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After making several exploratory missions to assess the setting and establishing initial contacts with the local authorities, in 2011 Doctors with Africa Cuamm started an intervention in Sierra Leone, a small country in West Africa, caught in the grip of a civil war between 1991 and 2002 and currently one of the poorest countries on the planet.

With the support and agreement of the Ministry of Health of Sierra Leone, Doctors with Africa Cuamm decided to intervene in the district of Pujehun with its population of approximately 250.000 inhabitants. This district is located in the south, on the border with Liberia, in one of the areas furthest away from the capital, Freetown. Dirt roads, which are even more difficult to drive over during the abundant rain season, hinder access to the only hospital facility in the city of Pujehun, in the centre of the District. There are only 2 doctors in the area, one of whom works in the hospital, 1 qualified midwife who is actually actively working and 4 qualified nurses. In these conditions, women do not have access to antenatal care and only 6% of child deliveries are suitably assisted.

Doctors with Africa Cuamm plans to implement a project over the next 3 years to strengthen the hospital and district health system, improving in particular access to quality health services for mothers and children.

The main project activities are as follows:

1) at the hospital level:

> support for the Maternity and Paediatrics wards and for overall hospital management, with infrastructure improvements to the old facility;

> reinstatement of the existing operating room and building of housing for local staff;

> local staff training.

2) at the district level:

> technical assistance for the District Health Official and his team in planning district healthcare activities;

> support for the referral system, i.e. transportation of urgent cases to the hospital's peripheral health units;

> training of peripheral health unit staff with liaison between the country's Medicine and Midwifery schools;

> supervision of physical and functional reinstatement of 5 health units that will become assisted delivery centres, as envisaged by the national health plan;

> strengthening of the health information system;

> informing and educating the communities on good preventive and treatment practices relating to the health of children and pregnant women;

> support for the development of a community to cover the cost of transport of pregnant women to hospital in the future.