Management Plan: Technical assistance will be provided to district- level staff on the benefits of the KM system and using and maintaining it. JHUCCP’s HC3 project will provide support to the HED in developing an orientation in Q2, Y1, which can be rolled out yearly from in Y2-Y5 to provide ongoing support. Estimated costs for this activity include travel expenses to the districts totaling approximately $2,000 per year (approx. $150 per district). Estimated total cost for this activity is $10,000.

6.1.3 Y1-Y5: Ensure HED and District SM Coordinators Have Internet Connectivity and an IT Person at the National Level: It will be impossible for the HED and social mobilization coordinators to use the HED KM system—Knowledge Gateway—to share tools, messaging guides, resources, best practices and more without internet access. Estimated costs for this activity include a monthly subscription to an internet service and a modem plus installation and IT support, which amount to approximately $4,000 per quarter for a total of $20,000 per year in Y1 for the national system at HED headquarters and approximately $20,000 for modems for coordinators in the 14 districts, for a total of $40,000 per year starting in Y2. Estimated total cost for this activity is $180,000.

6.1.4 Y1-Y5: Organize Electronic Files at HED (Maintaining the Knowledge Gateway): Through dedicated HED staff, electronic files will be maintained and organized in the HED Knowledge Gateway. There are no costs associated with this activity.

6.1.5 Q1, Y1: Organize Hardcopy Files at HED (Completing Filing System): In 2016, under the HC3 project, a system was put in place to organize hardcopy files within HED headquarters, and this filing system will be finalized in 2017. There are no costs associated with this activity. National Health Promotion Strategy (2017–2021) 84

6.1.6 Q1, Y1: Create Tailored Email Listservs that Include Relevant Partners: Listservs involving relevant partners will be developed and used. This email listserv will be linked with the Knowledge Gateway. The listserv will allow the HED and partners to share best practices, tools, and all health promotion resources and information. There are no costs associated with this activity.

6.1.7 Y2-Y5: Create Electronic and Hardcopy Versions of Health Promotion Newsletter Quarterly for Nationwide Distribution: The HED will develop and disseminate electronic and hardcopy versions of an HED health promotion newsletter to inform a variety of stakeholders of updated health promotion news and events. Print copies will be distributed to district-level staff and electronic versions will be distributed to a broader set of stakeholders includes government decision-makers, partners, community stakeholders, and others. Copies of the newsletter will be available on the Knowledge Gateway. Possible steps involved in producing and distributing the newsletter include developing a newsletter template (e.g., in Word), agreeing on story ideas for each issue— which partners can contribute to—and writing stories and including photos. The HED will ask partners to contribute stories and photos to the newsletter. Estimated costs are for printing and are $1,000 per year starting in Y2. Estimated total cost for this activity is $4,000.

6.1.8 Q3, Y1: Ensure HED Page is on MOHS Website, Linking to Knowledge Gateway: The HED will meet with the Ministry in charge of the MOHS website to ensure that an HED webpage is included on the site, with a link to the HED Knowledge Gateway. There are no costs associated with this activity.

6.1.9 Y2-Y5: Hold Annual HP Strategy Review and Best Practices Exchange Forum: With technical support from partners, the HED will hold an annual National Health Promotion review meeting, where the government and partners will also present on best practices. Progress on the National Health Promotion Strategy will be reviewed with an account of where additional support is needed. Partners can share stories on health promotion approaches that work (and those that do not), and can share tools, evidence and resources useful to the group. This will be framed as a review as well as a learning opportunity. Partners will either be assigned or can volunteer to present. Estimated costs for this activity is $3,500 per year, which includes venue, materials, printing, and local travel expenses for representatives from the districts. Estimated total cost for this activity is $14,000. National Health Promotion Strategy (2017–2021) 85 APPENDIX E. NATIONAL HEALTH PROMOTION STRATEGY (2017-2021) IMPLEMENTATION PLAN Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4 IMPLEMENTATION PHASE

0.1 Launch the Health Promotion Strategy

0.2 Orient District Teams on the Health Promotion Strategy

0.3 Meet with at Least 10 Partners/Donors to Secure Commitments to Support Individual Activities

0.4 Develop Detailed TOR for Proposed Technical Advisor

0.5 Recruit Technical Advisor to Support the HED Subtotal Inception Phase Total OBJECTIVE 1: STRENGTHEN HEALTH PROMOTION STRUCTURES SO 1.1: Rejuvenate the Social Mobilization and Communication Pillars at National Level and Strengthen Coordination Mechanisms Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

1.1.1 Review, Update and Disseminate SM Pillar TOR

1.1.2 Support the Finalization and Dissemination of the Communications Pillar TOR

1.1.3 Hold Monthly (More as Necessary) National SM Pillar Meetings

1.1.4 Hold National Communications Pillar Meetings (PHNEOC) Every Two Weeks 1.1.5 Participate in Inter-Pillar Meetings at National Level Called by PHNEOC for Improved Coordination

