Partners in Health, a Nonprofit Corporation
05/20/2026 | News release | Distributed by Public on 05/20/2026 11:02
Five Essential Elements Behind the Maternal Center of Excellence
Five Elements Transforming Maternal Care
On Feb. 14, 2026, the Paul E. Farmer Maternal Center of Excellence (MCOE) opened its doors to patients in Kono District, Sierra Leone. By the end of that first day, 27 women had been seen and 13 babies had been born. By the end of April, the facility had supported nearly 3,000 women with care and helped deliver more than 900 babies.
None of that happened by accident. It happened because of decades of deliberate work, and because every single one of what Partners In Health calls the "five S's" was in place.
When PIH thinks about building a strong health system, we return again and again to five essential elements: staff, stuff, space, systems, and social support. Each one is necessary. Remove any single element, and the whole structure weakens. Together, they don't just create a hospital-they create the conditions for people to get better.
The MCOE is, in many ways, the fullest expression of the five S's we have ever built. This series tells that story, one S at a time.
Staff: The People Who Make It All Possible
A building is only as strong as the people inside it. That's a lesson Francess Kamara, a senior midwife mentor at PIH-supported Koidu Government Hospital (KGH), knows well. When she started working in Kono, there were fewer than ten midwives to serve a district of hundreds of thousands. As PIH's reputation grew and more women came seeking care, the pressure on that small team became enormous. Something had to change.
Building the MCOE meant building the workforce to match it. In the months before opening, training intensified-staff ran simulations, practiced on new equipment, and worked through scenario-based exercises. On opening day, the MCOE welcomed approximately 200 clinical staff. That number will keep growing as the facility expands its phased opening.
"The building is beautiful, the systems and equipment are first class," Kamara says, "but none of that matters without the medical professionals to run it."
A dedicated training center and dormitory, a short drive from the MCOE, is now under construction. Lecture halls and simulation labs will ensure the next generation of Sierra Leonean clinicians is ready.
Stuff: The Tools That Make Treatment Possible
When 17-year-old Fanta Jimmy arrived at the MCOE on opening day with pre-eclampsia and a baby in distress, what saved her life wasn't just the skill of the clinical team. It was the ultrasound machine that confirmed the diagnosis. It was the IV fluids and the vital monitors. It was the neonatal transport incubator that carried her premature daughter to the NICU.
For years, clinicians in Kono had the training but not the tools. Midwife Boyama Gladys Katingor remembers the helplessness of knowing what a patient needed but not having access to the right equipment to provide it. During the 2014 Ebola epidemic, the gap became lethal-clinicians worked without adequate protective equipment while pregnant women labored with minimal clinical support.
The MCOE changed that equation. Today, it is the first facility outside Freetown to deliver piped oxygen and medical gas directly to patient beds. It houses Sierra Leone's first neonatal intensive care unit, with 39 NICU beds equipped with incubators and specialized monitoring systems. The "stuff" present at the MCOE isn't unusual in high-income countries-but in Sierra Leone, it is unprecedented.
The stuff article closes with a critical reminder: equipment alone isn't enough. The monitors, scanners, and oxygen systems matter because they are placed in the hands of people trained to use them well.
Space: Where Healing Happens
Dr. Paul Farmer used to say you can deliver bad care in good facilities, but you cannot deliver good care in bad ones. The old maternity ward at KGH proved his point. It had 48 beds. Women in labor shared rooms with mothers recovering with newborns and patients arriving with unrelated emergencies. There was no dedicated triage area. The structure was, in Lascher's words, "designed for scarcity."
The MCOE replaced that with something radically different. Four buildings. 120 inpatient beds. Three operating theaters. A dedicated triage area. An isolation room on every ward-a lesson learned from Ebola. A dormitory for mothers with babies in the NICU so women don't have to choose between their infant's bedside and a place to sleep.
