# Strengthening infection prevention and control during the COVID-19 pandemic: implementation of a decentralised mentorship model across 450 primary health facilities in Sierra Leone, 2021–2022

## TL;DR

This study shows how a mentorship program improved infection control in 450 health facilities in Sierra Leone during the pandemic, leading to better practices and funding.

## Contribution

The study introduces a decentralized mentorship model that successfully improved infection prevention and control in low-resource settings.

## Key findings

- Training coverage increased from 38% to 100% across facilities.
- Observed adherence to core IPC practices like hand hygiene and mask use improved significantly.
- The Ministry of Health established a dedicated IPC budget line, increasing domestic funding by 25%.

## Abstract

The COVID-19 pandemic exposed significant infection prevention and control (IPC) gaps in Sierra Leone's primary health care system. We evaluated whether a decentralised multicomponent mentorship model could improve IPC performance across 450 government primary health facilities and support sustainable domestic financing for IPC.

We conducted a pre-post quasi-experimental evaluation without a comparison group using facility-level indicators at baseline (April 2021) and endline (January 2022). The intervention package included competency-based IPC training, twice-monthly facility mentorship using structured observation checklists, routine monitoring with feedback using national IPC assessment tools configured in District Health Information Software 2 (DHIS2), targeted support for IPC commodities and water, sanitation and hygiene (WASH)-related infrastructure, community engagement, and budget advocacy through policy briefs and stakeholder meetings. We compared paired facility indicators using McNemar's chi-square test and examined service delivery patterns using month-matched comparisons to pre-pandemic levels (April 2019–January 2020). Primary outcome domains included training coverage, IPC supplies and infrastructure availability, and observed adherence to core IPC practices.

Facilities meeting ≥80% staff training coverage increased from 38% to 100% (p < 0.001). Availability of IPC SOPs/registers, triage infrastructure, and core IPC supplies improved in 20 of 22 indicators (p < 0.001). Observed adherence improved for hand hygiene (39% to 89%), appropriate mask use (50% to 98%), screening at entry (27% to 96%), waste segregation (21% to 98%), and sharps safety (89% to 100%) (all p < 0.001). Service delivery volumes were maintained or increased during the intervention period compared to pre-pandemic levels for six of eight indicators examined (p ≤ 0.007). The Ministry of Health (MoH) established the first dedicated IPC budget line, increasing domestic allocation by 25% from USD 384,000 to USD 480,000, with USD 2.3 million secured from partners.

A decentralized mentorship model embedded in government structures can rapidly strengthen primary care IPC capacity while catalysing the policy and financing commitments essential for sustainability. The consistency of improvements across indicators supports this approach for similar low-resource settings. Controlled designs are needed to establish attribution and assess long-term impact.