Sierra Leone is a small country situated on the west coast of Africa, bordering the North Atlantic Ocean between Guinea and Liberia. Administratively the country is divided into 4 provinces/regions, the northern, southern, eastern and western. Each province is subdivided into districts, and each district is sub-divided into chiefdoms. Overall, there are 14 districts and 149 chiefdoms. In 2011 the population was estimated at 6 million.
Sierra Leone was ranked last among the 177 countries surveyed globally in the 2007/2008 United Nations Human Development Index, with a per capita GDP of about USD 806, life expectancy of 47 years, and an adult literacy rate of 34.8 percent. The UNDP 2007/2008 Human Development Report estimated that in 2005 about 52 percent of the population lived on less than USD 1 a day. In 2007 about 70% of the population were living below the poverty line (UNDP, 2007. SLDHS, 2008).
The decade long civil war between 1991 and 2001 resulted in about 50,000 people being killed and hundreds of thousands became refugees in Guinea and Liberia never to return to their original settlements. This included skilled health care providers whose exodus was critical. The war also resulted in a substantial reduction in the standard of living (UNDP, 2005. SLDHS,2008).
Key MNH Indicators for Sierra Leone
- Maternal Mortality Ratio: 1100/100,000 live births (2014)
- % Skilled Birth Attendance: 61% (2014)
- % Contraceptive Prevalence Rate: 11% (2014)
- Total Fertility Rate (per woman): 4.78 (2014)
- Ante-Natal Care (at least one visit): 91% (2014) (Source: WHO/UN)
CMNH has been working in Sierra Leone since 2009 and has been involved in the following projects/studies:
The MiH programme aims to reduce maternal and newborn mortality and morbidity by increasing the availability and improving the quality of Skilled Birth Attendance (SBA) and Emergency Obstetric and Newborn Care (EmONC). The programme was delivered in 11 countries in Sub-Saharan Africa and Asia.
The MiH programme in Sierra Leone was implemented in partnership with UNICEF to support the Ministry of Health and Sanitation. The programme was implemented since 2009 and completed in 2014.
The programme has resulted in building the capacity of:
- 486 in service health care workers in EmONC
- 756 pre-service students in EmONC
- 157 course facilitators in EmONC
- 120 tutors in EmONC
- 84 health care workers in data collection and usage
- 72 health care workers in quality improvement methodologies.
This programme is coordinated by the Reproductive and Child Health Directorate (RCHD) at the Ministry of Health and Sanitation, with technical support from CMNH and financial support from UNICEF. It aims to train 2000 healthcare workers in sexual and reproductive health, nutrition and infection control at 200 sites, with at least 1 in each Chiefdom. The training is organised into 7 modules each delivered over 2 days, with teaching aids and equipment supplied to each training site. In addition we have trained 349 trainers and 56 master trainers (supervisors) with at least one trainer positioned in each training site.
In 2015 CMNH in partnership with the Ministry of Health and Sanitation, VSO and WaterAid completed the WoMaNS study (Working on Maternal and Newborn Services) exploring the impact of Ebola on routine maternal health services. The study showed that despite the continued provision of maternity services antenatal care visits dropped by 18%, postnatal care visits by 22% and deliveries by 17%. This led to a 30% increase in maternal deaths and 24% increase in the stillbirth rate.
The Ebola epidemic has impacted particularly heavily on health care workers and CMNH has worked with the Government to assess the levels of workplace stress in health care workers providing emergency obstetric care in Western Area and Bo. CMNH also provided training on stress management and peer support for health care workers which is being incorporated into staff induction programmes.
The stillbirth study aims to investigate the cause of, and factors contributing to, stillbirth in low- and middle-income countries. The study focuses on four countries: Kenya, Malawi, Sierra Leone and Zimbabwe. Under the project, healthcare providers in three targeted facilities per country have been trained to conduct perinatal death reviews.
A total of 1300 cases of stillbirth across the four countries have been reviewed and data collected for analysis. The outcomes of the study include identification of the major cause of, and factors contributing to, stillbirth in these countries. The data will also be used to guide development of tools to help healthcare providers in low-resource settings to identify cause of stillbirth, and take action to reduce mortality.
The KSRS was conducted in six African countries including Sierra Leone assessing how long knowledge and skills are retained after EOC&NC training and looking at the optimum time for the retraining of health care.
The study also identified factors that influence knowledge and skills retention post training including workload and cadre of staff. Skills and knowledge were tested before and immediately after training and then at 3, 6, 9 and 12 month intervals. The total recruitment across the all countries was 512 health care providers (or 87.5% of the target.)
• Nurse/midwives knowledge and skills at 12 months were higher than levels immediately post training
CMNH worked with Health Poverty Action to provide training in EOC&NC supportive supervision and quality improvement to health care workers in some of the most remote health facilities in Sierra Leone. A total of 64 participants were trained in EOC&NC with a further 22 being trained in Quality Improvement methods.
The training was received very well by the participants who said it would definitely improve their everyday work.