What's more, the MCOE was built in large part by women from Kono District itself, most of whom had never worked in construction before. At the peak of construction, women made up 65% of the workforce. Construction worker Diana "Success" Komba put it simply: "I see beauty. I see care in every detail. And I know that when a mother walks in, she will feel that too. She will know that she matters."
Natural light, ventilation, green courtyards planted with trees donated by community members-all of it was intentional. Farmer believed beautiful spaces help people heal. The MCOE was built on that belief.
Systems: The Invisible Infrastructure That Saves Lives
Of the five S's, systems are the hardest to photograph and the easiest to underestimate. But when systems fail, people lose their lives.
The MCOE was designed around this truth. When a woman develops complications at a rural clinic in Kono District, a clinic staff member calls the National Emergency Medical Services (NEMS) toll-free number. An ambulance is dispatched-carrying oxygen, a paramedic, and pre-hospital care capacity. The patient arrives at the MCOE, is registered, and her record is entered into the electronic medical record system. She moves through triage, is assessed, and the clinical team determines the next step. Every link in that chain has to hold.
Former PIH Sierra Leone executive director Jonathan Lascher remembers what it looked like when the links broke. In 2014, one ambulance served 500,000 people. Rapid test results took days. Women arrived too late. "Reducing maternal mortality requires long-term commitment across multiple systems," Lascher says. "I knew PIH could not do everything, nor could we do anything alone."
Today, the MCOE has dedicated triage, electronic records, reliable backup power, and a functioning referral network across all 14 chiefdoms of Kono District. Biomedical engineer Henry Amoakwa sums up the stakes plainly: "Hospitals run all day, every day. There cannot be a gap or a breakdown otherwise lives are at risk."
Social Support: Closing the Distance Between Home and Hospital
Even the best hospital in the world can't save a woman who can't reach it. In Kono District, many women live hours from KGH over difficult roads. Getting there requires money for transportation, often accommodation, and someone to accompany them. For women with high-risk pregnancies, the distance isn't just inconvenient-it can be fatal.
PIH's answer is social support: the practical assistance that helps patients reach care and recover once they leave. At the MCOE, that starts before delivery. Women assessed as high-risk can stay at the birth waiting home at PIH-supported Wellbody Clinic, where they receive housing, meals, and around-the-clock monitoring until they're ready to give birth. Finda Lahai, a 23-year-old referred from five hours away, was hesitant at first. After delivering a healthy baby by C-section at the MCOE, she described the experience: "I feel like I am being checked up 24 hours a day. I feel really cared for."
After delivery, vulnerable women may receive discharge packages with food staples. Across the district, hundreds of community health workers and traditional birth attendants accompany patients to facilities, answer questions, and reduce stigma. All admitted patients now receive three free meals a day through an inpatient feeding program.
The result is measurable. Deliveries at KGH increased by 69% from 2020 to 2025. More women are reaching facilities earlier. Trust in the health system is growing. "All of our community team members are our trusted messengers," says Kumba Tekuyama, PIH Sierra Leone's community-based programs manager in Kono. "The hope here has spread by word of mouth."
What it Takes to Reduce Maternal Mortality
Sierra Leone has reduced its maternal mortality rate by 78% since 2000. The MCOE represents the next chapter of that effort, and a proof of concept for what's possible when no element of care is left behind.
No single S is enough on its own. Skilled staff without equipment cannot act. Equipment without trained people to use it sits idle. A world-class facility with no referral system leaves women stranded at home. The best systems in the world mean nothing if a woman can't afford the bus fare to the hospital.
What the MCOE represents is the belief that everyone deserves all five-and that when communities, governments, and global health partners build together, it is possible.
"What we have done here can be replicated," Tekuyama says.
That is the promise of the five S's.
Programs
Partners in Health, a Nonprofit Corporation published this content on May 20, 2026, and is solely responsible for the information contained herein. Distributed via Public Technologies (PUBT), unedited and unaltered, on May 20, 2026 at 17:02 UTC. If you believe the information included in the content is inaccurate or outdated and requires editing or removal, please contact us at [email protected]