Dr. Francis L. Moses
Dr. Francis L. Moses is the Director of Reproductive and Child Health at the Ministry of Health in Sierra Leone. A reproductive health specialist with 18 years of experience, he has worked across both the public and private health sectors as a clinician and public health expert.
Dr. Moses has held key leadership roles at various levels of the healthcare system, including District Medical Officer, and Program Manager. Before his appointment as Director, he served for six years as the Program Manager for the National Reproductive Health and Family Planning Program.
He holds a Bachelor of Medicine and Surgery from the College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone, as well as two master’s degrees—Master of Medicine in Reproductive Health Sciences and Master of Philosophy by Research—from the University of Sydney, Australia. In addition, he has earned multiple certifications, including in Health Systems Leadership and Management and Operational Research.
Dr. Moses is an Associate Lecturer at COMAHS and has a strong interest in operational research. He has contributed to several research studies and has authored numerous publications in the field of reproductive and child health.
Programs
Brief on the Expanded Program on Immunization
Immunization in Sierra Leone began in the 1960s, initially offering BCG, Smallpox, and DPT vaccines. Between 1967 and 1970, the country joined the West African Smallpox Eradication/Measles Control Programme, with the Endemic Disease Control Unit (EDCU) in Bo training vaccinators nationwide. Vaccines for cholera (1972) and yellow fever (1975) were introduced for epidemic response. The 1974 launch of the Expanded Programme on Immunization (EPI) by WHO and UNICEF expanded services to cover six childhood killer diseases: Tuberculosis, Diphtheria, Pertussis, Tetanus, Poliomyelitis, and Measles.
Under the Directorate of Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) within the Ministry of Health, the EPI focuses on strengthening healthcare delivery systems, building human resource capacity, and scaling up evidence-based, low-cost, high-impact interventions.
Over time, additional vaccines were introduced—including TT, Yellow Fever, Pentavalent (DTP-HepB-Hib), Pneumococcal Conjugate Vaccine (PCV13), Rotavirus, Inactivated Poliovirus Vaccine (IPV), Human Papillomavirus (HPV), and Malaria Vaccines—to broaden protection against Vaccine Preventable Diseases (VPDs). The EPI is closely integrated with other public health programs, such as malaria, tuberculosis, HIV/AIDS control, nutrition, disease prevention, surveillance, and the National Public Health Agency (NPHA).
Currently, Sierra Leone’s immunization schedule covers 14 diseases: Hepatitis B, Diphtheria, Tetanus, Pertussis, Haemophilus influenzae type b, Polio, Pneumococcal disease, Rotavirus, Measles, Rubella, HPV, Tuberculosis, Malaria, and COVID-19. Vaccinations are provided free of charge at the point of service.
Vision
A well-functioning immunisation system that ensures quality, accessible, affordable, and equitable services, well integrated into overall health delivery.
Mission Statement
To deliver high-quality and equitable immunisation services and other essential primary healthcare interventions, ensuring they are accepted and effectively utilized by the communities.
Core Values
- Respect for life
- Right to health for all
- Equity
- Enabling work environment
Units or Sub-Units
Leadership, Governance and Finance
Leadership, governance, and management under the Expanded Program on Immunization in Sierra Leone have fostered effective coordination, financial management, and performance monitoring. Key national bodies such as the Technical Coordination Committee (TCC), Interagency Coordinating Committees (ICCs), and the National Immunization Technical Advisory Group (NITAG-SL) provide oversight, with NITAG-SL offering evidence-based technical advice on vaccines and immunization strategies to the Ministry of Health.
Service Delivery
The Service Delivery Unit within the Expanded Programme on Immunization (EPI) plays a critical role in ensuring equitable and high-quality immunization services across all healthcare levels. The success of the unit depends on Human Resources, who are foundational to program success. The program requires a well-trained, skilled, and motivated workforce at national, district, and facility levels. Immunization coverage rates serve as key indicators of both EPI program effectiveness and broader health system performance.
Core Functions include:
- Supporting equitable service delivery – Delivering safe, effective, and people-centered immunization services to protect against vaccine-preventable diseases (VPDs).
- Increasing access and utilization – Expanding outreach, especially in areas with low coverage and high numbers of zero-dose children, through tailored delivery strategies ensuring regular and accessible services.
- Maintaining a well-trained workforce at all levels, from national to community levels
Immunization Supply Chain
The Immunization Supply Chain (iSC) is a critical component of the Expanded Programme on Immunization (EPI), ensuring the consistent availability, quality, and timely distribution of vaccines and related supplies. It covers the end-to-end process of vaccine forecasting, procurement, storage, distribution, monitoring, and reporting to support immunization services at all health system levels. The effectiveness of the iSC directly influences national immunization coverage rates and contributes significantly to reducing vaccine-preventable diseases.