1.1.6 Conduct Periodic Capacity Assessment for Strengthening DRAFT Health Promotion Strategy (2017–2022) 86 National SM Pillar and Provide Support SO 1.2: Rejuvenate the Social Mobilization Pillar at District Level and Strengthen Coordination Mechanisms Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4 1.2.1 Review, Update and Disseminate District Level SM Pillar TOR

1.2.2 Map Active SM Pillar Partners and Identify Dormant SM Pillars

1.2.3 Hold a Revitalization Meeting to Present Mapping Landscape with Recommendations, TOR and Roles/Responsibilities

1.2.4 Conduct Two-day Capacity Assessment Meetings and Support (e.g., Training) for all District SM Pillars

1.2.5 Hold Monthly District-level SM Pillar Meetings (More Frequently as Needed) and Circulate Meeting Minutes

1.2.6 Attend Monthly District Coordination Meetings in person and include HP on the agenda, while serving as health advocates

1.2.7 Map and Develop MOUs with Functional Community Radio Stations in Each District for Message Dissemination SO 1.3: Strengthen Community-level Actors and Foster Community Ownership of Health Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

1.3.1 Develop and Disseminate Guidance on HP Roles and Responsibilities for Community Structures (e.g., VDCs, HMCs/FMCs, CHWs, Community Groups, etc.)

1.3.2 Support Integrated Training on HP Roles/Responsibilities for VDCs/HMCs/FMCs and Community Structures OBJECTIVE 2: STRENGTHEN NATIONAL HEALTH PROMOTION INTERVENTIONS National Health Promotion Strategy (2017–2021) 87 SO 2.1 Disseminate and Provide Guidelines on Use of Health Promotion Models Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

2.1.1 Develop and Disseminate HP Model/Pathway Brochure and Orient Partners on HP Model/Pathway and Other Guidance through Standing Pillar Meetings

2.1.2 Hold Regular MOHS Stakeholders Meetings to Include a Mandate in the SLA for Partners to Base Programming on Approved HP Model/Pathway, and Other Guidance Documents (e.g., SM TOR) SO 2.2: Support National Integrated Efforts to Reach Adolescents with Health Promotion Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

2.2.1 Gather and Share Existing Evidence with National and District Partners on Adolescent Health Behaviors through HED Knowledge Gateway

2.2.2 Conduct Biannual Meetings between HED and the School Health Program/Secretariat of Teenage Pregnancy to Strengthen Collaboration

2.2.3 Support Adolescent Campaign Design and Implementation

2.2.4 Support Advocacy on the Need to Reach Adolescents (e.g., Religious and Community Leaders)

2.2.5 Facilitate Community-level Adolescent-focused Program Activities SO 2.3: Strengthen Community-level Actors in Health Promotion Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

2.3.1 Conduct Mapping of Materials/Job Aids for Community- National Health Promotion Strategy (2017–2021) 88 level Actors and Supporting Partners to Identify Gaps

2.3.2 Develop Health Promotion Materials/Job Aids for Community-level Actors Based on Mapping/Review

2.3.3 Provide Opportunities (Training) for Community-level Actors to Use Health Promotion Materials and Become Health Promotion Advocates

2.3.4 Conduct Mapping of Materials/Job Aids for In-service Healthcare Workers to Identify Gaps

2.3.5 Develop Health Promotion Materials/Job Aids for Interpersonal Communication Skills for In-service Healthcare Workers

2.3.6 Provide Training for In-service Healthcare Workers on Interpersonal Communication Skills and Using Job Aids/Materials and Provide Follow-up Support (Incentives, Mentoring, Supportive Supervision) SO 2.4: Establish Evidence-base on Behaviours and Communication Channels to Guide Programming Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

2.4.1 Conduct Desktop Analysis to Identify Evidence Gaps on Knowledge, Attitudes, Practices and Behaviors Related to Priority Health Areas and Audiences

2.4.2 Support the Design, Implementation and Dissemination of Studies to Fill Gaps in Evidence (See 2.4.1)

2.4.3 Orient Government Agencies and Partners on Using Evidence in SBCC Programming

2.4.4 Facilitate National Communication Channels Assessment to Map Existing Approaches and Effectiveness, Selecting Key Channels/Approaches (e.g., Radio, Mobile, TV, Community Engagement)

2.4.5 Based on Assessment, Invest in Select Communication National Health Promotion Strategy (2017–2021) 89 Channels for Health Promotion (See 2.4.4) SO 2.5 Develop and Launch a National Health Promotion Campaign Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

