2025 Maternal & Child Health Mission HCW TogetherforGlobalHealth : simplebooklet.com

Executive SummaryThis report details the successful second iteration of our 5-day maternaland child health training, further expanding the cohort of midwives andnurses equipped with life-saving skills. At the Ministry of Health andSanitation's invitation, this training welcomed nurses and midwives fromdistrict hospitals and peripheral health units in the Kenema, Kailahun,and Kono districts. We had the privilege of hosting the training at thenewly opened Kenema Midwifery School, making history as the firstgroup to be certified at this institution—a milestone that underscores thegrowing investment in maternal and child health education in SierraLeone.While we remained committed to our core focus on Helping MothersSurvive: Bleeding After Birth and Essential Newborn Care, we alsoexpanded the training to include new sessions on quality improvementand mental health, recognizing the critical role emotional well-beingplays in both patient care and provider resilience. Incorporating lessonslearned from our first training in Bo, we refined our approach to ensureeven greater success, improving both the effectiveness and sustainabilityof the program.This training also provided an opportunity for Rising Trainers from ourprevious training in Bo to step into leadership roles, gaining hands-onexperience in teaching and mentorship. Empowering local trainerscreates a cascade effect, where knowledge is continuously passed down,ensuring that these life-saving skills reach even more midwives andnurses in the future. By equipping providers with practical, hands-ontraining, we are not only saving lives today but also laying the foundationfor long-term improvements in maternal and child health outcomesacross Sierra Leone.This training was made possible by the collaboration of trainers from theUnited States, Canada, and Sierra Leone, working together to build theskills and confidence of local healthcare providers. None of these effortswould be possible without the collaboration and dedication of ourpartner organizations, including Tenki for Born, Healey InternationalRelief Foundation, and Helping Children Worldwide.Together, we are strengthening the healthcare workforce, empoweringcommunities, and working toward a future where no mother or newborndies from preventable causes.01

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The Power of Collaboration03Effective partnerships are essential inaddressing the complex challenges ofmaternal and child health. Collaboratingwith the Ministry of Health is crucial, asthey provide the essential framework andoversight for healthcare delivery,ensuring that our efforts align withnational health priorities and contributeto sustainable systemic improvements.Working alongside the Ministry ensuresthat training, resources, and interventionsare integrated into existing healthsystems, maximizing reach and long-term impact. Furthermore, organizations with sharedgoals must break down silos andembrace collaboration. Even smallcollaborations, such as sharing bestpractices, loaning technical staff, orcoordinating resource distribution, canamplify the collective impact andprevent duplication of efforts. Bypooling expertise, resources, andnetworks, organizations can create amore comprehensive and effectiveresponse to maternal and child healthneeds, ultimately improving outcomesfor vulnerable populations.Our Maternal andChild Health Missionteam is a diversegroup of dedicatedindividuals, includingnurses, midwives,doctors, and supportstaff.

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Sustainable change in global health starts withinvesting in people. Each midwife we train, each life-saving skill they share, and each mother and babywho receives better care because of their effortscontribute to a stronger healthcare system. On behalf of our entire team, we extend our deepestgratitude to our donors for their incredible supportof our maternal health mission. Your generousdonations of funding and supplies have made aprofound impact, allowing us to provide essentialtraining and medical resources to empowermidwives to support mothers and babies in need.Because of your kindness and compassion, we areable to improve maternal health outcomes, ensuresafe deliveries, and offer hope to countless families. Thanks to your generous support, nurses are leadingthe charge in reducing maternal and newbornmortality, ensuring safer births, healthier mothers,and stronger communities across Sierra Leone.04A Special Thank Youto Our DonorsA very special thank you to our largestsupporter, the Tzu Chi Foundation.

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By empowering midwives with the skills to handlecomplex situations, we believe this will increase supportfor their work, fostering a cycle of improvement wherethose demonstrating success receive the resources tofurther excel. This training results in midwives beingbetter prepared to handle difficult situations and helpother midwives save lives. While training addresses onlya fraction of Sierra Leone's healthcare needs, midwives’sharing their skills with other midwives will create aripple effect of improved care, ultimately attracting vitalattention and investment from partners to strengthenmaternal and child health systems across the region.--YASMINE VAUGHAN, TECHNICAL ADVISOR FOR HELPING CHILDREN WORLDWIDE05BackgroundThe World Health Organization (WHO)states that skilled midwives could avertmore than 80% of all maternal,stillbirths, and neonatal deaths. InSierra Leone, due to limitedequipment, inadequate mentorship,and educational constraints, somemidwives have never had the chanceto receive hands-on training.These midwives need practicalexperience and support to improvetheir skills and boost their confidence.In addition to their knowledge,midwives must be confident, andprepared to act decisively andeffectively in life-saving situations,which are often high-pressure andresource-limited. It is essential not only to equipmidwives with the necessaryknowledge but also to foster theirconfidence. Therefore, our goal is toaddress the challenge of maternaland neonatal mortality by increasingthe competence and confidence ofmidwives to perform life-savingprocedures in Sierra Leone.Instituting a training initiative thatincorporates hands-on learning andmentorship components, canenhance knowledge retention andskills for midwives and nurses toimprove maternal health serviceswith the overall outcome ofpreventing the leading causes ofmaternal and neonatal mortality inSierra Leone. THE NEED FOR TRAINING