The EPI Supply Chain Unit works closely with national stakeholders, partners, and District Health Management Teams (DHMTs) to maintain a robust and responsive system that efficiently meets programmatic demands.
The iSC operates through a structured distribution flow, moving vaccines from the National Cold Room to District Cold Stores and Health Facilities. The vaccine procurement and supply cycle involves three key steps at each level:
- Annual Forecasting: UNICEF and MoH jointly forecast vaccines and related supplies.
- Biannual Receipt and Storage: Vaccines are received and stored twice a year in the national central cold rooms.
- Stock Monitoring: Ongoing stock management through the electronic Stock Management Tool (eSMT), maintenance of vaccine stock ledgers, and requisition books.
Demand Generation
Demand Generation is the communication arm of the EPI. It is critical in demand creation, community engagement, social mobilization, and risk communication. Its primary objective is to leverage existing community structures and promote a community-led approach to raising awareness, improving knowledge on the importance of vaccination, addressing misinformation, tracking and monitoring rumors, and responding to and mitigating vaccine hesitancy and refusal.
The department emphasizes using culturally relevant and locally resonant communication strategies to ensure that messages are clearly understood, reduce confusion, and build community trust.
Research and Innovations
This unit focuses on the coordination of scientific research activities, encompassing elements such as capacity building, the provision of advisory services tailored to specific programmatic contexts, as well as aspects related to the publication, archiving, and retrieval of research outputs.
Vaccine Safety
Modern vaccines are widely recognized for their safety and effectiveness. However, like all medical products, they are not completely free from adverse reactions. Adverse events following immunization (AEFI) can range from mild, non-serious responses to rare yet significant incidents. When AEFIs occur, they can erode public trust in vaccines and contribute to vaccine hesitancy. Therefore, effective monitoring of AEFIs is essential for maintaining public confidence in vaccination programs. This requires a strong collaboration between the Expanded Programme on Immunization (EPI), the Pharmacy Board of Sierra Leone (PBSL), public health programs, surveillance units, the Directorate of Planning, Policy, and Information, and vaccine manufacturers.
Vaccine Preventable Diseases Surveillance
Surveillance for vaccine-preventable diseases (VPDs) is a vital component of public health, integrating the monitoring of infectious and non-infectious diseases. The Expanded Programme on Immunization (EPI), in collaboration with the National Public Health Agency and other partners, conducts surveillance through sentinel sites and case-based methods. By delivering timely and essential data, the Ministry of Health (MoH) enhances early detection and response to VPDs, guides effective vaccine deployment, and informs disease control measures such as isolation.
Monitoring and Evaluation
The Monitoring and Evaluation (M&E) Unit of the Expanded Programme on Immunization (EPI) is vital in strengthening the national immunization program. It systematically collects, analyzes, and interprets immunization data to assess program performance, guide operational improvements, and inform decision-making.
To enhance data quality and security, the unit builds the capacity of M&E Officers and Chiefdom Data Entry Officers and promotes peer learning across districts. It also ensures accountability by tracking progress, identifying gaps, and supporting timely corrective actions.
Through ongoing performance monitoring and impact evaluation, the M&E Unit ensures that immunization investments deliver measurable results. Its work is essential to improving the effectiveness, efficiency, and value of immunization services in Sierra Leone.