2.5.1 Develop a National Health Promotion Campaign that Includes a National Logo

2.5.2 Hold National- and District-level Campaign Launches

2.5.3 Roll Out National Campaign (e.g., Broadcast, Print Distribution)

2.5.4 Monitor and Evaluate National Campaign Outcomes SO 2.6 Facilitate Development of an Emergency Communication Plan Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

2.6.1 Contribute to Emergency Communication Plan and Training Curriculum

2.6.2 Support Emergency Communication Training at District- level Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4 SO 2.7 Strengthen Integration of Health Promotion Activities with Activities in Other Sectors – e.g., Education, Agriculture, Youth – to Achieve Health and Development Gains

2.7.1 Convene Multi-stakeholder Meetings with Relevant Ministries to Integrate Health Promotion

2.7.2 Assign HP Role (e.g., Seconded, Focal Point) to Support HP Activities in Four Ministries (e.g., Education, Agriculture, Youth, Gender) National Health Promotion Strategy (2017–2021) 90 SO 2.8 Launch in Full Effect a National Public Health Information Line Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

2.8.1 Conduct Resource Mobilization Activities and Secure Funding from Stakeholders

2.8.2 Set-up a Toll-free Hotline Number or Operationalize/Broaden the Scope of the Existing Ministry of Health’s 117 Call Centre Line

2.8.3 Conduct Activities to Educate the Public on Using the Public Health Line 2.8.4 Integrate the Call Centre Approach to Health Promotion in all MOHS Strategic Plans as Part of Strengthening a Continuous National level Method of Health Promotion

2.8.5 Conduct Trainings for Call Centre Health Promotion and Information with Staff OBJECTIVE 3: IMPROVE HUMAN RESOURCES AND CAPACITY STRENGTHENING FOR HEALTH PROMOTION SO 3.1 Develop Training Program for Pre-service and In-service Health Promotion Professionals Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

3.1.1 Develop National Training Plan of In-service Training Opportunities for HP Professionals

3.1.2 Assign HED Staff to Attend International Health Conference (e.g., ASTMH, SBCC Conference) and Health Communication Study Tour (e.g., WHO)

3.1.3 Hold At Least One HP-focused Capacity Building TOT Per Year for HED and Partners at National/District Level (e.g., DSMCs ) – As Per Training Plan National Health Promotion Strategy (2017–2021) 91 3.1.4 Hold a Strategic Health Communication Training in Sierra Leone (Repeated Every Three Years) – As Per Training Plan 3.1.5 For Pre-service Training, Assess and Finalize Potential Partnership with Training Institution(s) 3.1.6 Develop Curriculum with Selected Training Institution(s)

3.1.7 Provide Annual General Support to Institution to Implement Training, (e.g., Support for Faculty, Materials) SO 3.2 Review and Update Human Resources for Health Policy to Include Health Promotion Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4 3.2.1 Update and Clarify HP Roles/Responsibilities, Terms of Service and Professional Development to Guide MOHS Leadership (Annually)

3.2.2 Advocate with MOHS Human Resources for Health and Partners to Influence Strengthening HED Workforce OBJECTIVE 4: RAISE AWARENESS AND MOBILIZE RESOURCES FOR STRENGTHENED HEALTH PROMOTION SO 4.1 Advocate for Increased Funding, Operational Support and Human Resources for Health Promotion Activities Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

4.1.1 Develop Advocacy Plan to Identify Objectives, Key Audiences, Messages and Opportunities to Raise the Profile of HP and Mobilize Resources

4.1.2 Develop and Disseminate Evidence Briefs on Impact and Importance of HP in Sierra Leone 4.1.3 Hold Training for Journalists to Orient Press on Covering Health Promotion Stories National Health Promotion Strategy (2017–2021) 92

4.1.4 Hold National Media Event to Launch Evidence Briefs and Raise Visibility of Health Promotion

4.1.5 Orient District-level Decision-makers (e.g., District Council, VDCs, FMCs/HMCs) on Impact of HP via Advocacy “Road Shows”

4.1.6 Hold Advocacy Meeting with Parliamentary Health Committee to Showcase HP Successes and Advocate for Increased Funding for Health Promotion SO 4.2 Engage at Least Five New Private Sector Institutions to Invest in National Health Promotion Activities Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

4.2.1 Develop Private Sector Brochure Outlining Options for Investing in HP in Sierra Leone, with a Business Case for Investing in HP

4.2.2 Hold Annual Business Networking Forums to Encourage Investments in Health Promotion OBJECTIVE 5: IMPROVE MONITORING AND EVALUATION SYSTEMS FOR HEALTH PROMOTION Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

5.1.1 Hold Stakeholder Meeting to Agree on HP Monitoring Indicators and M&E Priorities for HP

5.1.2 Create M&E Subcommittee with a TOR within the SM Pillar, and Facilitate the Incorporation of M&E in the Implementation of All Health Promotion Activities

