Direct Entry into Midwifery to Strengthen Sierra Leone’s Maternal Health Workforce
For decades, Sierra Leone relied on a single pathway to produce midwives: training experienced nurses to take on midwifery alongside their existing roles. But the model was failing to meet the country’s growing maternal health needs.
“We realized that most community health nurses who trained to be midwives entered training late in their careers and therefore could only practice for a short time before retiring,” said Cecillia Agnes Lansana, a tutor and practicing midwife at the school of midwifery in Makeni.
This posed a challenge in maintaining midwives and drove up the severity of midwife shortages. The previous model couldn’t keep up with the demand for quality and skilled maternal care. But this recently changed with the launch of the Direct Entry to Midwifery (DEM) program.
“Direct Entry to Midwifery is a full-time, pre-service midwifery curriculum designed to be taught over a period of three years, offering both theoretical and clinical practice. The curriculum is designed for students who have completed secondary education and meet the entry requirements for entrance into tertiary education,” explained Patricia Juana-Kamara, principal of the School of Midwifery, Bo.
She added that the curriculum reflects core international midwifery and WHO sexual and reproductive health competencies in primary health care. The introduction of DEM was supported by Seed Global Health working alongside the Ministry of Health through the Directorate of Nursing and Midwifery Services.
“Our objective at Seed is to train 1,100 midwives, which will amount to 37 percent of the national target of 3,000 midwives by 2030,” said Mustapha Sonnie, country director for Seed Global Health in Sierra Leone.
Cecillia also expressed high hopes for the DEM program, stating that DEM-trained midwives will bring both updated knowledge and youthful, vibrant energy to the health workforce. In turn, DEM training will build new midwives’ confidence, competence, and academic skills, which will make the specialty standout nationally.
The first cohort of 267 DEM students is set to graduate and join the health workforce in the first quarter of 2026. From providing educators who train students in the DEM program, to preparing preceptors who will guide the practice of newly graduated midwives in hospitals, Seed has worked closely with three midwifery schools and the Ministry of Health to help bring about direct entry midwifery.
Andrew Mustapha is one of the inaugural DEM students. He recounts how his aunt, a midwife, would return home after long shifts and share beautiful stories about delivering newborns safely despite the challenges in maternity wards at the time. “I used to smile and think, one day, I too will be a part of saving lives in the maternity ward like my aunt,” Andrew said. “Now, I’m so happy that I do not need to study a prerequisite course before studying midwifery and joining the movement to help women give birth safely.”
Students have access to manikins in the skills labs that support hands-on practice before clinical placement, with room for continued skills improvement to ensure even stronger midwifery training.
The impact of the DEM program is a testament to Sierra Leone’s commitment to building the health workforce needed to serve its communities. Reaching the 3,000-midwives-by-2030 target will be challenging, but trusted partners who believe in long-term systems change, like the Wagner Foundation, are helping to make it happen.
The Wagner Foundation’s support strengthens Seed’s work in Sierra Leone by helping train and graduate midwives who are not only skilled clinicians, but also teachers and mentors. Their impact extends far beyond a single patient: they elevate whole teams, helping to drive down maternal and newborn deaths across the country. With partners like Wagner Foundation, the DEM program is filling a critical gap and building a homegrown midwifery workforce that will define the future of safe, dignified maternity care in Sierra Leone.