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060102 03 04Quality of theCurriculumDelivery of theCurriculumWell-DesignedCurriculumWell-DeliveredTrainingGoodReception ofTraining +KnowledgeAcquisitionKnowledgeApplicationin PracticalSetting 05ImprovedMaternaland InfantOutcomesTreatmentReceiptTreatmentEnactmentTreatmentOutcomesThis Theory of Change outlines the pathway through which our maternal and childhealth training leads to improved maternal and infant outcomes. Each step buildsupon the previous one, ensuring a systematic and sustainable approach tostrengthening maternal and child healthcare.Well-Designed Curriculum – The effectiveness of the program depends on thestrength and relevance of this curriculum. The foundation of our training is a high-quality curriculum that is evidence-based, context specific, and tailored to theresources and needs of healthcare providers in Sierra Leone.Well-Delivered Training – Successful implementation requires engaging andeffective delivery, ensuring that participants receive the knowledge in a way that isaccessible and applicable to their work.Good Reception of Training + Knowledge Acquisition – When training is well-received, participants retain key knowledge and skills, equipping them with theinformation needed to improve patient care.Knowledge Application in Practical Setting (Confidence and Competence) –Learning translates into action when participants are confident and their skillsbecome second nature. Healthcare providers having the ability and the mindset toapply their training in real-world clinical settings directly impacts the quality ofcare provided.Improved Maternal and Infant Outcomes – Ultimately, the training aims toreduce maternal and newborn mortality and morbidity by ensuring thathealthcare providers can deliver high-quality, evidence-based care.THEORY OF CHANGEBackground (Cont.)

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The CurriculumOVERVIEW07ESSENTIAL NEWBORN CARE 1 & 2HELPING MOTHERS SURVIVE:BLEEDING AFTER BIRTHA step-by-step approach topreventing and managingpostpartum hemorrhage, theleading cause of maternal death.Training in immediate andcontinued newborn care, coveringneonatal resuscitation, thermalprotection, infection prevention,and feeding support.Our Maternal and Child Health Training Conference provided a 5-day intensive,hands-on learning experience for midwives, nurses, and frontline maternal healthproviders, emphasizing low-resource, high-impact strategies to improve maternaland newborn survival. The four main curricula used include Helping MothersSurvive Postpartum Bleeding (HMS: BAB), Essential Newborn Care (ENC), QualityImprovement Integrated Kangaroo Mother Care (QIiKMC), and the 10 steps ofEvidence-based Practice for Improving Quality (EPIQ). In addition to the standardcurriculum, we developed our own innovative modules for maternal and providermental health, and respectful maternal care. For the rising trainers, we alsodeveloped a module on effective teaching strategies in healthcare.QUALITY IMPROVEMENTINTERGRATED KANGEROO MOTHERCARETEN EVIDENCE-BASED PRACTICESFOR IMPROVING QUALITY TOIMPROVE OUTCOMESA framework for enhancing carepractices and patient outcomesthrough quality improvementinitiatives.Presents basic post-birthinterventions such asbreastfeeding, skin-to-skin contactand thermal care from a qualityimprovement perspective

