Building Care with Social Support: The 5 S’s of the MCOE

Editor's Note: The Paul E. Farmer Maternal Center of Excellence (MCOE), a Partners In Health (PIH)-supported facility, opened to patients in February 2026 on the campus of Koidu Government Hospital (KGH) in Kono District, Sierra Leone.

Built in partnership with Build Health International and the Sierra Leone Ministry of Health, the state-of-the-art facility was designed to confront one of the most urgent challenges in Sierra Leone: preventable maternal death. It represents years of deliberate work to strengthen care where it has long been weakest, part of a two-decade effort across Sierra Leone that has reduced the country's maternal mortality rate by 78% since 2000.

This series explores the MCOE through what PIH calls the "five S's": staff, stuff, space, systems, and social support, the essential elements of a strong health care system. In this article, we focus on social support: the basic necessities and resources, such as food and transportation, needed to ensure effective care.

Long before the MCOE opened, many women in Kono District faced pregnancy and childbirth with limited support and major barriers between home and the hospital, explains Kumba Tekuyama, PIH Sierra Leone's community-based programs manager in Kono.

But access to quality care is only useful if it can be reached in time.

A woman in a remote community may spend hours traveling over poor roads before arriving at a facility equipped to manage complications safely. Some walk part of the journey before climbing onto motorbikes or crowded public transportation. Seeking medical care can also require money for transportation, accommodation, or food-resources many families do not readily have.

Addressing these barriers is what PIH calls social support, the practical assistance beyond medical care that helps patients reach treatment and recover with greater stability afterward.

At the MCOE, that support often begins before delivery and continues long after discharge.

Birth Waiting Homes

Finda Lahai, a 23-year-old pregnant mother of two, attended prenatal appointments at her local clinic in Kenema-a five-hour drive, at minimum, from KGH. Staff there referred her to KGH due to complications during her prior pregnancy.

At KGH, staff advised Lahai to stay in the birth waiting home, which opened in 2017 at nearby PIH-supported Wellbody Clinic. This 12-bed facility provides housing, meals, and around-the clock care for women with high-risk pregnancies. Some women stay for weeks before delivery; others remain for months.

From left: Expectant mothers Finda Lahai, Finda Boyah, Fatmata Jalloh, and Mariatu Koroma listen to music and dance on the porch of the maternal waiting home at PIH-supported Wellbody Clinic in Kono District, Sierra Leone, on Feb. 12, 2026. Women staying at the waiting home receive regular prenatal checkups at Wellbody and are transported by ambulance to Koidu Government Hospital when they go into labor or are scheduled for a cesarean section. Photo by Caitlin Kleiboer / PIH

Lahai was initially hesitant about going to the birth waiting home. Leaving home and her family for an unfamiliar facility was daunting. But as she reflected on the complications during her previous delivery, she decided it was the safest option for both her and her baby.

"I feel like I am being checked up 24 hours a day. We are being monitored constantly," Lahai said during her time at the birthing waiting home. "The nurses sometimes come up to just chat and talk. I feel really cared for."

For women living far from advanced maternal care or facing high-risk pregnancies, like Lahai, that proximity and daily monitoring can be lifesaving.

On Feb. 22, Lahai delivered a healthy baby via C-section at the MCOE.

Community Support Networks

Community Health Worker Christiana Morquee (right) visits patient Aminata Sankoh at home on Oct. 31, 2024. Photo by Chiara Herold / PIH

Through a wide network of hundreds of community health workers (CHWs) and traditional birth attendants (TBAs), even more women and families have access to care and social support.

CHWs and TBAs often accompany patients from their homes directly to health facilities, navigating the health system and reducing stigma for those seeking care.

This is all in service of PIH's community-based model, which recognizes a simple reality: transportation, food, shelter, and other forms of material assistance often determine whether a vulnerable pregnant woman seeks care at all.

"TBAs, CHWs, chiefdom representatives, and local stakeholders meet every month," says Tekuyama. "People know we are doing the work, that we keep our promises, and that we care about their voices."

These trusted relationships and networks existed before the MCOE was built. Tekuyama has supported communities in Kono for more than a decade, including through the Ebola epidemic and COVID-19 pandemic. During both crises, the social realities affecting patients remained impossible to ignore.

"If you are asking people to quarantine, you must be able to provide their basic needs. We experienced this during Ebola; people were not staying in quarantine because they needed to go out for food," Tekuyama said in 2020. "So, we developed a strategy for supporting affected patients and families; clinicians would refer quarantining families to us, and we would make sure there was food at home."

Meeting Needs Beyond Direct Medical Care

Food support remains a key aspect of social support. At the MCOE, admitted patients now receive three free meals a day through a recently launched inpatient feeding program across KGH's entire campus. Before the initiative, many patients relied on relatives to bring food from home. Others went without meals entirely while receiving treatment. This new program helps patients stay nourished during recovery while easing financial pressure on families already navigating a medical crisis.

Pregnant women assessed as vulnerable may also receive food assistance and a discharge package after delivery. These packages often include staples such as rice, palm oil, benny (sesame seeds), and kenda (fermented locust bean).

Adama Kamara (left) and Bintu Kabba, PIH Sierra Leone volunteers, carry food as part of the inpatient feeding program at PIH-supported KGH. The hospital provides breakfast, lunch, and dinner daily to approximately 250 inpatients, including caregivers in the pediatric wards. Photo by Sean Andrew Bangura / PIH

These forms of support can make the difference between someone seeking care early and arriving too late. They also shape how people understand and trust the health system.

"All of our community team members are our trusted messengers, and the hope here has spread by word of mouth," Tekuyama says.

Through repeated engagement, communities begin to see that care is both available and accessible.

PIH has trained TBAs and CHWs on MCOE services so they can answer frequently asked questions accurately: what services are available, what remains free, and where women should go for care.

The message is reinforced through household visits, community meetings, and refresher trainings with local leaders. The goal, Tekuyama says, is to ensure trusted people in the community are sharing accurate information before fear or rumor fills the gap.

Building Trust in Care

Four generations gather on the day of Hawa Lebbie's discharge from the MCOE on Feb. 22, 2026. From left: Hawa Lebbie; her grandmother, Augusta Mansaray holding Lebbie's newborn son; and her mother, Fatmata Mansaray, stand together outside the postnatal ward. For Mansaray, the baby's great-grandmother, the moment marked the arrival of a fourth generation in her family. Photo by Caitlin Kleiboer / PIH

"You cannot achieve anything without inclusiveness," Tekuyama says. "Engaging with communities to communicate your mission and then [working] together to achieve it.

Still, trust is not built only through messaging. It grows through consistency and follow-through. As these networks strengthen, changes are becoming visible across Kono District. More women are choosing to deliver at health facilities. The number of women delivering at KGH increased by 69% from 2020 to 2025, while sharp increases were also observed in facility-based deliveries, C-sections, and antenatal care visits across PIH-supported sites as maternal access efforts expanded.

The shifts may be gradual, but they are significant. More women are reaching facilities earlier instead of delivering at home or arriving too late for treatment. Trust in the health system is growing alongside access to care.

"There are communities all over that are struggling with tuberculosis, HIV, and even malaria, in addition to maternal health," Tekuyama says. "What we have done here can be replicated."

For PIH and its partners, the goal extends far beyond providing care within the hospital walls.

The MCOE may provide advanced maternal care, but social support is what helps women reach its doors in time. It closes the dangerous distance between home and the hospital. And most importantly, it ensures women are never left to navigate high-risk pregnancy, childbirth, or recovery alone.