Humanitarian Health Initiative supports frontline response to improve maternal and child health in Sierra Leone

October 17, 2022

The Humanitarian Health Initiative (HHI) at the UNC Gillings School of Global Public Health worked with Sierra Leone nongovernmental organization (NGO) Rural Health Care Initiative (RHCI) to increase the impact of its response to the country’s maternal mortality crisis. Supported by individual philanthropy, this collaboration produced information RHCI could immediately act on to improve program areas that would have the greatest benefit for the mothers and children it serves. And act on them it did.

Sheila Leatherman, CBE, Hon FRCP Professor of Global Health, Department of Health and Management, and Gillings Global Advisor

Sheila Leatherman, CBE, Hon FRCP
Professor of Global Health, Department of Health and Management, and Gillings Global Advisor

“Our role at Gillings was to support the excellent health team at RHCI,” said Sheila Leatherman CBE, HonFRCP, professor of global health policy and Gillings global advisor. “We evaluated issues related to access and quality of care and provided insights on possible service improvements. We also conducted extensive qualitative data analysis and gathered information on best practices.”

Sierra Leone is still recovering from a 2002 civil war and has one of the world’s highest maternal and child mortality rates. Founded as a nonprofit organization in Minnesota and an NGO in Sierra Leone, RHCI provides vital services that mothers and children need to stay healthy. It operates two maternity waiting homes, provides mobile health services to eight villages and runs programs to prevent child malnutrition and promote food security.

Group of pregnant women staying at the Maternity Waiting Home in Tikonko

Group of pregnant women staying at the maternity waiting home in Tikonko

According to research led by the World Health Organization, maternal and newborn deaths are highly preventable through a standard course of obstetric and neonatal care. Common barriers to receiving these services, especially for residents of rural areas, include difficulty with travel and access. Maternity waiting homes are residential facilities where expecting mothers can spend the final weeks of pregnancy near places that provide vital care. Damage from the Ebola epidemic, which overwhelmed the country’s medical infrastructure and caused massive disruption and loss of life, led to a lack of trust in medical facilities, making the services these maternal waiting homes provide even more crucial.

Seeking to improve services at these maternity waiting homes, RHCI collaborated with the HHI to draw on UNC Gillings faculty and student expertise in program evaluation and public health work in areas of humanitarian crisis. The goals of the evaluation were to: identify if programs are operating as intended, determine if services were meeting the needs of our beneficiaries, identify unmet health care needs, and understand the attitudes, beliefs, values and experiences among people who use RHCI programs.

Through information collected from program staff, beneficiaries and other community members, the evaluations identified areas where the program could implement meaningful improvements.

Adama Fofana and newborn James; from Gbalahun in Tikonko Chiefdom

Adama Fofana and newborn James; from Gbalahun in Tikonko Chiefdom.

As an example, RHCI runs a program that helps prevent and reverse child malnutrition. As well as providing supplemental feedings to malnourished children, it also provides caregiver education; diagnosis, treatment, and prevention of other medical conditions that contribute to malnutrition; and transportation for critically ill children.

In May 2022, as a direct result of this collaboration, the program expanded its clinics days to provide twice-monthly visits for malnourished children, improved educational materials for the nutritionist and developed a training program for the rural community health workers in Tikonko Chiefdom.

To date, over 900 women have used RHCI maternity waiting homes with 99.9% surviving childbirth. Motorbike outreach programs serve eight remote rural villages and provide care for acute illness, immunizations, malnutrition, antenatal care, family planning and education. Annually, 10,000 people are served through this program. From this evaluation, a new program has been designed and implemented to provide assessment and intervention for newborns.

Dr. Leslie A. Lytle

Dr. Leslie A. Lytle

Maggie Holly

Maggie Holly

As a small NGO, RHCI found the collaboration valuable and plans to continue with further work on program evaluations with the expertise of the UNC team, led by Leatherman and including Leslie Lytle, PhD, adjunct professor of health behavior, Maggie Holly, a doctoral student in health policy and management and HHI intern, and Doreen

Doreen Alumaya

Doreen Alumaya

Alumaya, MPH ’22 (global health), who volunteered to support this project. The RHCI Minnesota-based team included Julie Hoffer, MD, research scientist at the Minnesota Department of Health, and Carol Nelson, MD, MPH, program director of RHCI’s medical programs in Sierra Leone.

The experience also proved meaningful for student interns and volunteers who work alongside faculty experts, including Leatherman, to contribute to public health solutions for people experiencing humanitarian crises.

“Working on this project with HHI under the leadership of Sheila Leatherman and the talented UNC-RHCI team was one of the most incredible experiences I had at UNC,” said Alumaya, HHI volunteer and recent UNC Gillings graduate. “It was an honor to use my lived experiences, expertise and skills in this project while learning from the best mentors. As a global public health professional, the results from this collaboration are evidence that community-based interventions might just be what global health programs need: a collaborative effort that centers the community in promoting health worldwide.”

Humanitarian Health Initiative internships offer Gillings graduate students opportunities to engage in service projects of a year (or longer) duration, with a supporting honorarium. Each intern works on one or more service projects focused on supporting international and national NGOs or multilateral health organizations in a specified body of work meeting the evaluation, policy, practice and service needs specified by collaborating NGOs.

The HHI is an effort to increase our impact on global health equity with the collective efforts of faculty and students through research; awareness building and education; capacity building and technical support to countries and NGOs; engagement and service projects; and advocacy and influencing of policy and practice.

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