As in many rural areas across Sierra Leone, the roads between Kukuna Township and the nearest maternity hospital in Kambia are in very poor repair. Although the journey is only 35 miles, it can take up to three hours—a very long time on a bumpy road for a woman in labor!

“Women referred to the health center in Kambia sometimes deliver their babies on the road or upon arrival at the hospital,” said Marian I. Samura, a volunteer maternal and child health aid at the Kukuna Community Health Center.

Prolonged and obstructed labor are key contributors to the high rate of maternal mortality in Sierra Leone, but without sufficient tools and training to identify and manage these conditions, health care workers in rural settings are compelled to refer complicated cases to larger health centers—even though they might be hours away.

To address this and other health system challenges, ICAP in Sierra Leone collaborated with the Ministry of Health and Sanitation, with funding from the U.S. Centers for Disease Control and Prevention (CDC), to implement a quality improvement (QI) project in 11 community health centers in Port Loko and Kambia districts, including Kukuna.

At the beginning of the effort, representatives from all 11 health facilities participated in a five-day intensive training on different methods that have been proven to reduce maternal mortality: the use of partographs to track labor progress, the “four bucket” system of separating medical waste to ensure infection prevention and control (IPC), and general environmental hygiene. Following the training, ICAP provided robust supportive supervision at each facility for six consecutive months, from September 2018 to March 2019.

During this six-month mentorship period, Kukuna health center set two targets to help decrease maternal deaths: increasing the recording of vital signs among women giving birth at the facility from 0 percent to 60 percent, and increasing compliance with environmental cleanliness guidelines from 18 percent to 85 percent during this same time period.

By analyzing the root causes of deficiencies in these areas and working methodically to establish systems for improving and maintaining performance—for example, instituting the use of partographs as recommended by the World Health Organization to track maternal and fetal data during labor—Kukuna CHC was able to meet and exceed both targets in just a few months.

“Marian has successfully delivered all our pregnant women without referring any to Kambia hospital as we used to,” said Musa Bangura, community health officer and peripheral head at Kukuna.

Since participating in the training, Marian has become a QI champion in her district, helping other nurses understand how using partographs and ensuring IPC compliance supports the fight to reduce maternal mortality in Sierra Leone.

“ICAP’s QI training and mentorship have essentially made me a midwife in practice!” exclaimed Marian.

Meanwhile, at the national level, ICAP has collaborated with the National Infection Prevention and Control Unit (NIPCU) to scale up QI and IPC efforts in additional hospitals and community health centers across Sierra Leone.

“We are very proud of the concerted efforts being made by health facilities to reduce maternal mortality in this country,” said Susan Michaels-Strasser, PhD, MPH, RN, FAAN, ICAP’s senior implementation director and associate director for nursing programs. “Irrespective of size and location, these facilities are crucial to the health care of the general population, and especially to the health and safe delivery of pregnant women.”

A global health leader since 2003, ICAP was founded at Columbia University with one overarching goal: to improve the health of families and communities. Together with its partners—ministries of health, large multilaterals, health care providers, and patients—ICAP strives for a world where health is available to all. To date, ICAP has addressed major public health challenges and the needs of local health systems through 6,000 sites across more than 30 countries. For more information about ICAP, visit: icap.columbia.edu

Photo captions—Header photo: a mother and her children at the Kukuna Health Center in Sierra Leone. Photo 2: waiting area outside Kukuna Health Center. Photo 3: a nurse at Kukuna Health Center.


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