Maternal, neonatal and child health
Lack of quality and uninterrupted delivery of comprehensive life-saving services still deny children their right to life and survival.
The maternal mortality rate in Sierra Leone is the highest in the world with 1,360 mothers dying in every 100,000 live births. The mortality rates of neonates, infants and children under five are also amongst the highest globally at 34, 82, and 111 deaths per 1,000 live births, respectively. These staggering figures represent the real and pervasive challenges women and children face in Sierra Leone with poor healthcare practices and sub-standard and ill-equipped health care facilities.
Maternal deaths account for 36 per cent of all deaths amongst women aged 15-49 years. The leading direct causes of maternal mortality in Sierra Leone are obstetric hemorrhage (46 per cent), hypertension (22 per cent), obstructed labor (21 per cent) and sepsis (11 per cent). Causes of neonatal deaths are prematurity (30 per cent), asphyxia (27 per cent), sepsis (23 per cent), pneumonia (7 per cent), congenital (7 per cent) and others (7 per cent). Newborn conditions (29 per cent), malaria (20 per cent), acute respiratory infection (ARI) (12 per cent) and diarrhoeal diseases (10 per cent) are responsible for more than 70 percent of the under-five deaths. Many of these deaths are preventable if managed timely by skilled health providers.
Since the introduction of Free Health Care Initiative (FHCI), Sierra Leone has seen marked improvements in MNCH coverage indicators. The proportion of delivery by skilled birth attendants increased from 61 per cent in 2013 to 93 per cent in 2017; and now more than 90 per cent of deliveries take place in healthcare facilities. Yet, increased service utilization has not translated to positive health outcomes. This raises concerns over the quality of care (QoC) offered at all levels of the health system. Preliminary results of the latest Service Delivery Indicator Survey (2017) suggested a high level of diagnosis inaccuracy (55%) and lack of adherence to clinical guidelines (30 per cent) across all conditions.
The Maternal Death Review and Surveillance Report (2017) indicated that 79 per cent of maternal deaths occurred within a health facility, which could be an indication of poor QoC at the hospital and periphery health units (PHUs), as well as delays in referrals from lower-level facilities or communities.
UNICEF contribution to the solution
The Sierra Leone National Reproductive, Maternal, Neonatal, Child and Adolescent Health (RMNCAH) strategy (2017-2021) sets ambitious targets of reducing maternal mortality to 650 per 100,000 live births, neonatal mortality to 23 per 1,000 live births and under-five mortality to 71 per 1,000 (SOPs) and training package for all levels of newborn services (level I, II, III); training of more than 1,400 health providers on essential newborn care (ENC); establishment of Special Baby Care Units (SBCU) in four regional hospitals with 106 beds dedicated to provide level II care for approximately 5,400 sick newborns annually; and training of 1,365 health workers on integrated management of newborn and childhood illnesses (IMNCI).
With ongoing capacity development support, the SBCU admission rate has nearly doubled since UNICEF began its support in January 2017, and the survival rate of newborns, particularly amongst out-born admissions is over 85 per cent at present.
UNICEF also promotes active citizens’ participation in health care governance issues through engaging community platforms based around the Village Development Committees (VDCs) to generate demand for and monitor quality of health services. With a view to increasing citizens’ awareness and knowledge about health services and entitlement, UNICEF engages youth, especially adolescent girls, to have a voice in the decision-making process through the U-Report platform.