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Improving quality of care to save lives in Sierra Leone

Improving quality of care to save lives in Sierra Leone

12 December 2024 | Sierra Leone
Earlier this year, 33-year-old mother of three Theresa Kpaka gave birth to twins at Bo Government Hospital, located in Bo Town in Sierra Leone’s southern Province, where nurses had been closely monitoring her pregnancy since the end of her first trimester. “They were always talking to me, always encouraging me. They reassured me that giving birth to twins would not be a problem and they treated me when I had bleeding after labour. They really took care of all three of us,” she says.

Freetown ‒ Sierra Leone has long had one of the world’s highest burdens of maternal mortality. But local health authorities have made commendable efforts to combat this devastating trend, as well high rates of infant mortality, with support from World Health Organization (WHO) and partners.

Over the past two decades, the rapid expansion of health facilities, increased production, deployment and retention of health workers, and improved access to life-saving and essential medicines, alongside policy reforms such as free health care for pregnant women and children since 2010, have significantly enhanced health outcomes. These initiatives have improved access to quality health services, resulting in better key performance indicators and a notable reduction in maternal and child mortality rates. Sierra Leone’s maternal mortality rate reduced by around 74% between 2000 and 2020, from 1682 deaths per 100 000 live births to 443, while under 5 mortality has seen a 55% decrease, from 225 to 101 per 1000 live births between 2000 to 2022. 

However, the country remains a long way off the UN’s 2030 Sustainable Development Goal for maternal mortality of 70 deaths per 100 000 live births. After a 2018 national report showed more than two thirds of maternal deaths were occurring in health facilities and were preventable with effective health measures, Sierra Leone has shifted its focus to bolstering the quality of care in its health facilities.

In 2018, Sierra Leone became the 10th country to join the global Quality of Care (QOC) Network, which aimed to halve maternal and newborn deaths in targeted health facilities within five years. “Despite high coverage in key maternal health indicators like antenatal care and skilled birth attendance, outcomes remain poor. To address this, the Ministry of Health launched the National Quality Management Programme, driving better care for all,” says Dr Tom Sesay, head of the Ministry of Health’s Reproductive and Child Health Directorate. In 2020, WHO supported the Ministry of Health in developing a quality-of-care strategic roadmap and has since assisted in the training of more than 500 health care workers in line with this strategy.

All 16 of Sierra Leone’s district hospitals, including Bo Government Hospital, now have a dedicated in-house quality of care officer. These officers both help to ensure that staff have all the necessary tools to provide patients with the right care while also overseeing the day-to-day implementation and coordination of the broader strategy. Rebecca Bockarie, quality of care officer at Bo Government Hospital, has noticed significant changes since the strategy was implemented. “Before quality of care, we had more maternal deaths as compared to now,” she says. “But since it was introduced into the system, and with all the trainings that staff have had, we are now giving the best care to our patients. There is much improvement.”

Dr Osman Kakay, the hospital’s medical superintendent, reinforces Bockarie’s assertion: “When I was posted here in November 2022, there was a lot of maternal death,” he recalls. “Since then, we have made a lot of strides, more than halving the number of maternal deaths in the hospital. The quality-of-care training has helped us greatly in this fight.”

WHO has also supported the adaptation and roll out national guidelines that aim to improve emergency obstetric care, as well as providing medical equipment and supplies for obstetrics and sexual and reproductive health and has held trainings on their use. “Regarding universal health coverage, we want to make sure that no one is left behind. WHO continues to work with and support the Ministry of Health and other partners to ensure that quality of care for maternal and child health services is the highest possible we can assure,” says Dr Innocent Nuwagira, WHO Representative in Sierra Leone. "Being the first manager of Sierra Leone’s Quality of Care Programme has been an honour,” says Dr Margaret Mannah, National Quality of Care Programme Manager. “With support from WHO and the Quality, Equity, Dignity Network, we've achieved milestones like developing policies, guidelines and training health workers while introducing a quality of care dashboard to track progress and improve outcomes.”

Dr Austin Demby, the country’s Minister of Health, has made maternal and child health a top priority, to the extent that he has declared that any maternal or child death should be treated as an emergency. “What we want to do is to focus on maternal mortality on the one hand but also focus on child survival. We are looking at child survival to the extent that we want to take this so seriously as a nation that we have declared an emergency, a local emergency, that allows us to focus and direct resources at not only having the safe delivery of a baby and allow this baby to not only survive but also thrive.”

Already, more and more women in Sierra Leone are now seeking health care services consistently throughout all stages of pregnancy, with over 80% of deliveries taking place in health care facilities by skilled birth attendants, up from 54% in 2010. Back at Bo Town Government Hospital, 29-year-old Fatmata Mansaray is eight months pregnant. “I’m not worried at all because of the good nurses the hospital has,” she says. “They are taking good care of us and they really encourage us.”

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