Narrative Case study: The most essential determinants to child and maternal health in Sierra Leone

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Abstract Background Sierra Leone is one of the poorest countries in the world, suffering from some of the worst maternal and child health outcomes. In 2013, it had a maternal mortality ratio of 1165/10000 live births and an under-five mortality of 156/1000 live births. The country has introduced a number of policies and interventions to tackle maternal and child health issues but still retains one of the highest global mortality rates. The purpose of this study is to determine the most essential determinants to infant, child and maternal health and recommend some interventions and policy changes to improve their health outcomes. Methods A small review of relevant policies and papers and analysis of relevant maternal and child health data and statistics was conducted to inform questions for Key Informant Interviews. Interviews were then conducted with relevant stakeholders to child and maternal health from UN Organisations, international NGOs and the Ministry of Health and Sanitation (MoHS). Results Analysis of transcribed Interview data with NVIVO showed that the most essential determinants were the lack of effective coordination between the MoHS and partners due to the emergency mindset, systematic problems with the attitude of the healthcare workforce especially towards women and socio-cultural restriction on women restricting their ability to make choices about their own health and lives Conclusions The study found that there was a focus on policies and interventions targeted at improving clinical determinants and health statistics while consideration of socio-cultural context were negligible. An inclusion of interventions focused on women's empowerment and increasing their voices will help to tackle some of these most essential determinants. Key messages Sierra Leone has the policy environment, political will, and technical expertise to continue making improvements to their high maternal and child mortality problem. An emergency mindset approach, and interventions targeted only at reducing clinical determinants of maternal mortality are missing out on addressing wider socio-cultural issues to improving health.