Near the shore in a bustling neighborhood in Freetown stands the Princess Christian Maternity Hospital (PCMH), the national referral maternity hospital in Sierra Leone. Nicknamed the “Cottage Hospital,” PCMH houses the National School of Midwifery (NSM), which trains both obstetric nurses and pre-service midwives from the country’s private and public hospitals.

“Being a teaching hospital, we have a lot of responsibilities, but also a lot of opportunities,” said Matron Susan Charles, RN, head of nursing at PCMH. “We have a high patient load and receive complicated cases, which means our trainees are able to become familiar with rare situations and learn in a supportive environment; and conversely, our patients receive an excellent standard of care because the students are trained in the latest best practices.”

This dual mission of teaching and service provision has sparked innovation at PCMH, and the latest initiative has led to a historic development: Sierra Leone’s first-ever model ward for nursing and midwifery. With a targeted focus on decreasing maternal and child mortality, reducing new HIV infections, improving HIV-related health outcomes, and integrating ideal infection prevention and control (IPC) practices in service delivery, the establishment of the model ward represents a commitment to excellence and quality improvement that is an example for the rest of the country.

Over the course of summer 2018, ICAP supported the Ministry of Health’s Nursing & Midwifery Directorate to establish the model ward at PCMH with NSM’s leadership and implementation. These activities are part of the Resilient & Responsive Health Systems Initiative (RRHS), funded by the Health Services and Resources Administration (HRSA) of the U.S. Department of Health and Human Services.

“A model ward is like a laboratory where we can improve delivery systems through better organization, putting in place safe, resilient, appropriate nursing and midwifery systems, in a bid to eliminate avoidable errors—while at the same time providing top-quality care,” said NSM Principal Joan Shepherd, PhD. “In the model ward, we strive to create the best possible conditions for both health care workers and patients, putting extra time, effort, and resources into making it an ideal clinical environment for trainees to learn and practice.”

The process of selecting which of the PCMH’s wards to undergo the transformation into a model ward began in June and was completed in July. A baseline assessment performed by ICAP in Sierra Leone with support from Deputy Chief Nursing and Midwifery Officer Amber Coker identified four possible wards, and then one was selected based on observations from ward visits and questionnaire-guided interviews.

“We were very happy that Dr. Koroma, the medical superintendent at PCMH, welcomed the idea and promised to support the team to ensure success and sustainability,” said Mame Toure, MD, MSc, country director for ICAP in Sierra Leone.

With the selection made, work began in August on inventory assessments to understand the current state of the ward’s staffing, equipment, and infrastructure. This process was led by Sr. Nanah Kamara from NSM, with support from Matron Charles at PCMH and the ICAP team. The findings enumerated the necessary improvements to provide sufficient medical staff, equipment, and space for ideal nursing care.

Patients will be moved to other wards while the model ward undergoes renovation and upgrades of technology and infrastructure, including the installation of IPC stations and purchase of patient monitors. One of the largest changes will be the reduction of ward capacity from 21 to 15 beds, necessitating contingency planning for possible impacts on other wards and patient flows throughout the hospital.

As the model ward’s activities continue, ICAP will collaborate with its implementing partners to offer in-service training for capacity building and professional development, and provide practical equipment and consumables such as syringes and gloves.

“Equipping the clinical staff with knowledge and clinical competence in various aspects of nursing and midwifery care is our top priority,” said Gertrude Chipungu, RNM, MA, RRHS project director for ICAP in Sierra Leone. “Strong nursing cadres are needed in order to provide accessible, quality care throughout Sierra Leone.”

Header image courtesy of ICAP in Sierra Leone, featuring the ward that was selected to become the model ward.

View a photoset from PCMH from Canadian news outlet The Globe and Mail

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