Strengthening Midwife Education and Improving Maternal Health in Sierra Leone

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Our partnerships with the Ministry of Health and Sanitation and two schools of midwifery are strengthening midwives and saving mothers’ lives

In 2020, the Ministry of Health and Sanitation (MOHS) invited Seed to help strengthen midwifery training and practice in Sierra Leone. Seed and the MOHS conducted a national needs assessment to identify challenges and gaps in midwifery clinical training at health facilities in Sierra Leone.

Seed established partnerships with the School of Midwifery Makeni (SOMM) and the School of Midwifery Bo (SoMBo) and their clinical practice hospitals. Seed places international midwife educators in Makeni and Bo, where they spend about 25% of their time engaged in skills training in the classroom, and the remaining 75% mentoring students and maternity unit staff in the clinical practice hospitals.

With postpartum hemorrhage (PPH) as the leading cause of maternal death in Sierra Leone, Seed and our partners deliver comprehensive training on proper management of PPH and other obstetric complications.

Improving Maternal Care in Hospitals

To improve maternal care at Bo Government Hospital and Makeni Regional Hospital, Seed provided the following support:

  • Introduction of a daily all-maternity unit meeting to improve communication and teamwork
  • Rearrangement of triage space and the creation of formal triage protocols 
  • Provision of patient charts and accompanying charting training 
  • Facilitation of staff trainings on obstetric emergencies
  • Creation of an obstetric hemorrhage ‘trigger tool’ – a checklist to help staff identify the steps and appropriate response to suspected hemorrhage cases 
  • Creation of a three-day orientation program for midwifery students entering clinical rotations
  • Provision of birth kits to ensure sterilization between deliveries and blood pressure machines to monitor for hypertension and preeclampsia

Strengthening National Policy and Practice

At the national level, Seed works with the MOH Directorate of Nursing and Midwifery Services to strengthen midwifery practice and policy. Seed has contributed to the development of the direct entry midwifery program to increase the number of practicing midwives in Sierra Leone, the development and rollout of a Maternal and Child Health Handbook for families, and the pilot of a new year-long preceptorship program in Makeni and Bo to increase the number of clinicians ready and able to mentor midwifery graduates.

Supporting Midwife Graduates

In December 2022, the first cohort of Seed-supported midwifery students graduated from SOMM, and Seed provided all 126 graduates with an “essential toolkit” that includes a blood pressure cuff, fetoscope, artery forceps, scissors, and nurse’s watch. In April 2023, Seed provided 93 graduates of SoMBO with essential midwifery toolkits.

A SoMBo midwife graduate receives her Seed-provided essential midwife kit on graduation day.
A SoMBo midwife graduate receives her Seed-provided essential midwife kit on graduation day.


At Makeni Regional Hospital, there has been a positive downward trend of maternal deaths. Between 2021 to 2022, Seed and our partners observed and tracked a 60% decline in year-to-year absolute maternal deaths at Makeni Regional Hospital. This trend occurred over the same period of time that Seed began its training and support to student midwives at the hospital.

Read more about our work in Sierra Leone.


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