5.1.3 Identify an HP Staff Person to Focus on M&E and Represent HED in M&E Steering Committee Meetings

5.1.4 Develop M&E Framework with DPPI and Partner Support

5.1.5 Review and Incorporate Behavioral Indicators into National Health Promotion Strategy (2017–2021) 93 Existing Monitoring Systems (e.g., HMIS)

5.1.6 Ensure HP M&E Framework is Included in MOHS M&E Trainings to Districts OBJECTIVE 6: STRENGTHEN KNOWLEDGE SHARING AND MANAGEMENT Year 1 Year 2 Year 3 Year 4 Year 5 Q1 Q2 Q3 Q4

6.1.1 Develop a Knowledge Management Plan Based on 2016 Knowledge Management Assessment 6.1.2 Provide Technical Assistance to Districts to Implement Knowledge Management Plan

6.1.3 Ensure HED and District SM Coordinators Have Internet Connectivity and IT person at the National Level

6.1.4 Organize Electronic Files at HED (Maintaining the Knowledge Gateway)

6.1.5 Organize Hardcopy Files at HED (Completing Filing System)

6.1.6 Create Tailored Email Listservs that Include Relevant Partners

6.1.7 Create Electronic and Hardcopy Versions of Health Promotion Newsletter Quarterly for Nationwide Distribution

6.1.8 Ensure HED Page is on MOHS Website, Linking to Knowledge Gateway

6.1.9 Hold Best Practices Exchange Semi-annually through SM Pillar Meeting National Health Promotion Strategy (2017–2021) 94 APPENDIX G. M&E INDICATORS FOR NATIONAL HEALTH PROMOTION STRATEGY (2017-2021) Monitoring & Evaluation Illustrative Source Measurement Indicators of Data INCEPTION PHASE

0.1 Launch the Health Promotion Strategy HP Strategy Program launched reports

0.2 Orient District Teams on the Health Promotion Strategy Orientations to all Program district teams held reports

0.3 Meet with at Least 10 Partners / Donors to Secure Commitments to Support Individual Meetings with at Program Activities least 10 key partners reports and/or donors held

0.4 Develop Detailed TOR for Proposed Technical Advisor TOR developed Program reports

0.5 Recruit Technical Advisor to Support the HED Technical advisor Program assigned reports OBJECTIVE 1: STRENGTHEN HEALTH PROMOTION STRUCTURES SO 1.1: Rejuvenate the Social Mobilization and Communication Pillars at National level and Strengthen Coordination Mechanisms

1.1.1 Review, Update and Disseminate SM Pillar TOR SM Pillar TOR Program disseminated reports

1.1.2 Support the Finalization and Dissemination of the Communications Pillar TOR Communication Program Pillar TOR reports disseminated

1.1.3 Hold Monthly (more as necessary) National SM Pillar Meetings Monthly SM Pillar Program meetings held reports

1.1.4 Hold National Communications Pillar Meetings (PHNEOC) Every Two Weeks Periodic Program Communication reports Pillar Meetings held

1.1.5 Participate in Inter-Pillar Meetings at National Level Called by PHNEOC for Improved HED representation Program Coordination in meetings reports DRAFT Health Promotion Strategy (2017–2022) 95 Monitoring & Evaluation Illustrative Source Measurement Indicators of Data

1.1.6 Conduct Capacity Assessment for Strengthening National SM Pillar and Provide Support Two capacity Program assessments reports completed and support provided SO 1.2:Rejuvenate the Social Mobilization pillar at District Level and Strengthen Coordination Mechanisms

1.2.1 Review, Update and Disseminate District Level SM Pillar TOR District-level TOR Program disseminated reports

1.2.2 Map Active SM Pillar Partners and Identify Dormant SM Pillars Mapping completed Program reports

1.2.3 Hold a Revitalization Meeting to Present Mapping Landscape with Recommendations, Revitalization Program TOR and Roles/Responsibilities meeting held reports

1.2.4 Conduct Two-day Capacity Assessment Meetings and Support (e.g., Training) for all Capacity building Program District SM Pillars assessment reports conducted in a 14 districts

1.2.5 Hold Monthly District-level SM Pillar Meetings (more frequently as needed), and District-level SM Program Circulate Meeting Minutes Pillar meetings held reports

1.2.5 Participate in Monthly District Coordination Meetings HED representation Program in meetings reports documented

1.2.7 Map and Develop MOUs with Functional Community Radio Stations in each District for MOUs with Program Message Dissemination community radio reports stations developed S.O. 1.3: Strengthen Community-level Actors and Foster Community Ownership of Health

