In recent years, Sierra Leone has made significant strides in addressing its maternal and child health challenges. Despite being one of the countries with the highest maternal mortality rates globally, the nation has seen marked improvements in health outcomes. With the support of the World Health Organization (WHO) and other partners, the country has managed to reduce maternal and child mortality rates significantly. From 2000 to 2020, Sierra Leone reduced its maternal mortality rate by about 74%, from 1682 deaths per 100,000 live births to 443. Additionally, under-five mortality dropped by 55%, from 225 to 101 per 1,000 live births, between 2000 and 2022.
While these numbers are encouraging, the country still faces a long road ahead to meet the United Nations’ 2030 Sustainable Development Goal, which aims to reduce maternal mortality to 70 deaths per 100,000 live births. In 2018, a national report revealed that a significant portion of maternal deaths occurred in health facilities, many of which were preventable with better healthcare measures. This led Sierra Leone to focus on improving the quality of care in its health facilities as a means of further reducing maternal and child deaths.
One of the key initiatives driving this change is the Quality of Care (QOC) Network, which Sierra Leone joined in 2018. The initiative’s primary goal is to halve maternal and newborn deaths in targeted health facilities within five years. Despite improvements in essential maternal health services like antenatal care and skilled birth attendance, the outcomes remained unsatisfactory. This prompted the Ministry of Health to launch the National Quality Management Programme, which aims to ensure better care for all.
The Ministry of Health, with the support of WHO, developed a strategic roadmap for quality of care in 2020. Since then, more than 500 healthcare workers have been trained to align with the roadmap’s goals. The 16 district hospitals in Sierra Leone, including Bo Government Hospital in the southern province, now have dedicated in-house quality of care officers who play a critical role in ensuring that health workers have the right tools and training to deliver quality care to patients.
At Bo Government Hospital, significant changes have been observed since the introduction of the quality of care strategy. Rebecca Bockarie, the quality of care officer at the hospital, has seen firsthand the positive impact of these improvements. “Before the quality of care program, maternal deaths were higher. But now, with the training and the focus on quality care, we are providing the best care to our patients,” she says. Dr. Osman Kakay, the hospital’s medical superintendent, concurs, noting that the number of maternal deaths has been reduced by more than half since the strategy was implemented.
WHO’s role in supporting Sierra Leone’s healthcare improvements has been crucial. Beyond training health workers, WHO has assisted in the adaptation and rollout of national guidelines for emergency obstetric care. It has also provided essential medical equipment and supplies to improve obstetrics and reproductive health services. Dr. Innocent Nuwagira, WHO Representative in Sierra Leone, emphasizes the importance of universal health coverage, ensuring that no one is left behind in the country’s healthcare journey.
The efforts to improve quality of care are also supported by the development of policies and guidelines, the introduction of a quality of care dashboard to track progress, and ongoing training for health workers. Dr. Margaret Mannah, the National Quality of Care Programme Manager, sees these advancements as milestones in the country’s efforts to improve maternal and child health.
While Sierra Leone still faces many challenges in its healthcare system, these efforts to improve the quality of care in health facilities are making a tangible difference in saving lives. With continued support and commitment, the country is on a path toward achieving its health goals and ensuring that mothers and children receive the care they deserve.
