Building Care with Space: The 5 S’s of the MCOE

Editor's Note: The Paul E. Farmer Maternal Center of Excellence (MCOE), a Partners In Health (PIH)-supported facility, opened to patients in February 2026 on the campus of Koidu Government Hospital (KGH) in Kono District, Sierra Leone.

Built in partnership with Build Health International and the Sierra Leone Ministry of Health, the state-of-the-art facility was designed to confront one of the most urgent challenges in Sierra Leone: preventable maternal death. It represents years of deliberate work to strengthen care where it has long been weakest, part of a two-decade effort across Sierra Leone that has reduced the country's maternal mortality rate by 78% since 2000.

This series explores the MCOE through what PIH calls the "five S's": staff, stuff, space, systems, and social support, the essential elements of a strong health care system. In this article, we focus on space: the physical environment where care takes place, and how it shapes what providers can do and what patients experience.

More than 30 years ago, Dr. Paul Farmer and co-founders started PIH in a single clinic in rural Haiti.

From there, PIH expanded across Haiti, then to Peru, across Africa, and to the Navajo Nation-supporting more than 270 facilities globally. Throughout, patients have remained at the center of PIH's work.

In some communities, spaces for patients already existed, but in most cases, facilities needed to be renovated or built from the ground up, like the MCOE in Sierra Leone.

"Paul used to say you can deliver bad care in good facilities, but you cannot deliver good care in bad ones," says Jonathan Lascher, former executive director of PIH Sierra Leone from 2017 to 2021. "Zanmi Lasante's [PIH's sister organization in Haiti] strategy lifted care for everyone. Our Haitian colleagues called this approach their chwal batay or their 'battle horse.' The MCOE is PIH Sierra Leone's chwal batay."

The MCOE in Kono District, Sierra Leone on May 5, 2026. Photo by Sean Andrew Bangura / PIH

The MCOE was built because the former maternity ward at PIH-supported KGH had, for years, proven Farmer's point and limited the care that clinicians were trained to give.

"The maternity ward, which was built with donor funds that had long since dried up, had never been equipped to serve Kono District," says Lascher. "The structure was crumbling. It was a ward designed for scarcity."

The inadequate space shaped the care clinicians could provide. Overcrowded rooms and aging infrastructure made it difficult to manage the growing number of patients arriving at the hospital. KGH's maternity ward and special care baby unit had just 48 beds.

This meant that women in labor, women recovering with their babies, and patients arriving with other emergencies were often managed within the same rooms. And for many families traveling long distances, there was little room not only for care, but for staying close by during it.

Designing the MCOE for Women, by Women

Dr. Moses Mugisha, obstetrician and gynecologist for PIH Sierra Leone, talks with Finda Boyah, 26, ahead of her cesarean section in the operating theater at the MCOE on Feb. 15, 2026. Boyah arrived at the MCOE on Feb. 15 from the maternal waiting home at PIH-supported Wellbody Clinic for a cesarean section. Boyah delivered twin baby girls-the first twins born at the MCOE. Photo by Caitlin Kleiboer / PIH

In a setting affected by resource constraints and histories of exploitation, a patient's experience of care within a hospital impacts not only health outcomes, but trust.

PIH and the Sierra Leone Ministry of Health broke ground on the MCOE in April 2021. From a floor plan mapped around a patient's journey to landscaped outdoor spaces that foster comfort and safety for patients and their families, it sets a new bar for maternal and neonatal care in Sierra Leone.

What's more, before it could become a place for women to receive care, it was a place built by them. Diana "Success" Komba, a construction worker who helped build the MCOE, says the project carried enormous significance for the women involved.

"When we first heard about the Maternal Center of Excellence, many of us wondered: would this really be for us? Would it reflect our hopes, our needs, our pride?" says Komba. "Today, I can say with full heart: yes, it does."

At the peak of construction, women made up 65% of the workforce and were trained on-site as laborers, quality assurance managers, and construction supervisors. Most had never worked in construction before, and as the building took form, so did a sense of ownership and pride.

