05/11/2025
Op-Ed.
Protecting Mothers, Saving Lives: A Shared Responsibility.
By the Minister of Health, Republic of Sierra Leone.
Fifteen years ago, giving birth in Sierra Leone was one of the most dangerous things a woman could do. One in every hundred women faced the risk of dying during childbirth. Today, that figure has fallen by nearly seventy percent, from 1,165 to 354 deaths per 100,000 live births.
These numbers represent mothers and children who are alive today because of deliberate investments in skilled midwives, better-equipped facilities, solar power, ambulance services, oxygen, and medicines. They are still not the numbers we want but they are real, hard-won gains. This progress has been possible because Sierra Leone made a clear commitment: that maternal and child health is both a moral and national priority.
This week, Human Rights Watch released a report alleging widespread ‘obstetric violence’ in our health facilities. We have reviewed this report carefully.
Some of the experiences described are painful to read and even harder to imagine. Where any woman has been neglected, disrespected, or made to pay unofficial fees, that is unacceptable. It betrays the spirit of the Free Health Care Initiative and the principles of service that guide this Ministry, which guarantee that cost should never determine who lives or dies.
The experiences captured in the report deserve to be heard and examined. But they reflect only a narrow snapshot of a complex and evolving health system; one serving millions of mothers and children across 16 districts, every day, under real-world constraints.
To understand Sierra Leone’s health system is to see both the struggle and the progress, side by side.
That fuller story includes the steady expansion of skilled birth attendance from 60 to 87 percent, recruitment of over 4,000 health workers in the last three years, with more being added to the payroll, the construction and rehabilitation of over 1,600 primary health units, and the establishment of 12 oxygen plants and more than 300 solar installations to keep facilities powered.
It also includes the commissioning of the Maternal and Child Health Centre of Excellence in Kono, a state-of-the-art facility providing high-quality care to mothers and newborns in the eastern region and serving as a model for equitable access across the country.
At the same time, Sierra Leone is investing in digital innovations that make care more efficient and responsive. The PReSTrack system, developed with the Directorate of Science, Technology and Innovation, is registering and tracking over 400,000 pregnancies nationwide, flagging high-risk cases and linking women to care earlier.
Alongside the quiet revolution of logistics systems like mSupply, which tracks medicines from the warehouse to the ward, and the NEMS ambulance network, which transports hundreds of women every month to emergency care, these investments demonstrate a health system in transition, one determined to do better, not deny its challenges.
We also recognise that the process by which this report was produced raises legitimate concerns. Any research or investigation that involves interviewing patients or accessing health facilities must go through the National Ethics and Scientific Review Committee and receive the Ministry’s authorization.
This is a global standard, designed not to stifle inquiry, but to ensure that data collection respects privacy, accuracy, and the dignity of participants. It also protects the credibility of the findings.
Unfortunately, in this case, the Ministry was not informed, nor did it grant permission for the research to be conducted in our facilities. Human Rights Watch wrote to the Ministry in July, after the research had already been conducted, requesting a meeting. In hindsight, we should have engaged them more proactively. That opportunity for dialogue was missed.
We have since set in motion plans to reopen communication, because we believe in engagement, not silence. But we also expect all partners, whether researchers, NGOs, or media, to operate within the national frameworks that govern ethical research and public reporting. Accountability must work both ways.
Our approach going forward remains clear and consistent: we welcome scrutiny, but we insist on fairness. We will continue to expand respectful maternity care training, ensure that patient complaints are addressed promptly, and strengthen facility supervision. We will deepen our maternal death review process, expand community monitoring, and ensure that Free Health Care remains truly free.
Our health reform journey is guided by what we call the Four A’s - our compact with citizens and partners: Accountability to one another and to the people we serve; Alignment with national priorities; Acceleration, because the health of our people cannot wait; and Accompaniment, walking together through every challenge. These form the foundation of our partnership approach and the principles by which we ask to be measured.
The progress of that journey reflects a coalition: the dedication of nurses, midwives, doctors, and community health workers; the trust of families and community leaders; and the collaboration of partners whose support we channel through a single national plan.
We invite all who share this mission, including those who critique us, to work within that plan. Bring evidence. Follow the rules that protect patients. Help us fix what is broken and scale what works.
Our path to universal health coverage is not perfect, but it is real and our destination remains the same. Our goal is not only survival, but dignity. We will continue to listen, learn, act, and strengthen our systems. Sierra Leone’s mothers deserve nothing less and that is the standard to which we hold ourselves.