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The Curriculum (Cont.)08This curriculum is designed to teachhealth workers how to provide bettercare to newborns, especially small andpreterm babies by using a combinationof quality improvement (QI) andkangaroo mother care (KMC). KMCinvolves skin-to-skin contact betweenthe mother and baby, exclusivebreastfeeding, and thermal support. Thebenefits of KMC are well-established, butit is often difficult to implement inpractice. This curriculum equips healthworkers with the knowledge and skillsthey need to successfully implementKMC in their health centers.This curriculum equips healthcareworkers to implement and lead qualityimprovement (QI) projects in theirhealth centers. It is an adaptation ofEvidence-based Practice for ImprovingQuality (EPIQ).The purpose of the training is forparticipants to be able to:work as a teamuse quality improvement toolsshare what they have learnedThe Plan-Do-Study-Act (PDSA) walksparticipants through the 10 steps ofquality improvement, includingidentifying the problem, selecting theteam, brainstorming causes, choosing apriority, mapping the process,identifying indicators, explaining theiraim, engaging partners, implementingthe change, and sharing the results.QUALITY IMPROVEMENTINTERGRATED KANGEROO MOTHERCARE (QIIKMC)EVIDENCE-BASED PRACTICE FORIMPROVING QUALITY (EPIQ)We believe there is an urgent need to strengthen maternal and neonatal healthcarethrough standardized, practical, and effective training. For our training, we use asthe standard curriculum required by the Ministry of Health and Sanitation(MOHSL)for teaching these topics. Each of these curricula was developed by global healthleaders, including the World Health Organization (WHO), the American Academy ofPediatrics (AAP), the Canadian Neonatal Foundation, JHPIEGO, and other maternaland child health organizations. and wsa reviewed and approved by the MOHSL.Each curricula is recommended to be taught over the course of two days, but basedon our last training we believed more time might be needed to absorb the material.To maximize learning, participants were divided, with some focusing on maternalhealth (HMS: BAB) lectures and others on newborn care (ENC 1, ENC 2, QIiKMC &EPIQ). It was unfortunate that participants could not receive all tracks of training, butby dedicating extra time to the maternal health lectures, participants were able toreinforce their knowledge, practice skills more thoroughly--a factor that likelycontributed to the improved confidence and performance scores.

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ESSENTIAL NEWBORN CARE (ENC)The Essential Newborn Care (ENC)curriculum is a two-part training programdesigned to empower healthcareproviders with the skills and knowledgeto deliver life-saving care for newborns intheir critical first days of life. ENC 1includes Helping Babies Breathe (HBB) aNeonatal Resuscitation Program (NRP)adapted for low-resource settings. ENC 2is the combined updated version ofEssential Care for Every Baby (ECEB) andEssential Care for Small Babies (ECSB).The Curriculum (Cont.)09This foundational module focuses onimmediate care after birth, emphasizingevidence-based practices to ensurenewborn survival and well-being. Keytopics include:Neonatal resuscitation and stabilizationThermal protection and prevention ofhypothermiaImmediate and exclusivebreastfeeding initiationInfection prevention and umbilical cordcareEarly recognition and management ofdanger signsBuilding on ENC 1, this advancedmodule delves deeper into ongoingnewborn care and management ofmore complex situations. Key topicsinclude:Care for low-birth-weight andpremature infantsKangaroo Mother Care (KMC)techniquesManagement of neonatal infectionsand sepsisFeeding challenges and support formothers with breastfeedingdifficultiesMonitoring growth and ensuringproper nutritionESSENTIAL NEWBORN CARE 1 (ENC 1): ESSENTIAL NEWBORN CARE 2 (ENC 2):

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For this training, we piloted thelatest version of the HMS BABcurriculum, which has not beenreleased by JHPIEGO.The Curriculum (Cont.)10Bleeding After Birth is acomprehensive, hands-on trainingprogram designed to equip healthcareproviders with the skills and knowledgeneeded to effectively prevent,recognize, and manage postpartumhemorrhage. This evidence-basedcurriculum combines interactivelearning techniques with practicalsimulations to build competency incritical areas.BLEEDING AFTER BIRTH (HMS: BAB)Key Topics Include:Active management of the thirdstage of labor (AMTSL) to preventhemorrhage and monitor bleedingIdentification of risk factors andearly warning signs of excessivebleedingRapid implementation of life-saving interventions, includinguterotonics, bimanualcompression, and other techniquesEffective teamwork andcommunication in emergencysituationsINNOVATIVE TRAININGCOMPONENTS: SOFT SKILLS INMATERNAL HEALTH We recognize that interpersonal skillsare as vital as technical expertise inproviding holistic maternal andnewborn care. Each day of theconference commenced with adedicated one-hour lecture, focusingon enhancing the essential soft skills ofour midwives in:Mental Health for HealthcareProvidersRespectful Maternal CarePerinatal Mental Health andPostpartum Mental HealthFor the rising trainers, we alsodeveloped a specialized curriculum toequip trainees with effective skills forteaching others. In the next section we provide anoverview of our approach to theseadditional topics.