"Many of us want to come and have our babies here in the future," Komba says. "Every wall, every corridor, every detail in the MCOE carries that legacy. To give birth in a place we built with our bodies and our hearts is incredible to think about."

Inside the MCOE: Design as Dignity

Composed of four buildings, the MCOE has three operating theaters and the first and only neonatal intensive care unit (NICU) in Sierra Leone. It is also the first facility outside Freetown to deliver piped oxygen and medical gas directly to patient beds. Outpatient services are located near the entrance, while the birthing center sits within its own cluster, all with heating, ventilation, and air conditioning systems for infection control and comfort.

The facility expands KGH's 48 beds to 120 beds, including 39 in the NICU. From the triage area to the birthing center and in-patient wards, it replaces the constraints of KGH's ward with a radically larger and more sophisticated physical environment capable of supporting modern maternal and newborn care.

Phebian Baningo, 19, holds her newborn daughter, Grace, in the NICU at the MCOE on Feb. 17, 2026. Photo by Caitlin Kleiboer / PIH

The layout is organized around medical urgency-including the severity and complexity of a case-and "clarity of circulation," meaning a seamless and efficient flow of people through the facility.

A dedicated triage area gives clinicians space to assess women before directing them onward; the old maternity ward had no such separation.

Every design choice prioritizes privacy. In the birthing center, half-height walls and closable curtains offer separation, while each ward includes an isolation room with its own toilet and dual access-a lesson shaped in part by Sierra Leone's Ebola epidemic in 2014.

Large, open-air covered waiting areas allow families to gather comfortably while maintaining a clear view of check-in stations. And critical infrastructure-including clean water systems, upgraded laundry and waste management, backup generators, and voltage regulators-support safe and uninterrupted care.

The Mother's Dormitory and NICU Proximity

For families of critically ill newborns, the design goes further.

Because many women travel long distances to reach KGH, and babies may remain in intensive care for weeks or sometimes months, the MCOE includes a dormitory for mothers with babies in the NICU.

For patients like 19-year-old Phebian Baningo, that distance couldn't be closer. After a complicated and unplanned at-home birth in Feb. 2026, Baningo arrived at the MCOE, where she stayed in the mother's dormitory while her baby Grace was admitted to the NICU.

Phebian Baningo, 19, holds her newborn daughter, Grace, in the NICU at the MCOE on Feb. 17, 2026. Photo by Caitlin Kleiboer / PIH

The dormitory has 17 beds and a communal kitchen, allowing women like Baningo to stay close to their infants without daily travel or sleeping in public areas. When she first saw the space, she thought, "It looked like America."

Every day while her baby received care, Baningo walked between the dormitory and the NICU, spending time at her daughter's bedside. That proximity allowed her to remain present during a critical period in her baby's life.

Anyone entering the NICU passes staff who enforce strict hygiene measures. The unit has two neighboring rooms-one for babies born at the MCOE and another for babies born at another facility or at home. This was a deliberate design choice to reduce infection risk.

Light, Air, Beauty

The plants and trees throughout the courtyards at the MCOE were donated by community members and nurtured in a nursery on the MCOE campus before being transplanted. These outdoor areas provide a peaceful environment for patients, families, and staff to gather, rest, and learn-reflecting the center's design philosophy that healing happens both inside and outside clinical walls. Photo by Caitlin Kleiboer / PIH

Just as the buildings were organized to support clinical care, nature was intentionally integrated throughout the facility as well.

Natural ventilation, daylight, and views of greenery were prioritized. In the in-patient wards, the design team oriented buildings around a central courtyard, with views directed toward green space. Many of the foliage and trees planted in the outdoor spaces were donated by community members.

Farmer always believed that beautiful spaces should exist alongside medical excellence. An avid gardener, he felt that such spaces could provide solace and help people heal, which is why he often incorporated gardens into PIH clinics around the world-and the MCOE was no exception. Farmer was deeply involved in planning the facility before his unexpected passing in February 2022.

Walking through the finished facility today, Komba observes so much more than a hospital.

"I see beauty. I see care in every detail," she says. "And I know that when a mother walks in, she will feel that too. She will know that she matters."