SLA Application Process

About MoHS Service Level Agreement

The Service Level Agreement (SLA) is an approach that is used by the Ministry of Health and Sanitation (MoHS) – a Government institution that is mandated with the overall responsibility to ensure provision of health care services in Sierra Leone – to delegate parts of this mandate to non-Government entities. The SLA is a Memorandum of Understanding signed between the Ministry of Health and Sanitation (MoHS) and Implementing Partners (IPs) prior to implementing activities in the health sector.

The objective of the SLA is to ensure that health sector programme implementation is aligned with the national priorities and contribute towards achieving better health outcomes.

Inform Decision
Making

Enables the MoHS to capture all projects implemented in the health sector into one database that can generate reports to inform decision making.

Aligning Projects to MOHS Priorities

Ensures that all proposed projects are aligned with the MOHS priorities and responds to the gaps identified in the district plans.

Equitable Service
Provision

Ensures that all partner support is rationed across the 15 districts, contributing toward equitable service provision for the Sierra Leonean population.

Adhearence to Quality

Ensures adherence to quality service standards for goods, services and works.

Improve
Coordination

Improves coordination of health care interventions at the district and lower levels and avoid duplication of partner efforts.

Strengthen Monitoring of Partner Interventions

Strengthens monitoring of partner interventions at the district and local levels and ensures that a significant proportion of donor investments reach the beneficiaries (value for money).

Prioritize Interventions at Lower Levels

Ensures that interventions (by type) at the lower levels are prioritized and that support to the 15 districts is equitable.

The Ministry of Health and Sanitation is aware that implementing partners have projects that are currently ongoing. The SLA applies to all active projects on a differentiated approach. For ongoing projects that were signed before 01 May 2015 using the MOU, the implementing partner should submit part of the required documents. The submitted documents will not undergo PRC review. Instead, the SLA will be screened for completeness and details of the project will be entered into the SLASLA database and filed for future references. All projects that were not endorsed by MOHS in one form or the other by 01 May 2015, an SLA is mandatory prior to implementation. It should be noted that extension of signed SLAs is possible without substantial review if the scope remains the same and it is no cost extension. If there is additional funding to support the extension, then the new/revised budget should be submitted to the SLA Team for review. For all projects whose SLAs were not signed by 22nd of September 2016 when MOHS communicated the Cabinet decision on institutional support, it is mandatory for the IP to pay the SLA institutional support prior to the review and approval of the SLA. Implementing partners are encouraged to book an SLA institutional support negotiation appointment with the SLA Team using the email address: SLA2015.MOHS@gmail.com and a member of the SLA Team will book the appointment. There are several options for IPs and these include: (i) IP negotiating directly with the MOHS; or (ii) The donor negotiating on behalf of the IP. It should be noted that MOHS will not sign SLAs with the donors as SLAs is meant to hold IPs accountable for services they provide at the implementation sites. It is the MOHS’ preference for an IP to engage the SLA Team on the institutional support prior to developing and/or finalizing the budget prior to formal submission to minimize back and forth.

Guiding Principles

The Government of Sierra Leone fully understands and appreciates the importance of partnerships in the rebuilding of the health sector. The fundamental principles that underpin the implementation of this agreement are:

1. Country Ownership

The Government of Sierra Leone is the ultimate body that is responsible for ensuring the health for all Sierra Leoneans and this responsibility is assigned to the Ministry of Health and Sanitation, with some of the health functions devolved to local councils. Government leadership, by extension, the leadership from the Ministry of Health and Sanitation on the provision of health care in the country, including its oversight role for the devolved functions, is key sub-principles that ensure country ownership. Therefore the approach to, implementation arrangements for and branding on any health project should reflect and promote country ownership.

2. Comprehensiveness

The Ministry of Health and Sanitation has developed a minimum package of services that should be provided at each level. Support to Government facilities should be comprehensive within the specific area of focus. For instance, if an IP intends to support Government facilities with refurbishment, the expectation is that all structures within the facility will be refurbished. Refurbishing one building and leaving others does not do justice to the needs of the targeted facility. Government preference is that IPs select fewer facilities and refurbish all buildings as opposed to refurbishing one of several buildings in many facilities. In the area of programme support, IPs SHOULD support specific interventions within the context of strengthening the health system to enable it to deliver high quality services across all diseases and interventions. In instances where an IP has no comparative advantage one component of a specific area of focus, the IP should form partnerships with other IPs that can implement and/or support those areas to ensure area-specific comprehensiveness.

