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.

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.