Sierra Leone

Sierra Leone: A unified plan gives hope of reducing maternal and child deaths from the world’s highest rates

The devastating impact of conflict on maternal and child survival is perhaps most evident in Sierra Leone, a war-ravaged country with the world’s highest rates of under-five and maternal mortality. Of every 1,000 live births in 2006, 270 children will die before the age of five – around 1 in every 4 children. Maternal mortality is the highest in the world, with the maternal mortality ratio at 2,100 per 100,000 live births in 2005, and the lifetime risk of maternal death at 1 in 8, compared to the sub-Saharan Africa average of 1 in 22 and an average of 1 in 8000 in industrialized countries.

The latest estimates for 1999–2006 show that almost one quarter of infants have low birthweight and only 8 per cent are exclusively breastfeeding during the first six months of life, 30 per cent of children under five are moderately or severely underweight, and 40 per cent are moderately or severely stunted. Over one third of infants are missing out on essential vaccines, such as three doses of diphtheria, pertussis and tetanus (DPT3) and polio. Access to improved drinking water sources in 2004 (the latest year for which firm estimates are available), at 57 per cent, and adequate sanitation, at 39 per cent, remain low.

In order to better address the devastatingly high rates of maternal and child death in Sierra Leone, a national Reproductive and Child Health Strategic Plan 2008–2010 has been developed by the Ministry of Health and Sanitation in collaboration with key partners. Several key UN agencies – UNICEF, World Food Programme, World Health Organization and the United Nations Population Fund – have developed a joint programme in support of the Plan.

The programme covers basic and comprehensive emergency obstetric care, immunization, and prevention and management of undernutrition. The venture is one of several collaborative initiatives related to the Reproductive and Child Strategic Health Plan that draw on the input of the government and a variety of international partners, including the Wold Bank and the United Kingdom’s Department for International Development. The overarching aim of these initiatives is to reduce the 2005 rates of maternal, under-five and infant mortality by 30 per cent by 2010.

The Reproductive and Child Health Strategic Plan represents a significant shift in addressing maternal and child survival, because it prioritizes integration and the involvement of all key partners. It uses the continuum of care framework, delivering health services first to women before, during and after pregnancy and then to newborns and young children. To maximize aid effectiveness, the plan emphasizes ownership, alignment, managing for results, mutual accountability and harmonization among key stakeholders – with the aim of bringing a unified approach to support Sierra Leone’s efforts to improve maternal and child survival and health.