Epidemic-Ready Primary Health Care and the Application of the 717 Metrics: A Case Study on a Measles Outbreak in Sierra Leone, January-March 2024

The COVID-19 pandemic exposed vulnerabilities in health systems abilities to detect, report, and respond to threats. Inadequate preparedness led to healthcare worker infections (HCW), essential service disruptions, and impacts on communities. Primary health care (PHC) is often overlooked in health security initiatives. Epidemic Ready Primary Health Care (ERPHC) is an initiative that strengthens PHC facilities to prevent, detect and respond to outbreaks, while maintaining essential services. ICAP at Columbia University, the Ministry of Health of Sierra Leone, and Resolve to Save Lives is implementing a multi-year ERPHC project in Sierra Leone. A retrospective data review of 52 confirmed measles cases across four PHC facilities from January - March 2024 was conducted. Data is presented using an adapted 7-1-7 quality improvement approach for detection and notification to evaluate the key tenants of ERPHC: speed, safety, surge. Out of 52 confirmed cases, 98% and 100% met the first "7" and "1" for detection and notification. Immediate case management and safety actions were completed for all 52 cases (100%). Zero facilities were able to implement two readiness parameters for surge: sufficient supplies and referral pathways. Key bottlenecks included late presentation to health facilities, delayed notification via the electronic case-based surveillance system, inadequate PPE, and no updated referral pathways. These results underscore the need to scale and implement ERPHC, using adapted 7-1-7 metrics, in PHC facilities. HCW safety, increased community engagement, national supply chain mechanism strengthening, and established patient referral pathways need to be the foci of further health security investment in Sierra Leone.