1.3.1 Develop and Disseminate Guidance on HP Roles and Responsibilities for Community Program Community Structures (e.g., VDCs, HMCs/FMCs, CHWs, Community Groups, etc.) roles/responsibilities reports guidance disseminated

1.3.2 Support Integrated Training on HP Roles/Responsibilities for VDCs/HMCs/FMCs Training completed Program National Health Promotion Strategy (2017–2021) 96 Monitoring & Evaluation Illustrative Source Measurement Indicators of Data and Community Structures reports OBJECTIVE 2: STRENGTHEN NATIONAL HEALTH PROMOTION INTERVENTION SO 2.1: Disseminate and Provide Guidelines on Use of HP Models

2.1.1 Develop and Disseminate HP Model/Pathway Brochure and Orient Partners on HP Brochure Program Model/Pathway and other Guidance through Standing Pillar Meetings disseminated reports

2.1.2 Hold Regular MOHS Stakeholders Meetings to Include a Mandate in the SLA for Meeting held Program Partners to Base Programming on Approved HP Model/Pathway, and Other reports Guidance Documents (e.g., SM TOR) SO 2.2: Support National Integrated Efforts to Reach Adolescents with Health Promotion

2.2.1 Gather and Share Existing Evidence with National and District Partners on Evidence shared Program Adolescent Health Behaviors through HED Knowledge Gateway reports

2.2.2 Conduct Bi-annual Meetings between HED and the School Health Program / Meetings held Program Secretariat of Teenage Pregnancy to Strengthen Collaboration reports

2.2.3 Support Adolescent Campaign Design and Implementation Adolescent Program campaign reports implemented

2.2.4 Support Advocacy on the Need to Reach Adolescents (e.g., Religious & Advocacy events Program Community Leaders) held reports

2.2.5 Facilitate Community-level Adolescent-focused Program Activities District events held Program reports SO 2.3: Strengthen Community-level Actors in Health Promotion

2.3.1 Conduct Mapping of Materials/Job Aids for Community-level Actors and Mapping completed Program Supporting Partners to Identify Gaps reports

2.3.2 Develop Health Promotion Materials/Job Aids for Community-level actors Based Tools and resources Program on Mapping/Review developed reports

2.3.3 Provide Opportunities (Training) for Community-level Actors to Use Health Training conducted Program Promotion Materials and Become Health Promotion Advocates reports

2.3.4 Conduct Mapping of Materials/Job Aids for In-service Healthcare Workers to Mapping completed Program National Health Promotion Strategy (2017–2021) 97 Monitoring & Evaluation Illustrative Source Measurement Indicators of Data Identify Gaps reports

2.3.5 Develop Health Promotion Materials/Job Aids for Interpersonal Communication Materials and job Program Skills for In-service Healthcare Workers aids developed reports

2.3.6 Provide Training for In-service Healthcare Workers on Interpersonal Training conducted Program Communication Skills and Using Job Aids/Materials and Provide Follow-up reports Support (Incentives, Mentoring, Supportive Supervision) SO 2.4: Establish Evidence-base on Behaviors and Communication Channels to Guide Programming

2.4.1 Conduct Desktop Analysis to Identify Evidence Gaps on Knowledge, Attitudes, Desktop analysis Program Practices and Behaviors Related to Priority Health Areas and Audiences conducted reports

2.4.2 Support the Design, Implementation and Dissemination of Studies to Fill Gaps in Research conducted Program Evidence (see 2.4.1) reports

2.4.3 Orient Government Agencies and Partners on Using Evidence in SBCC Orientation Program Programming conducted reports

2.4.4 Facilitate National Communication Channels Assessment to Map Existing Report on Program Approaches and Effectiveness, Selecting Key Channels/Approaches (e.g., Radio, assessment reports Mobile, TV, Community Engagement) completed

2.4.5 Based on Assessment, Invest in Select Communication Channels for Health Priority Program Promotion (see 2.4.4) communication reports channels funded SO 2.5: Develop and Launch a National Health Promotion Campaign

2.5.1 Develop a National Health Promotion Campaign that Includes a National Logo National health Program campaign developed reports

2.5.2 Hold National- and District-level Campaign Launches Launches conducted Program reports

2.5.3 Roll Out National Campaign (e.g., Broadcast, Print Distribution) Media aired, Program community events reports conducted

2.5.4 Monitor and Evaluate National Campaign Outcomes Monitoring and Program evaluation reports reports National Health Promotion Strategy (2017–2021) 98 Monitoring & Evaluation Illustrative Source Measurement Indicators of Data completed SO 2.6: Facilitate Development of Emergency Communication Plan

2.6.1 Contribute to Emergency Communication Plan and Training Curriculum Plan completed Program reports

2.6.2 Support Emergency Communication Training at District-level Training conducted Program in each district reports SO 2.7: Strengthen Integration of Health Promotion Activities with Activities in Other Sectors – e.g., Education, Agriculture, Youth – to Achieve Health and Development Gains

