Birth waiting homes and health system strengthening in Koinadugu District, Sierra Leone: A model for improved rural maternal and infant health outcomes

Koinadugu District is the largest of 14 districts in Sierra Leone occupying an area of 11,509 sq km with a population of about 285,000. The terrain is extremely rugged and roads and bridges (made of palm tree logs) are dangerous and impassable to any form of motorized vehicle for months each year. Most villages scattered through this environment have no ready access to trained health practitioners resulting in unacceptably high death rates throughout the population, but with particularly high maternal mortality of 1800/100,000 and very high parity – up to 16. Despite increasing global attention to achieve MDGs 4 and 5, the huge gap that persists between global concern and community-level action led the Koinadugu District Health Management Team to develop a multi-disciplinary and broad-based Working Group (WG), including NGOs, as well as community leaders. The WG was tasked with developing and implementing a solution to the high maternal/infant mortality. Details of the WG's plan of action, including community outreach, formation of pregnant women support groups and a Women's Savings and Loan scheme will be discussed. Additional information on creation of the Birth Waiting Home (BWH), training and incorporation of traditional birth attendants (TBAs), strengthening of the referral and health delivery system, and improved Emergency Obstetric Care (EmOC) training for all levels of health practitioner will be shared. BWH outcome data from 2006 to 2010, as well as discussion of challenges and pitfalls, strengths and achievements will be presented, with a particular focus on the role for external partners.