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11Innovative TrainingComponents MENTAL HEALTH SUPPORTWhat makes our training conferencesunique is our intentionality in incorporatingother critically important topics into ourtrainings, such as perinatal mental health,understsanding signs of postpartumdepression, self- care for healthcareproviders, and compassionate servicedelivery. UNDERSTANDING DEPRESSION ANDBURNOUT: A CRITICAL ISSUE FORHEALTHCARE PROFESSIONALSPRESENTED BY COLONEL DR. SEVALIEHealthcare professionals operate in high-stress environments, making themparticularly vulnerable to depression andburnout. Col. Dr. Sevalie’s presentationprovided essential insights into theseconditions, their distinctions, and effectiveprevention strategies. Recognizingsymptoms early can prevent severe healthimpacts, reduce absenteeism, and improveoverall well-being. Dr. Sevalie emphasizedthe need for supportive workenvironments and self-care practices tomaintain mental health in high-pressuresettings. His presentation reinforced that aresilient healthcare workforce requiresproactive mental health care andorganizational commitment.Depression is a mooddisorder marked bypersistent sadness, fatigue,and loss of interest in dailyactivities. Severe cases mayinvolve suicidal thoughts.Burnout results fromprolonged workplacestress, leading toemotional exhaustion,detachment, and reducedeffectiveness.Shared Symptoms includefatigue, difficultyconcentrating, sleepdisturbances, and physicalcomplaints.KEY TAKEAWAYS:For Depression: Psychotherapy (CBT,IPT, MBCT), antidepressants, andlifestyle adjustments like exercise andsleep hygiene.For Burnout: Workplace reforms topromote balance, stressmanagement techniques, andpsychological support.INTERVENTION STRATEGIES:

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12MINDFULNESS FOR MIDWIVES: AVITAL TOOL FOR RESILIENCEIn the demanding world of maternaland newborn healthcare, midwives andhealthcare professionals often findthemselves navigating high-stresssituations with limited resources. Theirwork is not only physically exhaustingbut also emotionally taxing, requiringimmense resilience and compassion.Recognizing the need for self-care andmental well-being, the training teamintegrated mindfulness sessionsdesigned specifically for healthcareproviders operating in such challengingenvironments.Mindfulness—the practice of being fullypresent in the moment—has beenwidely recognized as an effective tool tomanage stress, improve focus, andenhance overall well-being. Formidwives and maternal healthcareworkers, cultivating mindfulness canhelp reduce burnout, strengthenemotional resilience, and improvepatient care.During the workshop, led by Josephine Garnem, guided mindfulnesssessions were introduced as a practicaland accessible strategy for healthcareworkers to incorporate into their dailyroutines. The practice includedgrounding exercises, consciousbreathing, a body scan for stressawareness, and moments of gratitude.Participants were encouraged to takethese techniques into their workplaces Innovative TrainingComponents (Cont.)to foster calmness, enhance focus, andimprove their ability to respond toemergencies with clarity and composure.By prioritizing self-care, we empowermidwives and healthcare professionals tosustain their life-saving work with clarityand compassion. This workshop reinforcedthat resilience isn’t just about endurance—it’s about renewal, balance, and ensuringthat those who care for others are alsocared for themselves.Josephine Garnem, ED Healey IRFMany midwives shared how themindfulness practice helped them feelmore centered and emotionally refreshed,even in the midst of their demandingroles. One participant remarked, "For thefirst time in a long while, I felt truly atpeace. This practice reminded me thatself-care is not selfish—it is essential." Theenthusiasm and demand underscoredthe urgent need for sustained mentalwellness support for midwives andhealthcare professionals working in low-resource settings.

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PREPARING RISING TRAINERSOur maternal health mission prioritizesthe development of rising trainersbecause we know that sustainableimprovements in maternal healthoutcomes rely on building localcapacity. By equipping individualswithin communities with the skills toeffectively train others, we create aripple effect, multiplying the reach ofevidence-based practices and ensuringlong-term knowledge transfer.Therefore, a significant focus has beenplaced on cultivating skilled trainerswho can teach others effectively.While subject matter expertise isessential, we recognize that trueimpact of rising trainers hinges on theability to effectively disseminateknowledge and empower others.Especially in contexts where corporalpunishment and traditional didacticteaching methods prevail, simplyunderstanding the material isinsufficient. Future trainers requirerobust support and guidance totransition from subject experts toeffective educators, capable offacilitating participatory learning andempowering others to become agentsof change within the maternal healthlandscape.13Drawing from the Carnegie studyfindings, as summarized by PatriciaBenner's apprenticeship model, wehighlight the importance of teachingthat results in knowledge, practical skills,and ethical formation. This is furthercontextualized by Benner's Novice toExpert theory, outlining the stages ofclinical competency. We stress thesignificance of empowering learnersthrough a collaborative partnership,fostering a learner-centeredenvironment, and delivering organized,accessible material. Educators areencouraged to adopt coaching overmentoring techniques, prioritizinginquiry-based learning over directinstruction. Looking forward, we aim toexpand the curriculum to includespecialized training in simulationpractice and effective debriefingtechniques, equipping trainers with thetools to facilitate experiential learningand enhance clinical skills.Please see our Appendix A for acomprehensive list of resources used. CRITICAL TOPICS USED TO PREPARERISING TRAINERSWe build upon Malcolm Knowles' adultlearning theory, recognizing the uniqueneeds and motivations of adult learners.Innovative TrainingComponents (Cont.)