2.7.1 Convene Multi-stakeholder Meetings with Relevant Ministries to Integrate Health Meeting held Program Promotion annually reports

2.7.2 Assign HP Role (e.g., Seconded, Focal Point) to Support HP Activities in 4 Point people Program Ministries (e.g., Education, Agriculture, Youth, Gender) assigned reports SO 2.8 Launch in full effect a national public health information line

2.8.1 Conduct Resource Mobilization Activities and Secure Funding from Stakeholders Resource Program mobilization reports activities conducted

2.8.2 Set-up a Toll-free Hotline Number or Operationalize/Broaden the Scope of the Call centre line is set Program Existing Ministry of Health’s 117 Call Centre Line up reports

2.8.3 Conduct Activities to Educate the Public on Using the Public Health Line Education activities Program conducted reports

2.8.4 Integrate the Call Centre Approach to Health Promotion in all MOHS Strategic Center approach is Program Plans as Part of Strengthening a Continuous National level Method of Health integrated into reports Promotion MOHS strategic plans

2.8.5 Conduct Trainings for Call Centre Health Promotion and Information with Staff Trainings conducted Program reports OBJECTIVE 3: IMPROVE HUMAN RESOURCES AND CAPACITY STRENGTHENING FOR HEALTH PROMOTION National Health Promotion Strategy (2017–2021) 99 Monitoring & Evaluation Illustrative Source Measurement Indicators of Data SO 3.1: Develop Training Program for Pre-service and In-service Health Promotion Professionals

3.1.1 Develop National Training Plan of In-service Training Opportunities for HP Plan completed Program Professionals reports

3.1.2 Assign HED Staff to Attend International Health Conference (e.g., ASTMH, SBCC International health Program Conference) and Health Communication Study Tour (e.g., WHO) conference and reports study tour attended

3.1.3 Hold At Least One HP-focused Capacity Building TOT Per Year for HED and Annual training held Program Partners at National/District Level (e.g., DSMCs )- As Per Training Plan at national/district reports level

3.1.4 Hold a Strategic Health Communication Training in Sierra Leone (Repeated Every Training held Program Three Years) - As Per Training Plan reports

3.1.5 For Pre-service Training, Assess and Finalize Potential Partnership with Training Assessment report Program Institution(s) completed reports

3.1.6 Develop Curriculum with Selected Training Institution(s) Curriculum Program developed reports

3.1.7 Provide Annual General Support to Institution to Implement Training, (e.g., Institutional training Program Support for Faculty, Materials) implemented reports SO 3.2: Review and Update Human Resources for Health Policy to Include Health Promotion

3.2.1 Update and Clarify HP Roles/Responsibilities, Terms of Service and Professional Health promotion Program Development to Guide MOHS Leadership (Annually) scheme of service reports updated

3.2.2 Advocate with MOHS HRH and Partners to Influence Strengthening HED Meetings with Program Workforce MOHS HRH/HSC reports held OBJECTIVE 4: RAISE AWARENESS AND MOBILIZE RESOURCES FOR STRENGTHENED HEALTH PROMOTION SO 4.1: Advocate for Increased Funding, Operational Support and Human Resources for Health Promotion Activities

4.1.1 Develop Advocacy Plan to Identify Objectives, Key Audiences, Messages, and Advocacy plan Program National Health Promotion Strategy (2017–2021) 100 Monitoring & Evaluation Illustrative Source Measurement Indicators of Data Opportunities to Raise the Profile of HP and Mobilize Resources developed reports

4.1.2 Develop and Disseminate Evidence Briefs on Impact and Importance of HP in Briefs developed Program Sierra Leone reports

4.1.3 Hold Training for Journalists to Orient Press on Covering Health Promotion Stories Journalist training Program held reports

4.1.4 Hold National Media Event to Launch Evidence Briefs and Raise Visibility of Health Launch held Program Promotion reports

4.1.5 Orient District-level Decision-makers (e.g., District Council, VDCs, FMCs/HMCs) on Orientation Program Impact of HP via Advocacy “Road Shows” conducted reports

4.1.6 Hold Advocacy Meeting with Parliamentary Health Committee to Showcase HP Event held Program Successes and Advocate for Increased Funding for Health Promotion reports SO 4.2: Engage at Least Five New Private Sector Institutions to Invest in National Health Promotion Activities

4.2.1 Develop Private Sector Brochure Outlining Options for Investing in HP in Sierra Brochure developed Program Leone, with a Business Case for Investing in HP reports

4.2.2 Hold Annual Business Networking Forums to Encourage Investments in Health Networking forums Program Promotion conducted reports OBJECTIVE 5: IMPROVE MONITORING AND EVALUATION SYSTEMS FOR HEALTH PROMOTION