Material for Publication on Website
| Category | Document | Description |
|---|---|---|
| Research and Innovations | The use of the DHIS2 AEFI module on the performance of an AEFI surveillance system in Sierra Leone: Early lessons learned during the COVID-19 pandemic | This study, conducted in 2022, evaluates the use of the COVID-19 AEFI DHIS2 module. It identifies successes, challenges, and recommendations to enhance signal detection, investigation of serious adverse events, causality assessment, and AEFI management to facilitate effective policy formulation, planning, budgeting, monitoring, and evaluating the COVID-19 response. |
| COVID-19 Vaccine Post-Introduction Evaluation, Sierra Leone | This study aimed to evaluate the COVID-19 vaccine deployment (March 2021 – September 2023) among the targeted population in Sierra Leone and its interaction with the introduction of the HPV vaccine and the broader routine immunization program. This report documents best practices and improvement opportunities, including action recommendations. | |
| Access, demand, and utilization of childhood immunization services: A cross-sectional household survey in Western Area Urban district, Sierra Leone, 2019 | This was a cross-sectional household survey in the Western Area Urban district of Sierra Leone, stratified by slums and non-slums as defined by the United Nations Development Program. The study estimated vaccination coverage from 450 children aged 12-36 months (household response rate=83%) and factors related to accessing routine immunization services from 444 caregivers. | |
| Qualitative assessment of caregiver experiences when navigating childhood immunisation in urban communities in Sierra Leone (Published 2022) | An exploratory qualitative assessment comprising 16 in-depth interviews was conducted to gain an in-depth understanding of the caregiver experience when navigating urban immunization services for their children. | |
| Using photovoice methodology to uncover individual-level, health systems, and contextual barriers to uptake of the second dose of measles-containing vaccine in Western Area Urban, Sierra Leone, 2020 | The study used a ‘Photovoice’ approach to identify community-specific barriers caregivers face in accessing MCV2 services for their children and health workers in delivering MCV2 from March to September 2020. | |
| Evaluation of health system readiness and coverage of intermittent preventive treatment of malaria in infants (IPTi) in Kambia district to inform national scale-up in Sierra Leone | The study used a mixed-methods approach to evaluate IPTi implementation at 3 and 15-17 months of introduction to establish strengths and weaknesses and recommendations for nationwide scale-up. | |
| Immunization Supply Chain and Logistics Management | Cold Chain Inventory Assessment, October 2022 | Background Sierra Leone, located on the west coast of Africa with a population of 7,075,000 (2015 census), consists of 16 districts and multiple chiefdoms. A cold chain assessment was conducted in September 2022 to evaluate immunization equipment status nationwide. Data collection used KoBoCollect and was led by the national team with support from UNICEF Supply Division.Key Findings 1. Coverage: 1,526 health facilities assessed (1 national store, 16 district stores, 1,509 PHUs). 2. Electricity: Reliable only at the national level. 3. Equipment Count: 1,459 units (16 national, 177 district, 1,266 PHUs). 4. PQS Compliance: 84% of equipment meets WHO PQS standards. 5. Power Source: 73% powered by solar energy (mainly PHUs), 17% powered by electricity (mostly national/district). 6. Waste Disposal: Mostly by burning/burying; few incinerators in use.Key Recommendations 1. Implement the 5-year expansion/replacement plan. 2. Validate PHUs lacking equipment. 3. Install unused Beyond Wireless RTMDs. 4. Provide dry storage at national level. 5. Supply freezers to boost icepack freezing capacity at districts. 6. Install voltage regulators for electricity-powered units. 7. Ensure regular cold chain inventory updates. |
| Effective Vaccine Management (EVM), Sierra Leone 2022 | Overview The Effective Vaccine Management Assessment (EVMA) is a quality management tool used to assess and improve a country’s immunization supply chain. In 2022, Sierra Leone conducted its EVMA using the new EVM 2.0 tool, which evaluates 13 criteria (9 operational, 4 managerial).Assessment Process – Training: A two-day orientation and five-day assessor training were conducted. – Data Collection: Took place from November 21–27, 2022, covering 1 national, 16 district, and 42 service delivery facilities. – Scoring & Analysis: Final scores and improvement planning were completed in December 2022.Key Results – Overall Composite Score: 64%, below the 80% benchmark. – Input Scores (C1–C6): Infrastructure, Equipment, Policies/Procedures: 56–59%; Information Technology: 75%; Financial Resources: 38% (lowest); Human Resources: 82% (only score above benchmark). – Output Performance (O category): 56%. – Poor scores in Management (25%), Annual Work Planning (35%), and iSC Performance Monitoring (33%). – Only Vaccine Arrival (E1) exceeded 80%. – Low staff performance was linked to limited funding and staff attitudes. Key Recommendations | |
| Monitoring and Evaluation | COMPREHENSIVE EPI REVIEW AND HPV POST-INTRODUCTION EVALUATION Final Report – February 2024 | The overall goal of the EPI Review is to document the programme’s successes and challenges to guide future performance towards sustainable control of vaccine-preventable diseases and provide recommendations that would form the foundation for strategic planning. The review covered immunization and surveillance systems and the implementation status of all the program components from national to health facility levels. |
| Leadership and Governance | NATIONAL IMMUNISATION POLICY 2023 | This National Immunisation Policy is a revised version of the 2002 edition. It is intended to guide all categories of stakeholders, including immunisation service providers, policy, and decision-makers, administrators, managers, government agencies, and health development partners engaged in the provision of immunisation services in Sierra Leone. |