Dr. Kim E. Dickson, UNFPA Representative in Sierra Leone

Speech at the

“Launch of the health sector annual MDSR Report”

 Wednesday, 31 May 2017 at 0830

 Miatta Conference Hall, Youyi Building, Freetown

 His Excellency the President of Sierra Leone, Dr. Ernest Bai Koroma,

Secretary to the Cabinet and Head of the Civil Service, Dr. Ernest Surrur,

Honorable Minister of Health, Dr. Abu Bakarr Fofanah,

Deputy Chief Medical Officer, Dr. Sarian Kamara,

Honorable Members of Parliament,

Honorable Ministers of Government,

Civil Society Representatives,

Distinguished guests,

Development partners,

Representatives of the media,

Colleagues, Ladies and Gentlemen,

It is a pleasure to be with you today to share the findings from the latest Maternal Death Surveillance and Response Annual Report, also referred to as the MDSR. This report was developed with an aim to provide information to stakeholders on the current status of maternal deaths in the country, to share key challenges, and initiatives in place to avert the needless loss of maternal lives. Most importantly, the MDSR system, and this report provides us with vital data that should be used to strengthen our health systems and prevent maternal deaths. This is the S and R in the MDSR – the RESPONSE. A MDSR system in any country is useless until ACTION is taken to improve care and prevent maternal deaths.  

Maternal deaths are defined as any death that occurs during pregnancy or in the first six weeks after delivery.

Sierra Leone has one of the world’s highest estimated maternal mortality ratio of 1,165 deaths per 100,000 live births while in the United Kingdom for example, it is only 9 deaths per 100,000. Even in neighboring Ghana it is only 319 per 100,000! The sad truth is that most of these deaths of mothers can be prevented if adequate care is available and provided. The worrying trend illustrates that the number of maternal mortalities in Sierra Leone has been increasing considerably over the years.

The MDSR report highlighted that in 2016, forty per cent of maternal deaths were among teenaged girls aged 15- 19 years. This a tragedy, this means that we are losing young girls who could have contributed to the future economic development of this country and help to harness the Demographic Dividend.

In 2016, an estimated sixty per cent of deliveries were conducted by a skilled birth attendant, this statistic could be better but is relatively high in comparison to other developing countries. However, the MDSR report also shows indicates that of the 218,818 live births which took place in Sierra Leone in 2016, 5,608 were still births – most still births can be prevented by doing good monitoring during pregnancy, labour and delivery. The main cause of the maternal deaths is postpartum hemorrhage – bleeding after delivery - which accounted for 33 per cent of all deaths.  

But the biggest challenge in tackling maternal mortalities in the first instance is the under-reporting of such deaths, especially when they occur in communities. Only 20 to 29 per cent of the expected number of deaths, were reported signaling a need for improving the reporting of maternal deaths, or revisiting the current maternal mortality estimates for the country. The MDSR report indicated that punitive by-laws could possibly be causing the under-reporting of deaths.

Distinguished guests, ladies and gentlemen,

The United Nations – UNFPA, UNICEF and WHO, has been working together with government and development partners to save women’s lives. Together we are working to build the capacity of those on the ground to deliver quality services to the people who need them the most. Some of our achievements the first few months of this year alone in 2017 include:

The training a total of midwives as Maternal Death Investigators – we have trained 28 midwife Investigators - that’s two midwives from each district.

Community health workers have been trained to enhance prompt maternal death notifications – 359 have been trained and we have also trained 10 monitoring and evaluation officers on how to record data on maternal death notification.

In addition, MDSR committee members have been trained on MDSR Standard Operating Procedures for improving surveillance, notification, quality investigations, reviews, reporting, data management and documentations. Additionally, we continue to support the District Health Management Teams to hold maternal death review meetings in every district.

But despite these efforts, maternal mortalities continue to rise in Sierra Leone among the most vulnerable and marginalized women and girls. For example, in 2014, the estimated total number of maternal deaths was 226. In 2015, there were 456 deaths, and in 2016 as noted in the latest MDSR report, there were 706 maternal deaths.

We recognise that persistent challenges remain in reaching optimum quality of the MDSR program implementation, and that they urgently need to be addressed.

Some of the major challenges of the MDSR system were: 

• Limited practices in verification of all deaths among women of child-bearing age to rule out maternal deaths; 

• Low levels of community participation and ownership;

• The reluctance to report maternal deaths at both community and health center level, possibly because of a fear of punitive measures;

• Only a few number of MDSR committee members are trained on MDSR;

• Limited verification of deaths among women of child-bearing age; and

• Poor quality of maternal death investigation and reviews given poor recording of obstetric information and lack of review guides.

The United Nations System will continue to support the Republic of Sierra Leone to address these challenges.

Distinguished guests, ladies and gentlemen,

In line with the President’s Recovery Priorities for 2015 to 2017, we need to work together to save the lives of 600 women and 5000 children by 2018.

If our collective aim is to reduce maternal mortalities significantly in Sierra Leone, in addition to working in health facilities to improve infrastructure and strengthen human resources, we also need to work with communities.

We need to mobilise community leaders, men and women to work together to prevent deaths and saves lives.

Lastly, which I cannot stress enough, is the importance of reporting maternal deaths.

Sierra Leone is aligned with the aspirations of the world to eliminate maternal deaths as part of the Sustainable Development Goals.  And I look forward to the future with optimism and renewed strength as we set about doubling our efforts to save the lives of women in the country.

The maternal death numbers for Sierra Leone in the MDSR report speak for themselves, we need to act fast.

In Africa we say ‘No matter how beautiful and well-crafted a coffin might look, it will not make anyone wish for death’

None of us wish to die; we cannot continue to allow our mothers to die. We need to ACT NOW and save our mothers from these unnecessary deaths.

Thank you all for your attention