our work

TMF AREA OF FOCUS

Transportation and Referral System (The "Second Delay"). While we have strong outreach and in-facility care, a common point of failure for rural maternal health is the inability to transport a woman with a complication to a higher-level facility (hospital) in time. Commonly known as the "Second Delay." Areas to Strengthen:

● Emergency Transport Network: Our current programs help women deliver in our clinics, but we must solidify a 24/7 emergency referral system (transportation) to move women with complications (e.g., severe bleeding, eclampsia, obstructed labor) from clinics to the regional hospital. ○ Action: Formalize a clear protocol with dedicated, pre-paid emergency transport (e.g., motorbike ambulance, vehicle service) and a dedicated fund for referrals until we can purchase our own.

Retention of Skilled Staff and Local Management. We train staff and provide supplies, but the Human Resources for Health (HRH) challenge in rural Sierra Leone is chronic: staff are often underpaid or not paid at all, lack staff housing, and many of them lack passion. This undermines program sustainability. Areas to Strengthen:

● Incentives and Retention: We need to move beyond general training to implement a robust, long-term staff retention package for key personnel (midwives, nurses) in our rural clinics. ○ Action: Provide non-financial incentives like staff quarters, performance bonuses tied to quality metrics, and opportunities for advanced training/mentorship.

● Supervisory and Mentorship Cadres: Ensure the quality of training translates into sustained clinical competency. ○ Action: Establish a dedicated, frequent, and structured mentorship and clinical supervision model for our clinic staff. This ensures the skills from the Point-of-Care Ultrasound and other training remain sharp.

● Local Management Transition: After five years on the ground, local ownership must be more formalized. ○ Action: Develop an exit or transition plan by training local community or District Health Management Team (DHMT) representatives in operational management, budgeting, and supply chain oversight to take over certain programmatic elements (e.g., clinic feeding program management) in the next five years.

Postnatal Care and Integrated Psychosocial Support. Our programs have a strong focus on ANC and delivery, but the period after delivery is a significant risk for both mother and infant. Furthermore, our current programs do not yet address the pervasive issue of Maternal Mental Health. Areas to Strengthen:

● Robust Postnatal Care (PNC) Linkage: Maternal deaths often occur in the immediate postpartum period, and infant complications can be missed. ○ Action: Strengthen the follow-up system for PNC visits, especially home visits by Community Health Workers, to monitor for complications (e.g., postpartum hemorrhage, infection) and ensure infant feeding/wellness. ● Psychosocial Integration (Future Initiative): Introduce our planned maternal mental health service as a pilot program. Addressing mental distress will enhance all other programs by improving adherence to ANC education, facility delivery, and feeding protocols. ○ Action: Pilot the Integrated Perinatal Mental Health Screening and a community-based support program (as previously discussed) to improve the mother's overall "quality of life" (Mission).

● Data Quality and Utilization: We have many excellent programs, but we must ensure we are consistently capturing and using data to prove their impact on the final Maternal Mortality Rate (MMR). ○ Action: Establish a robust Monitoring and Evaluation (M&E) system that goes beyond output (e.g., # of birthing buckets distributed) to outcome (e.g., reduction in Postpartum Hemorrhage rates or ANC attendance vs. delivery complication rates).

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