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Dr. Bah presented on his research acrossfive districts in Sierra Leone (Bo, Bombali,Port Loko, Kono, and Western Area),which highlighted the alarmingconsequences of untreated psychologicaldistress during pregnancy and afterchildbirth. Pregnancy and Adverse Outcomes:Common perinatal mental disorders,such as anxiety and depression, havebeen linked to preterm birth, low birthweight, and decreased fetal growth. Infants born to mothers withuntreated perinatal psychologicaldistress are at increased risk fordevelopmental delays and behavioralproblems. Mental distress can disrupt themother-infant relationship and affectessential practices like breastfeeding.Mental distress impacts the overallability to care for oneself and one’sfamily deteriorates, increasingvulnerability to substance abuse andharmful behaviors. Presented by Dr. Abdulai Jawo BahResearch Associate, NIH DiversitySupplement ScholarPERINATAL PSYCHOLOGICALDISTRESS IN SIERRA LEONEResearch HighlightOur integration of maternal mental healthinto the training draws from establishedstudies that demonstrate the critical linkbetween mental well-being and positivematernal and child health outcomes. Thisresearch-driven approach ensures thatour curriculum reflects the latest scientificunderstanding and promotescomprehensive, holistic care for mothers.Below is a highlight of one of the researchprojects that was presented as a part ofthis training. Dr. Jawo emphasized the role ofcommunity support and theimportance of early identification ofdistress, despite limited formal mentalhealth services. His research supportsthe idea that even common distresssigns like anxiety or low mood can leadto significant disability at a populationlevel, necessitating culturally tailoredmental health interventions.Mother to mother support groups, aform of task-sharing intervention, andconsultation with mental healthprofessionals at the district level wereamong the critical resourcesrecommended for providing culturallyappropriate support. Otherrecommendations include access tomental health resources, such asmental health nurses at the districtlevel and clinical psychologists.Please check out our appendix B for acomplete bibliography of Dr Jawo'swork in perinatal mental health.14

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15IMPACT ON A GLOBALSCALEThis training utilized the latestversion of the post-partumhemorrhage curriculum, which hasnot yet been publicly released byJHPIEGO. As a pilot project, ourfindings are crucial in informingfuture revisions and improvementsto this globally recognizedcurriculum. This curriculum servesas a gold standard for manyorganizations worldwide, and ourfeedback will directly contribute toits refinement and ultimatelyenhance maternal and child healthoutcomes globally. In addition toJHPIEGO, we plan to disseminateour findings to key stakeholderswithin the global health community,including the American Academy ofPediatrics, USAID Momentum, theInternational Confederation ofMidwives, and the InternationalCouncil of Nurses.By sharing our results with theseinfluential organizations, we aim tocontribute to the growing body ofevidence on effective maternal andchild health interventions. We alsoplan to publish our findings in peer-reviewed journals to furtheradvance the field of maternal andchild health. Furthermore, our findings will alsoinform the future of WHO careguidelines, as these guidelines arecontinually shaped by real-worldimplementation experiences likeours.

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16ResultsPARTICIPANT RESULTSParticipants either received the BABtraining or the ENC training withQIiKMC and EPIQ. Only the EssentialNewborn Care (ENC) and HelpingMothers Survive (HMS) curricula havemeasurable assessments required forcertification. Participants were tested intwo forms for ENC and HMS: knowledgechecks and skills checks. Eachknowledge test was done twice, as apre- and post-test. There are 2-3 skillschecks, also called Observed StructuredClinical Evaluations (OSCEs), for eachcurricula that test skill’s application inspecific scenarios, and participants weregiven up to 3 chances to pass theseskills assessments.The results of each of these tests areshown on the following pages. All of theparticipants in BAB and all but oneparticipant in the ENC training wascertified. Additionally, participantsshowed a 15-30% improvement onknowledge checks from pre to post test.ParticipantsTrained in EssentialNewborn Care24ParticipantsTrained in BleedingAfter Birth19Rising TrainersTrained to beTrainers4on the content, group dynamics, andpresentation and facilitation of theirtraining. Although only 1 of the 4 RisingTrainers was certified as a Trainer, therest were re-certified as PracticeCoordinators. Additionally, 6participants from ENC and 6 from BABwere tapped to become new practicecoordinators. Because of their highscores and leadership potential, theywere given training supplies andmaterials. They are expected to conductlow-dose, high-frequency (LDHF)trainings at their facilities and pass ontheir knowledge to other nurses andmidwives at their facility. As a part ofthe ongoing support, these practicecoordinators are monitored to ensurethey do LDHF training once a monthand the training is delivered withcompetence and quality. Four Rising Trainers in BAB, drawn fromthe most diligent practice coordinatorsfrom our previous training in Bo, wereevaluated to determine if they could befull Trainers. Using an assessmentespecially developed for this training,the Rising Trainers were asked to teachone section of the curriculum per dayand were evaluated RISING TRAINER & PRACTICECOORDINATOR RESULTS

