The Kambia Appeal

Strengthening Maternal and Newborn Health in Kambia District, Sierra Leone

This project seeks to support Kambia District Health Management Team efforts to reduce maternal and neonatal mortality in line with MDGs 4 and 5 and specific UN indicators for Sierra Leone. The project forms a pilot for district-level integrated maternal health care strengthening, including interventions for needs identified at all stages of the patient journey. Outputs address the provision of basic maternal and newborn care, and need to seek early care; support to increased access through adequate transport facilities; and increases in skilled services available at health centres and the district hospital.

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  • Health/WellbeingHealth/Wellbeing


  • Children (3-18)Children (3-18)
  • Women & GirlsWomen & Girls



The 1992-2002 civil war in Sierra Leone severely undermined the functioning of the health system. Many health workers were killed or displaced; access to health care was disrupted as people were forced to flee to neighbouring countries. Much of the country’s health infrastructure was damaged or destroyed. Even within the context of Sierra Leone, health services in Kambia District are poor, hampered by chronic staff shortages and inadequate facilities. Kambia District has a total population of 337,212, served by one secondary health facility—Kambia District Hospital. Within the health sector, the shortage of trained and motivated staff is undoubtedly one of the key factors undermining the delivery of satisfactory care to pregnant women. The absence of skilled health personnel at birth; lack of drugs, medical equipment and other supplies; inadequate provision of emergency obstetric care; and an ineffective referral system are also known to be amongst the major contributory factors to the country’s poor maternal health indicators. This project is a direct response to requests from community-level representatives and district health professionals. Needs requests were identified as part of a 2008 evaluation of the Kambia Appeal, which was funded by THET, and consolidated by a further planning exercise in June 2009. The basic concept of this project is simple: to support the achievement of the global MDGs 4 and 5 in a district of a country with the world’s highest indicators for under-five, infant and maternal mortality, and one of the lowest percentages of skilled birth support in the world. The project aims to do this by addressing the “three delays” that cause maternal mortality: 1) delay in deciding to seek care, 2) delay in reaching care in time, and 3) delay in receiving adequate treatment. The project will contribute to the improvement of maternal and neonatal health, and reduce mortality and morbidity rates within three years in the Kambia district of Sierra Leone by: • increasing the number of women in Kambia district attended by a trained health professional from 20% to 30% over three years • training at least 90% of health workers in Kambia district in either maternal and newborn health care, or emergency obstetric care and surgical skills, over three years • increasing the number of health centres in Kambia district with emergency transport systems from 2 to 6, resulting in a rise in the number of patients using these services to reach skilled care from 160 to 1,200 over three years. The first priority activity within this project is to provide 30 days of training for 580 Traditional Birthing attendants to encourage them to take pregnant women to local health facilities for antenatal care and delivery. This training is estimated to cost £65,000, which includes food for all participants, fees for local trainers, learning materials, TBA kits and new uniforms. Anticipated start date for this training is March 2010.