246441 Birth waiting homes and health system strengthening in Koinadugu District, Sierra Leone: A model for improved rural maternal and infant health outcomes

Tuesday, November 1, 2011: 9:06 AM

Samuel Kargbo, MD, MPH , Director, Reproductive and Child Health Programme, Ministry of Health and Sanitation of Sierra Leone, Freetown, Sierra Leone
Dayo Spencer-Walters, MPH , Sierra Leone Office of the First Lady, Santa Monica, CA
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.

Learning Areas:
Basic medical science applied in public health
Diversity and culture
Planning of health education strategies, interventions, and programs

Learning Objectives:
1. List and describe 3 pre-existing environmental conditions in which birth waiting homes are indicated 2. Describe the community-outreach steps taken to help ensure success of the BWH referral model 3. Identify 5 key constraints in BWH ongoing operations which can be alleviated with external partner support

Keywords: Access to Health Care, Maternal and Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I developed the birth waiting home concept in Sierra Leone and implemented the described project in Koinadugu District. I am now promoting dissemination of the model as it is effective.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.