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Lessons LearnedWe observed that small groups of four orfewer participants significantly enhancedlearning, particularly for those strugglingwith the material. When participantswere moved into smaller groups, theydemonstrated marked improvement. Wealso noted the importance of balancingpractice with progression. Excessiverepetition can lead to wasted time, sotrainers must regularly assessparticipants' understanding andreadiness to advance.GROUP SIZING AND PACING19The participants were varied in termsof their years of experience, from 6months to 30 years practicing as anurse or midwife. A key takeaway wasthat progress should be measured bywhether the participants advanced tothe next stage of competence inmaternal and newborn care andgained new knowledge.Patricia Benner’s Novice to ExpertTheory describes how nurses developskills and clinical expertise over timethrough education, experience, andpractice. The theory outlines fivestages of skill acquisition:Novice – Beginners with little to noexperience who lack confidenceand require continual verbal andphysical cues. 1.Advanced Beginner – Nurses whohave some experience and canrecognize recurring patterns butstill need guidance.2.Competent – Those with 2-3 yearsof experience who can efficientlyplan and organize care but maylack flexibility in unexpectedsituations.3.Proficient – Nurses who seesituations holistically, prioritizeeffectively, and adapt based onexperience and intuition.4.Expert – Highly skilledprofessionals who make quick,intuitive decisions and functionwith deep clinical understanding.5.LEARNING AS A CONTINUUMWe identified a potential gap in ourtraining approach: the exclusion ofhospital matrons who are not midwives.These individuals often supervise nursesand midwives but may lack thespecialized knowledge to effectively guideand support their teams. Future traininginitiatives will consider expanding toinclude these critical personnel, ensuringcomprehensive support for all healthcareproviders involved in maternal and childhealth.EXPANDING TRAINING REACHIt is unrealistic to expect midwives whoare novices to become experts within asingle week. Instead, our focus for thetraining was on on ensuring thatwherever the nurses began, theyadvanced up one step in their skills.

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Lessons Learned (Cont.)20While our training focused primarily onclinical skills for managing maternaland newborn emergencies, werecognized a significant need toincorporate soft skills that are critical toimproving patient outcomes. CommunicationOne key area identified was the needfor effective communication,particularly during procedures and inpatient handoffs. Midwives and nursesmust be equipped with the skills tocommunicate patient conditions andtreatments effectively, especiallyduring emergency situations. Weidentified a need to reinforcestructured communicationframeworks such as SBAR (Situation,Background, Assessment,Recommendation) to improve clarity,efficiency, and accuracy in clinicaldiscussions. In the same vein,documentation practices emerged asa crucial skill requiring more attention.Incomplete or inconsistent record-keeping create gaps in accountability. Review & Continuous LearningAnother major area for growth isstructured post-mortem reviewsfollowing adverse outcomes. Trainingmidwives and nurses to conduct rootcause analyses can help identifypreventable factors contributing tomaternal or neonatal deaths, leading Empowered Decision-MakingFinally, empowering midwives throughleadership support from higher levelsof the healthcare system is critical. Many midwives work in settings wheretheir clinical expertise is undervalued orwhere decision-making structures donot fully incorporate their input. Byfostering leadership development,mentorship, and advocacy training, wecan help midwives gain the confidenceand institutional backing needed toimplement best practices, advocate forpolicy improvements, and elevate thestandard of care for mothers andnewborns.ADDRESSING SOFT SKILLS IN PATIENT CAREto continuous quality improvementand stronger patient safety protocol.

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21Nurse Isatu, a dedicated midwife fromCHASL-member Nixon Memorial UMCHospital in Segbwema, is a shiningexample of how investing in midwiferytraining creates a ripple effect ofpositive change. Isatu’s journey withus began when she participated in ourmaternal and newborn health trainingin Bo in January 2024.She not only excelled in the trainingbut also demonstrated outstandingleadership and teaching abilities,making it clear that she was not justlearning for herself—she was learningto uplift others. Following her training,Isatu took her newfound skills andknowledge back to Nixon MemorialUMC Hospital, where she led trainingsfor her fellow midwives, ensuring thatthe impact of the program extendedbeyond her own learning. She utilizedthe supplies and materials Impact Storyprovided through the training toequip her colleagues with better toolsand knowledge, strengtheningmaternal and newborn care at herfacility.Recognizing her dedication andexpertise, we were thrilled to inviteNurse Isatu back as a trainer for thisyear’s maternal health training inKenema. Seeing her step into the roleof an full Trainer—sharing herexperiences and guiding fellownurses and midwives—was aninspiring testament to the power ofcapacity building and mentorship.Isatu’s transformation from trainee totrainer embodies the sustainableimpact we strive for: empoweringlocal healthcare providers to takeownership of improving maternal andnewborn health in their owncommunities.FROM LEARNER TO LEADER: NURSE ISATU – A CHAMPION FORMATERNAL HEALTH IN SIERRA LEONEBy equipping local champions likeIsatu, we are not just improvingindividual skills—we are building anetwork of empowered healthcareproviders who will continue this life-saving work for years to come.

