Improving Maternal and Neonatal Health and Training in Sierra Leone

As part of Sierra Leone’s longer-term strategic objective to reduce the rate of maternal and child deaths by 45 and 55%, respectively, by 2021, the purpose of the pilot was to enable the MOHS to demonstrate in six clinics and two hospitals in Moyamba and Kambia districts, that it is possible to achieve a dramatic - and sustainable - impact on essential maternal and child health care service delivery indicators in a very short timeframe. The broader focus was to build capacity in the districts to organize health-related 100-Day Challenges now and in the future. 

One of the inspiring parts of this effort was how quickly the RE!NSTITUTE  team and the coach trainees pivoted from face-to-face to app-based training and learning. This was in response to the global pandemic, which gripped the country right after the launch of workshops in the districts. The RE!NSTITUTE  team developed an app, loaded training materials on it, and uploaded this on smartphones in the space of three weeks. The phones were then distributed to the coach trainees in the districts, who proceeded to learn on a just-in-time basis as they prepared for the Midpoint Reviews and the Sustainability Workshops. 

The focus areas of the specific 100-Day Challenges differed for each district. Overall these fell under the following themes:

• Reducing antenatal care drop-out rates 
• Reducing still-birth rates
• Reducing maternal mortality rates (during or as a result of childbirth)
• Increasing antenatal care visits during the first trimester
• Increasing the percentage of neonates tested for hypothermia during the first hour after birth 
• Increasing blood donations to the blood bank

Despite the COVID-19 pandemic and the lockdown striking the 100-Day Teams in the middle of their journey, the teams persisted and achieved impressive results. A total of 13 goals were set for the 100 days across the 8 teams. 

There was good progress in 12 of the 13 goals – which were either achieved or had substantial progress. Some of those results include:

• In Bomotoke, they increased Antenatal Class attendance from 62% to 100%
• In Moyamba, they decreased stillbirth rates from 12.7% to 4%
• In Kambia, they Increased neonates tested for hypothermia within 1hr of birth from 0% to 86%
• In Kukuna, they increased the number of women attending their  4th Antenatal Clinic visit by 90%
   

As we often experience in 100-Day Challenges, these results were achieved through more intensive collaboration and simple innovative ideas despite the initial setback caused by the pandemic. 

Here are a few other noteworthy observations about the process:

• The Ambassadors engaged with the make-do training app and remote program enthusiastically, as evidenced by their responses to the embedded questions and tasks, as well as the outputs of the workshops they designed and facilitated. This was also evidenced by the active participation of the Ambassadors in the “WhatsApp Office Hours” we set up to help them get ready for the reviews. 
• The pre and post-team self-assessment survey indicated significant shifts in attitude and behaviors, towards more inclusive decision making, rapid experimentation, using data for decision making, and so on. These indicators point to the sustainability of the impact created during the initial 100 Days.
• The whole performance tracking and local method and evolution (learning) systems got a ‘shot in the arm’ so to speak, as teams were eager to better understand their baseline performance and the week-to-week progress towards the goals they set.    
   

Apart from the pandemic, the teams faced several challenges, including delays in getting the basic clinic requirements that the Ambassadors identified before the 100-Day teams were even launched. 

Here are some of the other difficulties that the teams encountered during the 100 Days:

• Some challenges with obtaining data from units external to the facilities, e.g., blood bank.
• Initial technology challenges with maneuvering the online training, which were resolved during the course of training.
• Time commitment challenges with competing training and programs.
   

• The World Bank 
• The Sierra Leone Ministry of Health & Sanitation

• Sierra Leone – MOHS RE!NSTITUTE  100-Day Project: Maternal and Child Health