Sierra Leone: Helping pregnant women reach the hospital in time

Enhancing access to maternal health care in Sierra Leone Medical Activity Manager Dr. Alejandro Martin listening to the heartbeat of three months old Lansana Sannoh inside the Intensive treatment family care ward which caters to children of both acute and moderate malnutrition in the MSF Mother and Child Hospital in Hangha, Kenema District, Sierra Leone.
In Sierra Leone, MSF ambulances refer patients from MSF-supported Peripheral Health Units (PHUs) in Mile 91 area (Yoni Mamila, Yoni Mabanta and Malal chiefdoms) to Magburaka Government Hospital in Tonkolili district for more advanced medical care.
MSF car driving through a body of water heading to Robis village in Tonkolili District, Northern Province of Sierra Leone, with the Integrated Community Case Management team (ICCM).
In Sierra Leone, MSF ambulances refer patients from MSF-supported Peripheral Health Units (PHUs) in Mile 91 area (Yoni Mamila, Yoni Mabanta and Malal chiefdoms) to Magburaka Government Hospital in Tonkolili district for more advanced medical care.
MSF car driving through a body of water heading to Robis village in Tonkolili District, Northern Province of Sierra Leone, with the Integrated Community Case Management team (ICCM).

Despite major progress made this century, in 2020 Sierra Leone still ranked 18th in the list of countries with the highest number of women’s deaths in childbirth, with an estimated 443 maternal deaths per 100,000 live births, according to the World Health Organization.

Many women in Sierra Leone live in remote, rural areas, far from health facilities, and cannot afford the high cost of transport to reach a hospital. This is compounded by poor roads, a countrywide shortage of ambulances and a lack of proper patient referral mechanisms. By the time a woman experiencing complications in childbirth does manage to reach a hospital, it may be too late.

In order to ensure as many pregnant women as possible are able to receive the care they need, MSF operate ambulances in some of the most isolated regions of Sierra Leone. This lifesaving service helps bring women to get the antenatal support they, while also transferring critical patients to more equipped medical facilities.

“Late referrals can be fatal and some medical complications could be avoided if women with obstetric emergencies were able to reach health facilities on time.”

“We had a patient from Daama village, about two hours from our hospital, who was pregnant and was referred very late. When the doctors did a scan, they found out that the baby did not have a heartbeat. The mother was also very anaemic and in a critical condition.”

Amadu Musa, a nurse at MSF’s mother and child hospital in Hangha, Kenema district.

Midwife Mariama Vandi and maternity nurse, Watta Koroma using a fetal doppler to listen to the heartbeat of the baby of a pregnant woman inside the maternity unit of the MSF Mother and Child Hospital in Hangha, Kenema District, Sierra Leone.
Medical staffs consulting with a patient during their morning rounds in the maternity unit of the MSF Mother and Child Hospital in Hangha Kenema District, Sierra Leone.  The maternity unit in the hospital often see cases of pregnancy induced hypertension, antepartum haemorrhage, postpartum haemorrhage, anaemia in pregnant women etc.
Medical staffs consulting with a patient during their morning rounds in the maternity unit of the MSF Mother and Child Hospital in Hangha Kenema District, Sierra Leone.  The maternity unit in the hospital often see cases of pregnancy induced hypertension, antepartum haemorrhage, postpartum haemorrhage, anaemia in pregnant women etc.

MSF’s team in Kenema carry out emergency caesareans and other lifesaving surgery for pregnant women and new mothers. MSF teams also work in two other locations in Sierra Leone – in Mile 91, and in Magburaka, Tonkolili district – to help local health staff respond to maternal and pediatric medical emergencies. In the first seven months of 2023, MSF teams in Kenema, Mile 91 and Magburaka helped 3,326 women deliver their babies, 505 of them by emergency caesarean.

This is 28-year-old Baindu Massaquoi holding her baby girl inside the maternity ward of the MSF Mother and Child Hospital in Hangha, Kenema District, Sierra Leone. This is Baindu’s second C-section.

“I have given birth to seven children but only two are alive. During each of my pregnancies I have always been going to the government health centres for antenatal care and delivery, but during this pregnancy, I was in the market selling when I felt a sharp pain and immediately started bleeding.” 

“I knew my due date was still far away, so I decided to take a motorbike and quickly come to the MSF hospital in Hangha. That same day, I underwent a Cesarean section and right now I feel great. Both my baby and I will be discharged soon.” 

MSF’s work in Sierra Leone also includes running an ambulance service to get women and children in need of emergency care to hospitals as fast as possible.