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Thank You!We extend our deepest gratitude to all the individuals andorganizations who made this training possible. To thededicated volunteers and trainers who generously gave theirtime and expertise, the organizations who provided technicalsupport and in-kind contributions, and the leadership whoensured the success of this initiative—we thank you. Yourunwavering commitment has empowered nurses andmidwives to lead the charge in reducing maternal andnewborn mortality, ensuring safer births, healthier mothers,and stronger communities across Sierra Leone. 22Chief Nursing and Midwifery Office, MoHSLKenema School of MidwiferyDistrict Health Medical Team KenemaNational Child Health Programme, MoHSL Christian Health Association of Sierra LeoneUniversity of Makeni Center of Excellence for Maternal & ChildHealth Education & ResearchTogether, we are creating lasting change, and wecould not do it without you!Trainers, Speakers, and Support Team: Mariama Veronica Satta LumehMessie AlphaNancy BayohNaomi D. Y. HydePriscilla FunsaniAbu BanguraAnn Marie RhodaFlorence BullMark SankohSia KoromaJosephine GarnemMolli GoetzJosephine AmaraMatthew GartmannSenesie MargaoYasmine L. VaughanAmanda NapoletDana WhittakerJames TaylorJoyce VogelKari MasonMariama Massaquoi-GartmannRuth MielkeSusan Van BoomAlice Boi Yatta ThorntonBanneh DaramyCarrie Jo CainChristiana Leonora Daphne DeckerFatmata Janka DaboGladys A SesayIsatu Baby BoimaJosephine H Powell

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23More Information AboutOur WorkEMAILWEBSITE :TGH@HelpingChildrenWorldwide.orgTogether4GlobalHealth.orgThis training and report has been prepared by the Together for Global Healthnetwork convened by Helping Children Worldwide. Together for Global Health isa global coalition of individuals and organizations dedicated to promotingsustainable health care and wellness in low-resource communities to ensure thepeople we serve can receive care regardless of ability to pay. Our mission is tobring together diverse health-focused organizations and individuals that share aspirit of collaboration and empowerment, to support and partner with lowresource communities globally. We hope youenjoyed this report.THANK YOU!If you’re passionate about strengthening healthsystems and expanding access to quality care, weinvite you to connect with our network. While thisreport focuses on maternal and child health training,our work goes far beyond that—the network isdesigned to amplify the individual and collectiveimpact of community-based partners throughinformation and resource sharing, joint advocacy anddirect capacity-building support to help ensuresustainability. Our goal is to support and grow thecadre of these organizations, to eventuallysaturate the globe with models of compassionatecare that eliminate preventable deaths andprovide access to care to everyone everywhere. Ifyou or your organization are interested incollaborating, please reach out.For organizations dedicated to maternal and childhealth, we hope this report serves as both aninspiration and a practical guide for developingand strengthening healthcare provider trainingprograms. Investing in capacity-building is a key steptoward improving health outcomes, and weencourage you to adapt and implement thesestrategies in your own initiatives. Additionally, weinvite you to explore last year’s training report, whichcontains further insights and valuable lessonslearned from our past efforts. Together, we can continue to enhance theimpact of global health initiatives!

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When Baby Blues TurnsDeadly: Maternal MentalHealth, Breaking the Silence& Sharing PreventionMatron Mary AugustaFullah, Chief Nursing andMidwifery Officer forSierra LeoneDr. Abdulai Jawo BahTune in to our podcast, where you'll hear directlyfrom the dedicated individuals driving this vitalwork. From stories of frontline healthcare workers toresearchers and ministry leaders, their voices offerunique perspectives and insights into thechallenges and triumphs of improving maternalhealth outcomes. Scan the QR Codeto access ourpodcast website:We also are available onthe following platforms:Don't forget tolike, subscribe,and share!24Dive Deeper into the StoriesBehind our Maternal and ChildHealth MissionEmpowering Midwives: TheKey to Saving Lives

