Sierra Leone: ladies in pink who save lives

Exactly a year ago I landed in Lungi Airport and had a nerve-wracking boat ride across the bay to Freetown.

After a few days in the office I was acquainted with some of the initiatives undertaken by the Ministry of Health and Sanitation (MOHS), especially the free healthcare initiative for under-fives and mothers.

Some of Save the Children’s initiatives to improve conditions for under-fives and mothers at a national level were also really amazing, such as advocating for free healthcare and advocating for increasing the number of midwives from 150 to 346.

To understand the context and health issues better, I travelled to Kailahun – one of the more remote districts in south-eastern Sierra Leone, bordering Guinea and Liberia.

Improving healthcare

Save the Children has worked here since 2007 and has contributed a great deal to improving the quality of healthcare.

While visiting the Save the Children-supported Peripheral Health Units (PHU) in Daru, Upper Bambara and Mendu Chiefdoms, I saw the facilities were refurbished, and consultations and community satisfaction were high.

Staff pointed out that the most common diseases for under-fives are malaria, pneumonia and diarrhoea. For pregnant mothers the major complications reported were anaemia, post-partum haemorrhage, sepsis, retained placenta and obstructed labour.

This learning helped me contribute to strengthening our EVERY ONE campaign, which demanded the training, deployment and retaining of more midwives, as there are only 44 in the whole country.

Our EVERY ONE campaign successfully put pressure on the MOHS to increase the number of health workers, especially midwives.

Maternal child health aides

During my time in Sierra Leone, I’ve realised that our advocacy also needs to focus on increasing another type of health worker – the maternal child health (MCH) aide.

It’s the MCH aide who provides obstetric, newborn and child health services in remote areas and in most health facilities except hospitals. They have the most contact with poor women and children, whereas midwives are limited to the hospitals.

Almost every health facility I’ve visited had one community health officer (CHO) who was in charge, while all other services were provided by the MCH aides.

In fact, the whole of Kailahun district has only one midwife! This means the bulk of births are assisted by MCH aides who are often under-trained and badly supported.

I’m convinced that, besides needing more doctors, nurses and midwives, a sharp increase in MCH aides is vital to impact maternal and infant mortality rates at community level.

Save the Children is training MCH aides in Kailahun district as they often lack basic skills to deliver obstetric care and identify complications, leading to delays in referral and increasing risks.

They often work under harsh conditions with no electricity. There are very few ambulances and some mothers have even given birth in torchlight!

Despite these challenges, MCH aides persevere and continue to save lives in Sierra Leone.

Meeting MDGs 4 and 5

For Sierra Leone to achieve MDGs 4 and 5, it needs to meet the need for more MCH aides and ensure they are distributed evenly.

The ideal would be at least four MCH aides at least per health unit, with their numbers increasing depending on population.

MCH aides are lowest paid health staff and should be offered better benefits  such as staff accommodation, transport allowances and basic facilities such as electricity and water.

Paramount to all this is better training for all MCH aides and Save the Children can play a crucial role in equipping them and supporting their efforts to save the lives of Sierra Leone’s poorest women and children.