A narrative review of progress and lessons from a decade of implementing infection prevention and control in Sierra Leone following the Ebola epidemic

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Infection Prevention and Control (IPC) is essential for resilient health systems and emergency preparedness. In Sierra Leone, inadequate IPC practices during the 2014–2016 West Africa Ebola epidemic catalysed the establishment of a national IPC programme. This review examines a decade of IPC implementation lessons, progress, challenges, and policy implications. We conducted a structured narrative review with targeted literature search (2015–2025). Evidence was drawn from peer-reviewed and grey literature and national reports, including the International Health Regulations (IHR, 2005) core capacity monitoring reports. Searches were conducted in PubMed, Scopus, organisational databases/libraries, Ministry of Health archives, and Google. Quantitative performance scores were benchmarked against regional and global averages, while qualitative data were synthesised thematically to identify lessons learned. The IPC programme demonstrates strong national foundation and achievements that compare favourably with global trends, particularly in similar low- and middle-income countries (LMICs). Policy reforms included expansion of IPC structures, enhanced partnership, integration, and updated policies/strategies and guidelines. Practice improvements were evident in rising IPC performance scores, outbreak response, workforce training, innovation and operational research. Though disparities exist at the healthcare facility level with critical gaps in financing and healthcare-associated infection surveillance, progress has been internationally recognised. Its critical functions during public health emergencies underscored resilience and need to extend IPC beyond health facilities to communities through culturally appropriate risk communication. Important lessons along with key policy implications were systematically reported. This decade review of IPC programme rooted in lessons from the Ebola epidemic, has shown evidence of progressive and sustainable implementation. Providing testament that IPC can be established and scaled even in resource-constrained and vulnerable settings when political commitment and international partnerships align. By embedding both policy reforms and practice improvements, it offers a solid foundation for strengthening healthcare across the continuum with transferable lessons for other LMICs.