MSF’s work in Sierra Leone also includes running an ambulance service to get women and children in need of emergency care to hospitals as fast as possible.
Mile 91 - Enhancing access to maternal health care in Sierra Leone Patients sitting inside the MSF ambulance in Hinistas Community Health Center (CHC), Mile 91, Tonkolili district, about to be referred to the MSF-supported Magburaka Government Hospital, Tonkolili district, in Northern province of Sierra Leone.
Patients and staff standing outside the MSF supported Hinistas Community Heath Centre (CHC) one of the largest primary healthcare facility in Yoni Mamaila chiefdom, Tonkolili district, in the Northern province of Sierra Leone, while the ambulance is preparing to depart for the Magburaka Government Hospital, in the district capital, with patients in need of further medical care. 4 hours away by road.
Midwife assistant Elizabeth Conteh using a pinard stethoscope to listen to the heartbeat of six-month pregnant Sowie Vandy in the MSF supported Peripheral Health Unit in Nekabu, Kenema District Sierra Leone.
18-year-old Umu Ngamanga and her brother-in-law, Albert Ngamanga, been driven by a private moto-taxi to Hinistas Community Health Centre in Mile 91, Tonkolili District, in the Northern Province of Sierra Leone; following a referral by the medical staff of the Foindu Peripheral Health Unit (PHU) due to the medical complications of her newborn.
Patients and staff standing outside the MSF supported Hinistas Community Heath Centre (CHC) one of the largest primary healthcare facility in Yoni Mamaila chiefdom, Tonkolili district, in the Northern province of Sierra Leone, while the ambulance is preparing to depart for the Magburaka Government Hospital, in the district capital, with patients in need of further medical care. 4 hours away by road.
Midwife assistant Elizabeth Conteh using a pinard stethoscope to listen to the heartbeat of six-month pregnant Sowie Vandy in the MSF supported Peripheral Health Unit in Nekabu, Kenema District Sierra Leone.
18-year-old Umu Ngamanga and her brother-in-law, Albert Ngamanga, been driven by a private moto-taxi to Hinistas Community Health Centre in Mile 91, Tonkolili District, in the Northern Province of Sierra Leone; following a referral by the medical staff of the Foindu Peripheral Health Unit (PHU) due to the medical complications of her newborn.

“There is a significant need for ambulances to transfer pregnant women experiencing complications from local clinics to hospitals.”

“A good referral system is key and needs to be prioritised to ensure a decrease in maternal and neonatal mortality and save more lives.”

Kennedy Uadiale, MSF medical coordinator

Between January and July 2023, MSF’s eight ambulances transferred 372 pregnant women and new mothers with their babies to a hospital for emergency care. The women faced a range of life-threatening conditions including pregnancy-induced hypertension, post-partum haemorrhage, anaemia in pregnancy and antepartum haemorrhage.

MSF also reimburses women for the cost of taking a motorbike-taxi, the only alternative transportation available in most places, to health facilities paying for 900 trips in the first seven months of 2023.

Meet some of the MSF maternity patients in Sierra Leone

Pregnant women and lactating mothers waiting for their monthly check-up at the triage area of the Masengbeh Peripheral Health Unit, Tonkolili District, Northern Province, Sierra Leone. MSF supports this Ministry of Health Primary Healthcare facility to provide free and quality services to children under the age of five as well as pregnant and lactating mothers.

18 year old, Fatmata Fofanah, walking around the maternity in the MSF-supported Magburaka Government Hospital, Tonkolili District, assisted by a Ministry of Health and Sanitation midwife. Fatmata gave birth inside the MSF ambulance assisted by an MSF midwife while she was being referred to the Magburaka Government Hospital from the Hinistas Community Health Center in Mile 91, both supported by MSF. She and her baby were discharged a few days later, fully recovered. 

Umu Jalloh, 35 years old, is carrying her twin boys in the triage area of the Hinistas Community Health Centre (CHC) in Mile 91, Tonkolili District. Her children were screened for malnutrition and given ready-to-use therapeutic food. She was requested to come for regular check-ups with her children to ensure they regain their health.

Seven-month pregnant Aminata Bangura can be seen walking to the Petifu Fullamasa Peripheral Health Unit, Tonkolili District, for antenatal care. In order to ensure her and her baby continue regular check-ups, Aminata walks close to one hour to get to the nearest primary health facility, as motorbikes are very expensive in the community.

18-year-old Umu Ngamanga is holding her one-day-old baby boy in front of the Tiama River, which she has to cross in order to reach the MSF-supported Foindu Peripheral Health Unit, Tonkolili District, in the Northern Province of Sierra Leone.

“I started experiencing labour pains at night, but it takes me two hours of walking and crossing a river to get to the nearest peripheral health unit, which is in Foindu, 10 kilometres from my home. My baby could not eat and had fever, so I took him to the peripheral health unit the next day after I gave birth. He was immediately taken by motorbike to Hinistas Clinic in Mile 91. After close monitoring, he was later taken to the Magburaka Government Hospital by the MSF ambulance and after receiving care he got well and was discharged”. 

