Maternal Center of Excellence: The Future of Dignified Care in Sierra Leone

Isata Dumbuya witnessed one maternal death during her decades-long nursing and midwifery career in the United Kingdom. Then, she went to work in Sierra Leone and that quickly changed. 
 
During her first week working in Kono District, where she was born, Dumbuya, Partners In Health (PIH) Sierra Leone’s director of reproductive, maternal, neonatal, and child health, watched two young women under 18 die from preventable maternal health complications. Her devastation soon turned to anger, as she wondered: “How is this allowed to happen here? Why is this happening?” 
 
The short answer: injustice. 
 
After the country’s 11-year civil war, already vulnerable people suffered even more, notably those in rural Kono District, the epicenter of the violence. Jobs were scarce, educational opportunities were limited, and the health care system was broken.  
 
Daily life was challenging for many, but especially pregnant women in need of high-quality health care. Infrastructure was inadequate, medicines and supplies were hard to find or expensive, and there were few skilled medical professionals. In most cases, women gave birth at home with the assistance of traditional midwives, running a higher risk of complications or death.  
 
Due to those reasons, among many others, Sierra Leone ranks as one of the countries with the highest maternal mortality rates for many years with profound improvements made in recent years. In 2020, the lifetime risk of women dying in pregnancy or childbirth was 1 in 52. For context, the same rate is 1 in 3,800 in the United States and 1 in 5,200 in the United Kingdom.

A Bold Solution

There have been vast improvements in maternal health care in Kono District since PIH Sierra Leone began working in the country in 2014. At Koidu Government Hospital (KGH), Dumbuya and other leaders ushered in changes such as adding a blood bank and pharmacy next to the maternal ward, training nursing and midwifery staff on how to identify warning signs for at-risk pregnancies, and improving access to family planning for all women seeking care. Because of these and other efforts, there was a 36% increase in women choosing to give birth there from 2020 to 2022. In the recently established special care baby unit, premature or high-risk newborns now have a 96% survival rate.  
 
While we’re moving in the right direction, more needs to be done to address demand and decrease maternal mortality, Dumbuya emphasizes. That’s where the Maternal Center of Excellence (MCOE) comes in. Designed to provide advanced maternal and child health services, the MCOE is a first-of-its-kind facility in Sierra Leone. It will contain 166 beds, dramatically expanding KGH’s current 48-bed maternal ward and special care baby unit.  
 
“It's going to be a space where women are going to feel appreciated and treasured,” says Dumbuya. “No one has ever invested in maternal health ever before in this country to this extent.” 
 
A collaborative effort among the Government of Sierra Leone, PIH, and longtime partner Build Health International (BHI), the MCOE will launch and scale maternal, child, and reproductive health services; provide new clinical education opportunities for doctors, midwives, and nurses; and serve as a blueprint for future investments in women and children’s health—both inside the country, and around the world. 
 
In 2017, key partners began conversations about the facility, and in 2021, PIH broke ground on the MCOE.

‘Women Building for Women’ 

The MCOE construction crew, led by BHI Site Supervisor John Chew, is a success story in itself. A majority of the crew is women, a rare occurrence for a male-dominated field. For many, it’s become more than just a job, but rather a place to grow—both personally and professionally. 
 
Before working at the MCOE, Yei Mansara, a 29-year-old mother of five, sold plantains and made little to no money. One day, she ran into a friend returning home from the construction site and asked what was going on there. Mansara decided to check out the site herself, but when she arrived, it was closed for the December holidays. Upon reopening, she went to look for work, along with an estimated 200-400 people who waited outside the gates every day.  
 
She left her home at 4 a.m. to walk miles in the pre-dawn hours to wait at the site gates. Weeks went by before she caught the attention of Komba Alpha, MCOE labor foreman and site controller. After sharing details about her personal story, including about her physically and emotionally abusive husband, she was let in because of her resilience and strong work ethic. Finally, a promising new opportunity. 
 
Mansara was hired as a laborer, promoted to a cleaner, and now works in the depot department, which is where all the tools and equipment are organized and stored. With no formal education, Mansara never learned how to read or write—until her job in the depot. Now, she knows the alphabet and numbers. Those skills are key, as it's her job to categorize and organize tools. 

"I don't know everything, but I know many things now," says Mansara. Her husband left her, but that’s no problem, she says, because she can now take care of herself, children, and mother because of her steady, well-paying job.  
 
“If you feed a woman, you feed a family, you feed a community, you feed a village,” says Chew. “When they come here, this is their house ... They know how to manage things and they are very meticulous about their work ... and want to learn, they want to grow, and ... they are committed.”

Because of Chew, this is not your typical construction site, explains Dumbuya. Leading by example, Chew has created a family who is devoted to the work. 
 
“And why do you think so many women work here?” questions Dumbuya. “Because, like I say, … this is women building for women.” 

‘A Dream Come True’ 

Upon completion, the facility will boast multiple buildings. Spaces will include a triage section, critical care unit, maternal ward, Kono’s first-ever neonatal intensive care unit, labor and delivery suites, a surgical suite, an adolescent and youth friendly space, and more.  
 
Beyond clinical spaces, there will be landscaped courtyards where patients and their families can socialize and relax, giving a sense of comfort, dignity, and peace.  

Construction is occurring in phases, with the South Ward and Birth Center completed first. Other buildings and neighboring staff housing will rise over time, under the careful hands of Chew’s construction crew.  
 
The expansive facility, adjacent to KGH, is projected to provide a 120% increase in facility-based deliveries, 140% increase in district-wide C-sections, and tripling of the number of family planning visits. All of this means fewer women will die due to complications of pregnancy or childbirth, and more will be able to choose when or if they want to become mothers or expand their families. Seen this way, quality health care is a path to women's empowerment and financial stability. It's a way to break intergenerational cycles of poverty and gender inequality.  

“This is a dream come true,” says Dumbuya as she sits at the construction site in April, while imagining hearing babies crying and women rejoicing. “And just to hear that general clatter of nurses and midwives moving around and delivering care in here. Words cannot even express what that means to me.”