5.1.1 Hold Stakeholder Meeting to Agree on HP Monitoring Indicators, and M&E Meeting held Program Priorities for HP reports

5.1.2 Create M&E Subcommittee with a TOR within the SM Pillar, and Facilitate the Subgroup active Program Incorporation of M&E in the Implementation of All Health Promotion Activities reports

5.1.3 Identify an HP Staff Person to Focus on M&E and Represent HED in M&E Steering Staff member Program Committee Meetings appointed reports

5.1.4 Develop M&E Framework with DPPI and Partner Support M&E framework Program completed reports

5.1.5 Review and Incorporate Behavioral Indicators into Existing Monitoring Systems Behavioral indicators Program (e.g., HMIS) incorporated reports

5.1.6 Ensure HP M&E Framework is Included in MOHS M&E Trainings to Districts Trainings conducted Program reports National Health Promotion Strategy (2017–2021) 101 Monitoring & Evaluation Illustrative Source Measurement Indicators of Data OBJECTIVE 6: STRENGTHEN KNOWLEDGE SHARING AND MANAGEMENT

6.1.1 Develop a Knowledge Management Plan based on 2016 Knowledge Management Plan documented Program Assessment reports

6.1.2 Provide Technical Assistance to Districts to Implement Knowledge Management TA provided to 14 Program Plan district teams reports

6.1.3 Ensure HED and District SM Coordinators Have Internet Connectivity Internet connectivity Program is enabled for HED reports and SM coordinators

6.1.4 Organize Electronic Files at HED (Maintaining the Knowledge Gateway) Electronic files Program organized reports

6.1.5 Organize Hardcopy Files at HED (Completing Filing System) Hardcopy files organized

6.1.6 Create Tailored Email Listservs that Include Relevant Partners Listservs developed Program and in use reports

6.1.7 Create Electronic and Hardcopy Versions of Health Promotion Newsletter for Electronic and Program Nationwide Distribution Hardcopy Versions reports of the Newsletter produced and disseminated periodically

6.1.8 Ensure HED Page is on MOHS Website, Linking to Knowledge Gateway HED webpage is on Program MOHS website, reports linking to Knowledge Gateway