MSF has also trained traditional birth attendants in Kenema district to monitor pregnant women and watch out for danger signs, referring them to the closest health centre for medical attention, or calling an MSF ambulance to take them to hospital if they need advanced care.

MSF Midwife, Mariama Kaloko, talking to the people in Luwma village about the importance of early referral of patients facing medical emergencies to Petifu Fullamasa, the nearest Ministry of Health and Sanitation (MoHS) MSF supported Peripheral Health Unit (PHU), Tonkolili District, Northern Province of Sierra Leone. This is particularly important for pregnant women in labor, or facing medical complications during or after their pregnancies.
 Magburaka - Enhancing access to maternal health care in Sierra Leone MSF Clinical Health Officer, Tejan Kargbo, reviewing the records of the Community Health Workers (CHWs) at the Integrated Community Case Management (ICCM) site that offers screening and treatment to children under the age of five suffering from malaria, pneumonia, diarrhea and malnutrition in Robis village, Tonkolili District, Northern province of Sierra Leone.  MSF provides testing kits, medication and training to the CHWs at the Integrated Community Case Management (ICCM) sites in 7 villages in Tonkolili District, Sierra Leone.  People from 14 different villages bring their children to the ICCM site in Robis village and an average of 30 children are screened in a day for malaria, pneumonia, diarrhea and malnutrition. Patients with mild symptoms are treated at the ICCM sites while patients with severe symptoms are referred to the Magburaka Government Hospital supported by MSF.  MSB167699   Linked Assets
Patients cross the Rokel river with the ferry at Komrabai, Tonkolili District, Northern province of Sierra Leone on their way to the MSF-supported Integrated Community Case Management (ICCM) site in at Robis village. MSF provides testing kits, medication and training to the Community Health Workers (CHWs) at Integrated Community Case Management (ICCM) in Robis village, as well as in 6 other villages in Tonkolili District, Sierra Leone. Patients with mild symptoms are treated at the ICCM sites while patients with severe symptoms are referred to the Magburaka Government Hospital supported by MSF.
People getting out of a canoe after crossing the Rokel river, at Komrabai, Tonkolili District, Northern province of Sierra Leone. People from the communities on the other side of the river often have to cross it to access MSF-supported Integrated Community Case Management (ICCM) site in at Robis village, as well as the local market.
 Magburaka - Enhancing access to maternal health care in Sierra Leone MSF Clinical Health Officer, Tejan Kargbo, reviewing the records of the Community Health Workers (CHWs) at the Integrated Community Case Management (ICCM) site that offers screening and treatment to children under the age of five suffering from malaria, pneumonia, diarrhea and malnutrition in Robis village, Tonkolili District, Northern province of Sierra Leone.  MSF provides testing kits, medication and training to the CHWs at the Integrated Community Case Management (ICCM) sites in 7 villages in Tonkolili District, Sierra Leone.  People from 14 different villages bring their children to the ICCM site in Robis village and an average of 30 children are screened in a day for malaria, pneumonia, diarrhea and malnutrition. Patients with mild symptoms are treated at the ICCM sites while patients with severe symptoms are referred to the Magburaka Government Hospital supported by MSF.  MSB167699   Linked Assets
Patients cross the Rokel river with the ferry at Komrabai, Tonkolili District, Northern province of Sierra Leone on their way to the MSF-supported Integrated Community Case Management (ICCM) site in at Robis village. MSF provides testing kits, medication and training to the Community Health Workers (CHWs) at Integrated Community Case Management (ICCM) in Robis village, as well as in 6 other villages in Tonkolili District, Sierra Leone. Patients with mild symptoms are treated at the ICCM sites while patients with severe symptoms are referred to the Magburaka Government Hospital supported by MSF.
People getting out of a canoe after crossing the Rokel river, at Komrabai, Tonkolili District, Northern province of Sierra Leone. People from the communities on the other side of the river often have to cross it to access MSF-supported Integrated Community Case Management (ICCM) site in at Robis village, as well as the local market.

MSF’s activities to support care for mothers and children in Sierra Leone are crucial, but much more is needed if the country is to continue the progress made in the past 23 years.

Mohamed Morchid, MSF head of mission:

“Health programming in the country needs to include staffing, maintenance and fuel cost for existing ambulances at the National Emergency Medical Services.”

“It is also important to consider creative and sustainable models supporting emergency transport needs from patients' houses to their nearest health facilities, as this remains one of the main barriers identified by our patients in terms of their access to quality medical care.”