PURPOSE:
Koidu Government Hospital (KGH) in Sierra Leone faces persistently high maternal and neonatal mortality due to systemic challenges, including limited staffing, inadequate training, and low community engagement. In 2021, the hospital recorded 27 maternal and 28 neonatal deaths, followed by 23 maternal and 25 neonatal deaths in 2022, highlighting the urgent need for transformative action.

DISCUSSION:
In 2023, KGH launched a midwifery-led quality improvement (QI) initiative to strengthen Emergency Obstetric and Newborn Care (EmONC) services and increase community participation. Key interventions included: • Quarterly hands-on EmONC training workshops for 36 maternity staff. • Six community forums that reached over 1,200 individuals to promote recognition of pregnancy danger signs and encourage facility-based deliveries. • Five focus group discussions with pregnant women, adolescent girls, male partners, and traditional birth attendants to adapt services to cultural needs. • Implementation of evidence-based care pathways. • Continuous monitoring of indicators and proactive stakeholder collaboration to ensure sustainability.

EVIDENCE WHERE RELEVANT:
Within one year, maternal deaths at KGH decreased by 59% (from 23 to 11), and neonatal deaths by 12% (from 25 to 22). The proportion of EmONC-trained maternity staff increased from 52% to 90%, while active community engagement rose from 27 to 80 members. Health workers reported improved confidence and skills, and communities demonstrated greater involvement in maternal health decisions.

KEY MESSAGE:
Engaging health workers and communities through a participatory, systems-based approach is crucial for achieving sustainable improvements. We can drive meaningful and lasting change by combining clinical capacity building with community mobilization, bolstered by mentorship, regular feedback, and multi-sector collaboration. Continuous evaluation is vital for adapting, refining, and scaling successful interventions Quality improvement