6.1.9 Hold Best Practices Exchange Semi-annually Through SM Pillar Meeting Community of Program practice meetings reports held semi-annually National Health Promotion Strategy (2017–2021) 102 REFERENCES Abdelmalak, M. J., Ahmed, B. S., & Mehta, K. (2015). Health knowledge and health practices in Makeni, Sierra Leone: a community-based household survey. International health, ihv059. Amnesty International. (2009). Out of Reach: the cost of maternal health in Sierra Leone. London: Amnesty International. Bakshi, S. S., McMahon, S., George, A., Yumkella, F., Bangura, P., Kabano, A., & Diaz, T. (2013). The role of traditional treatment on health care seeking by caregivers for sick children in Sierra Leone: Results of a baseline survey.ActaTropica, 127(1), 46-52. Boas, M., Hatloy, A., &Bjorkhaug, I. (2008) Alcohol and drugs in post-war Sierra Leone. African Journal of Drug and Alcohol Studies,7(1). Boima, F. (2014).In Sierra Leone, food from WFP vital to fight against child malnutrition. Freetown: United Nations World Food Program (WFP). Coinco, E. (2010). A glimpse into the world of teenage pregnancy in Sierra Leone. Freetown, Sierra Leone: UNICEF. Denny, L., Gordon, R., & Ibrahim, A. (2015). Teenage pregnancy after Ebola in Sierra Leone: mapping responses, gaps and ongoing challenges. Researching livelihoods and services affected by conflict. Working paper 39. London: Overseas Development Institute (ODI). Dynes, M. M., Miller, L., Sam, T., Vandi, M. A., Tomczyk, B., &Centers for Disease Control and Prevention (CDC). (2015). Perceptions of the risk for Ebola and health facility use among health workers and pregnant and lactating women—Kenema District, Sierra Leone, September 2014. MMWR Morb Mortal Wkly Rep, 63(51), 1226-1227. Jones, S., Ameh, C. (Eds.) (2015).Exploring the impact of the Ebola outbreak on routine maternal health services in Sierra Leone.VSO. Freetown: Voluntary Service Overseas (VSO). Kanu, J. S., Tang, Y., & Liu, Y. (2014). Assessment on the knowledge and reported practices of women on maternal and child health in rural Sierra Leone: A cross-sectional survey. PloS one, 9(8), e105936. Kennedy, N. (2008). The Sierra Leone Global Youth Tobacco Survey Report. Brazzaville: Center for Disease Control and Prevention (CDC)and the World Health Organization(WHO). Ministry of Health and Sanitation.(2010). National Leprosy and Tuberculosis Control Programme, Annual Report. Government of Sierra Leone. National Malaria Control Programme (NMCP) [Sierra Leone], Statistics Sierra Leone, University of Sierra Leone, Catholic Relief Services, and ICF International. (2013). Sierra Leone Malaria Indicator Survey. Freetown, Sierra Leone: NMCP, SSL, CRS, and ICF International DRAFT Health Promotion Strategy (2017–2022) 103 Nest Builders International. Rural WASH in Schools Programme in Sierra Leone: Baseline Study Report. Freetown: Nest Builders International. Oyerinde, K., Harding, Y., Amara, P., Kanu, R., Shoo, R., &Daoh, K. (2011). The status of maternal and newborn care services in Sierra Leone 8 years after ceasefire. International Journal of Gynecology & Obstetrics, 114(2), 168-173. Oyerinde, K., Harding, Y., Amara, P., Garbrah-Aidoo, N., Rugiatu, K., &Oulare, M. (2012). Barriers to uptake of emergency obstetric and newborn care services in Sierra Leone: a qualitative study. J Commun Med Health Educ, 2(5), 1-8. Patel, P. (2016). In the Wake of Ebola: Measles Outbreak in Sierra Leone. Global Connections. UN Foundation. Retrieved fromhttp://unfoundationblog.org/in-the-wake-of-ebola-measles-outbreak-in- sierra-leone/. Risso-Gill, I. & Finnegan, L. (2015).Children’s Ebola Recovery Assessment: Sierra Leone. Save the Children, Plan International & World Vision International. Save the Children (2012). Breast-milk substitutes threaten young lives: 2012 research into use of breast- milk substitutes in Sierra Leone. Save the Children. Scott, K., McMahon, S., Yumkella, F., Diaz, T., & George, A. (2014).Navigating multiple options and social relationships in plural health systems: a qualitative study exploring healthcare seeking for sick children in Sierra Leone.Health policy and planning, 29(3), 292-301. SMART Survey.(2014). Sierra Leone National Nutrition Survey 2014.Freetown: MOHS and UNIVEF Sierra Leone Statistics Sierra Leone (SSL) and ICF International.(2014). Sierra Leone Demographic and Health Survey 2013. Freetown, Sierra Leone, and Rockville, Maryland, USA: SSL and ICF International. Statistics Sierra Leone (SSL) and ICF International.(2009). Sierra Leone Demographic and Health Survey 2013. Freetown, Sierra Leone, and Rockville, Maryland, USA: SSL and ICF International. Statistics Sierra Leone, & the United Nations International Children’s Emergency Fund. (2011). Sierra Leone Multiple Indicator Cluster Survey 2010 Final Report. Freetown: Statistics Sierra Leone, & UNICEF. Takahashi, S., Metcalf, C. J. E., Ferrari, M. J., Moss, W. J., Truelove, S. A., Tatem, A. J., ... &Lessler, J. (2015). Reduced vaccination and the risk of measles and other childhood infections post- Ebola.Science, 347(6227), 1240-1242. Joint United Nations Programme on HIV/AIDS (UNAIDS).(2014). Sierra Leone National AIDS Response Progress Report 2014. Freetown: UNAIDS/Government of Sierra Leone (GoSL). United Nations Fund for Population Activities (UNFPA).(2015). Rapid Assessment of Ebola Impact on Reproductive Health Services and Service Seeking Behaviour in Sierra Leone. Freetown: UNFPA. National Health Promotion Strategy (2017–2021) 104 United Nations Fund for Population Activities (UNFPA).(2015).Rapid Assessment of Pregnant Adolescent Girls in Sierra Leone. Freetown: UNFPA. United Nations International Children’s Emergency Fund (UNICEF). (2014). Sierra Leone Health Facility Survey 2014: Assessing the impact of the EVD outbreak on health systems in Sierra Leone. UNICEF. World Health Organization (WHO). (2015). National Profile: Sierra Leone. Retrieved from http://www.aho.afro.who.int/profiles_information/index.php/Sierra_Leone World Health Organization (WHO).(2012). Sierra Leone Launches National Cancer Registry. Retrieved fromhttp://www.afro.who.int/en/sierra-leone/press-materials/item/4715-sierra-leone-launches- national-cancer-registry.html World Health Organization (WHO), United Nations International Children’s Emergency Fund (UNICEF), United Nations Fund for Population Activities (UNFPA), World Bank Group, & the United Nations Population Division. (2015). Trends in Maternal Mortality: 1990 to 2015. Geneva: WHO. Wittels, A.(2016). Exploring the role of communication in community health in Sierra Leone. London: BBC Media Action. National Health Promotion Strategy (2017–2021) 105