Sierra Leone has a young population – 33.5 per cent is within 10- 24 years and 39.4 per cent is between the ages of 15 – 35 years. The country faces a host of development challenges. Pregnancy rates are high among adolescents; according to the Sierra Leone Demographic and Health Survey approximately 28 per cent of adolescents aged 15 -19 years old have begun childbearing, this is higher in rural areas than urban areas (34 per cent versus 19 per cent). An estimated 30 per cent of currently married or in union adolescents aged 15-19 years have unmet need for family planning. Furthermore, among all sexually active females aged 15-19, nearly 80 percent are not using any form of contraction.

UNFPA plans support the Government of Sierra Leone, with DFID funding, to develop and roll out a national mobile health (mHealth) application to connect young people in Sierra Leone with interactive family planning information as one component of broader efforts to reduce unmet need for family planning. The proposed intervention is intended to be implemented primarily through mobile phones and will target young people in urban and rural areas of Sierra Leone.

Aim – An international individual consultant is required to support the development and implementation of an mHealth solution to equip young people with the information they need to make informed choices about family planning in Sierra Leone.

Sierra Leone has one of the highest maternal mortality ratios in the world, with 1,165 maternal deaths per 100,000 live births. The main cause of maternal mortality is postpartum haemorrhage, which accounted for 33% of all deaths and unsafe abortion among adolescents (10%). The Government of Sierra Leone has outlined strategic priorities for development in its new direction. Specifically, the strategic objective of the health sector is to transform the under-resourced, ill-equipped, dysfunctional and inadequate health infrastructure and healthcare delivery system to make it high quality, efficient, reliable, cost-effective, affordable and sustainable. This will increase access for all the population (particularly mothers, children and the elderly).

The National Nursing and Midwifery Strategic Plan 2019–2023 for Sierra Leone was developed in line with this new direction. The process of development was based on a systematic approach to determine the strengths and challenges of the nursing and midwifery systems. It was also to outline service provision strategies within the wider remit of the relevant policies of the MoHS and global provisions. Preceptorship systems development was identified as a key focal area for competency building for quality improvement in midwifery education.

UNFPA is currently implementing the DFID supported Saving Lives Programme which is aimed among others to improve the lives of children, adolescents, and women and reduce preventable maternal and newborn morbidity and mortality. A key component of this is the deployment of skilled providers especially midwives for the implementation of a quality of care package for women, mothers and their newborn.

According to United Nations (UN) estimates, Sierra Leone has the highest maternal mortality ratio (MMR) of 1,360 deaths per 100,000 live births and 1 in 17 women have a lifetime risk of dying during pregnancy or childbirth.

Out of a total of 706 maternal deaths reported in 2016, 80% were in health facilities with the leading causes of death being haemorrhage, hypertension disorders and sepsis. Recent country reports show that out of a total of 218,818 live births reported in health facilities in the country 5,608 were stillbirths, which translates to a rate of 25.7 per 1,000 live births. Nearly half of the stillbirths were fresh stillbirths; indicating suboptimal intrapartum care. This is due to inadequacies in the quality of care provided in health facilities. The evidence shows that high maternal, perinatal, neonatal and child mortality rates are associated with inadequate and poor quality health services.

The Health Sector Recovery Plan calls for the establishment of six Centres of Excellence (CoE) for maternal, newborn and child health care and nutrition with the aim to reduce maternal, newborn and child mortality through improvements in quality of care. Centers of excellence (CoEs) are created in various healthcare settings to signify that exceptional quality of service can be provided. CoEs for women’s health services have proven to be a successful approach for delivering high-quality care and have helped to raise the profile of women’s health issues and improve outcomes.
This consultancy is aimed at providing technical support to the UNFPA CO and the MoHS for the implementation of quality of care interventions in the country

Sierra Leone has one of the highest maternal mortality ratios (MMR) in the world, estimated at about 1360 per 100,000 livebirths in 2015. Poor access to maternal health services and the
low rate of skilled birth attendance make Sierra Leone one of the most unsafe places for women to deliver. One of the key strategies for averting maternal mortality is ensuring that
quality skilled birth attendance is available, accessible and used throughout the country.

A strong health care system balances clinical, prevention and intervention strategies, provides health education for its citizens and maintains an active health care workforce capable of
providing competent services for quality health. It provides sufficient resources and enabling environments for optimal health and protects public health. Consequently, investing in
strengthening the nursing and midwifery structure of a country is a must for a robust health care system.

The Sierra Leone Rapid Emergency Obstetric and Newborn Care (EmONC) Assessment conducted in 2017 revealed gaps in the quality of EmONC services provided in the country.
To address the gaps and improve the quality of EmONC services, government with support from the partners including UNFPA is planning to support selected health facilities to provide
efficient and quality health services to the people of Sierra Leone. Specifically, 2 tertiary hospitals and 4 regional hospitals have been designated Centers of Excellence. These include
PCMH and the hospitals at Jui, Kenema, PortLoko, Bo and Makeni. In addition, UNFPA is also planning to improve the quality of BEmONC services provided in selected Community
Health Centers starting with the Community Health Centre at Regent. This consultancy is aimed at providing technical assistance in the field of maternal health for quality improvement processes
as well as support specific midwifery interventions in the UNFPA country office and to the Ministry of Health and Sanitation and other midwifery stakeholders.