3. Accountability and Transparency

Funds, regardless of source, that are transferred to IPs are allocated to Sierra Leone on the basis of the needs among Sierra Leoneans and therefore should be used for its intended purpose and adequately accounted for to the public and the relevant statutory bodies in addition to accounting to the funding source. The Government of Sierra Leone’s Ministry of Health and Sanitation is keen to see value for donor partner investments. Therefore, review of the budget, both detailed and summary budgets, will provide to the Government of Sierra Leone, a better understanding of which cost categories are big tickets for the project. A Summary Budget template will be provided to help the Ministry determines the percentages spent on HR, Other support costs, Training, Travel etc. to help determine the percentage that reach the beneficiaries – the Sierra Leonean people.

4. Appropriate Prioritization

The Ministry of Health and Sanitation, as the Government entity responsible for health in the country, is accountable to the people on health care services provided to them. Therefore the Ministry of Health and Sanitation has the Government of Sierra Leone’s delegated authority to determine priorities in terms of areas of focus, specific interventions within the identified areas of focus and geographic locations for implementation. Implementing partners can propose specific geographic locations for implementation; however, the final decision on such proposals shall rest with the Ministry of Health and Sanitation and shall be based on assessments conducted either by or in collaboration with the Ministry of Health and Sanitation. Where such assessments are not feasible, the best available data, acceptable to the Ministry of Health and Sanitation shall be used to prioritize interventions, districts and implementation sites within districts. The Ministry of Health and Sanitation is thriving toward equitable access to health care and encourages taking health care and other services to under-served districts and locations as a priority to saturating an over-subscribed district.

5. Efficiency and Value for Money

IPs will uphold the principles of cost efficiencies and ensure value for money during implementation of funded interventions. In addition to the budget review at the beginning of the project, IPs will be required to submit expenditure reports as part of their quarterly reports. As the Ministry frequently receives donations as well as requests to enter into agreements with new partners, such information will enable the Ministry to make decisions on funds still available in the health sector and how much of it could be reallocated. For instance, if an implementing partner has funds to procure a specific drug on behalf of the Government and the Ministry of Health receives a donation of that particular drug, then the Ministry can engage with the implementing partner to reallocate the funds that were meant for the procurement of the donated drug. This will enable the health sector to stretch the investments much broader to benefit the Sierra Leonean population.

6. Quality Standards of Health Care Service Provision

MOHS is aware that resources are limited. However, the Ministry believes that there are minimum standards that implementing partners should adhere to when supporting the health sector. To this end, the MoHS will compile a list of standards for goods, services and works and communicate with implementing partners the expected quality. The Program Review Committee (PRC), an integral structure of the SLA review process, will ensure that proposed interventions adhere to the quality standards. When the expertise required for reviewing and ensuring that the standards for proposed interventions is lacking among PRC members, (i.e. building works etc.) the required expertise will be secured from the relevant units within MOHS and the relevant MDAs. In addition, MOHS will assess the capacity of Implementing Partners to ensure that IPs have appropriately qualified staff and resources to make a significant contribution to the delivery of quality health services in the public health sector.

7. Alignment with Government Priorities

The Health Sector Recovery plan for the period 2015 – 2020 along with the operational plans (initially the 6-9 months and now the 10-24 months plans) provide a blueprint on priority health care activities for the period ending December 2017. All interventions proposed should be directly linked to the overall Health Sector Recovery Plan, from which operational plans were derived. In addition, Implementing Partners applying for SLA must be a registered NGO and must have an Attestation Letter from the Ministry for the project executing year, which is expected to be renewed every year for subsequent implementing year/s. SLAs for previous health programmes will be reviewed to guide MOHS on letters of attestations.

8. Transition and Sustainability

The parties understand that the delegated responsibility to the IP is temporary. The intention of both parties is for the implementing partner to develop a sustainability and transition plan defining how the gains from project implementation will be sustained as well as a clear plan for transitioning direct service provision and activity implementation back to the MOHS.

Meet the Executives

Meet the experienced MoHS SLA team

Dr Austin Demby
Minister of Health and Sanitation

Morie Momoh
Permanent Secretary
Ministry of Health and Sanitation

Dr Dennis Marke Health System Strengthening Program Manager

Sulaiman Phoray-Musa Senior Program Manager, SLA

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