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25Appendix AFURTHER RESEARCH ON MENTAL HEALTH BY ABDULAI JAWOBAHAger, A., Horn, R., Bah, A., Wurie, H., & Samai, M. (2025). Policy and practiceimplications of contextual understanding of—And tools to address—Mental healthand psychosocial support needs in Sierra Leone. Frontiers in Psychiatry, 16.https://doi.org/10.3389/fpsyt.2025.1419448Bah, A. J., James, P. B., Bah, N., Sesay, A. B., Sevalie, S., & Kanu, J. S. (2020). Prevalenceof anxiety, depression and post-traumatic stress disorder among Ebola survivors innorthern Sierra Leone: A cross-sectional study. BMC Public Health, 20(1), 1391.https://doi.org/10.1186/s12889-020-09507-6Bah, A. J., Wurie, H. R., Samai, M., Horn, R., & Ager, A. (2025a). Developing andvalidating the Sierra Leone perinatal psychological distress scale through an emic-etic approach. Journal of Affective Disorders Reports, 19, 100852.https://doi.org/10.1016/j.jadr.2024.100852Bah, A. J., Wurie, H. R., Samai, M., Horn, R., & Ager, A. (2025b). Feasibility, acceptabilityand preliminary effectiveness of a culturally adapted nonspecialist delivery Problem-Solving Therapy: Friendship Bench Intervention for perinatal psychological distress inSierra Leone. Cambridge Prisms: Global Mental Health, 12, e16.https://doi.org/10.1017/gmh.2025.6Bah, A. J., Wurie, H. R., Samai, M., Horn, R., & Ager, A. (2025c). The cultural adaptation ofthe Friendship Bench Intervention to address perinatal psychological distress inSierra Leone: An application of the ADAPT-ITT framework and the Ecological ValidityModel. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1441936Harris, D., Endale, T., Lind, U. H., Sevalie, S., Bah, A. J., Jalloh, A., & Baingana, F. (2020).Mental health in Sierra Leone. BJPsych International, 17(1), 14–16.https://doi.org/10.1192/bji.2019.17James, P. B., Osborne, A., Bah, F. S., Bah, A. J., Kangbai, J. B., & Yendewa, G. A. (2025).Psychological distress and coping mechanisms due to the COVID-19 pandemicamong the adult population in Bo Sierra Leone. A cross-sectional study. PLOS MentalHealth, 2(2), e0000177. https://doi.org/10.1371/journal.pmen.0000177(PDF) Pathways to mental health services across local health systems in Sub-SaharanAfrica: Findings from a Systematic Review. (2024, December 9). ResearchGate.https://doi.org/10.1101/2024.01.11.24301103Williams, S. A., Baldeh, M., Bah, A. J., Robinson, D. R., & Adeniyi, Y. C. (2024). Pathwaysto mental health services across local health systems in sub-Saharan Africa: Findingsfrom a Systematic Review (p. 2024.01.11.24301103). medRxiv.https://doi.org/10.1101/2024.01.11.24301103

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26Appendix BAlfaro-LeFevre, R. (2013). Critical Thinking, Clinical Reasoning, & ClinicalJudgment. St. Louis: Saunders.Benner, P. (2015). Curricular and Pedagogical Implications for theCarnegie Study, Educating Nurses: A Call for Radical Transformation.Asian nursing research, 9(1), 1-6. doi:10.1016/j.anr.2015.02.001Benner, P. (1983). From novice to expert: Excellence and power in clinicalnursing practice. Menlo Park: Addison-Wesley, pp. 13-34Jeffries, P. R. (2022). The NLN Jeffries Simulation Theory. Philadelphia:Wolters Kluwer.Karsten, M. & Baggot, D. (2010). Professional Coaching as an effectivestrategy to retaining frontline managers. Journal of NursingAdministration. 40 (3). p.140-144.Power, A., & Wilson, A. (2019). Mentor, coach, teacher, role model: what'sin a name? British Journal of Midwifery, 27(3), 184-187.doi:10.12968/bjom.2019.27.3.184Rudolph, J. W., Simon, R., Rivard, P., Dufresne, R. L., & Raemer, D. B.(2007). Debriefing with good judgment: combining rigorous feedbackwith genuine inquiry. Anesthesiology clinics, 25(2), 361–376.https://doi.org/10.1016/j.anclin.2007.03.007Szyld, D., & Rudolph, J. W. (2013). Debriefing with Good Judgment. In A. I.Levine, S. DeMaria, A. D. Schwartz, & A. J. Sim (Eds.), The ComprehensiveTextbook of Healthcare Simulation (pp. 85-93). New York, NY: SpringerNew York.RESOURCES FOR PREPARING TRAINERS OF ADULT LEARNERS INCLINICAL EDUCATION

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