Building Care with Staff: 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 staff: the full range of people who keep the facility running safely and effectively-from nurses and midwives to technicians, cleaners, and support teams- and the skills, training, and support they need.

Francess Kamara, senior midwife mentor for PIH Sierra Leone. Photo by Sean Andrew Bangura / PIH

For Francess Kamara, a senior midwife mentor at the PIH-supported KGH, her work is deeply personal.

"My motivation in life and as a midwife has always been to help the most vulnerable people," Kamara says. "That is why I applied to work at Wellbody, before it became part of PIH. I knew the problems in maternal care were very serious in Kono."

Kamara began her career at Wellbody Clinic, a PIH-supported primary care facility in Kono District, where women often receive prenatal services before being transferred to the district's only referral hospital, KGH, for complicated pregnancies and obstetric emergencies.

Over time, the number of patients at Wellbody Clinic and KGH has grown rapidly, placing strain on an already stretched team of midwives.

"Because of the reputation of PIH, many more people were coming in for care," Kamara recalls. "Yet we were not even up to ten midwives initially."

When Staff are Stretched

As more patients arrived, more space and better-supported staff were needed to address the demand.

In 2017, this need culminated in early planning beginning for the MCOE-a state-of-the-art facility designed to dramatically expand services at KGH and set a new standard of maternal care for women in Sierra Leone.

"It had to be a center capable of providing the best care possible in [what used to be] one of the most dangerous places on earth to be a woman," says Jonathan Lascher, former executive director of PIH Sierra Leone from 2017 to 2021. "In a country [initially] with only 150 doctors, it also had to be a training center for Sierra Leonean clinicians."

When PIH first began working in West Africa, during the Ebola epidemic in 2014, finding staff was one of the immediate priorities. During that time, PIH trained and deployed 200 volunteer clinicians from the United States and hired 2,000 community health workers and support staff across Liberia and Sierra Leone.

Building Toward Bigger

Diana "Success" Komba takes measurements for rebar placement at the MCOE construction site on Oct. 28, 2024. Photo by Abubakarr Tappiah Sesay / PIH

Across PIH sites and clinics worldwide, hiring local staff is essential to what we do and the care we deliver. This is true across roles and departments, including the workforce hired to build the MCOE.

PIH and the Sierra Leone Ministry of Health broke ground on the MCOE in April 2021, and at the peak of construction, local women made up 65% of the MCOE construction workforce and were trained on-site as laborers, quality assurance managers, and construction supervisors.

Most women had never worked on a construction site or had a formal, steady job before.

"For many of us, this was the first time we saw a project like this led with respect. We are not just laborers; we are partners," says Diana "Success" Komba, a member of the MCOE construction team.

This investment not only created economic opportunities for families while the MCOE was being built but, critically, strengthened the pool of skilled workers across the district for years to come.

Training Staff to Lead Care

From second to left: Gladyse A. Kanu, Isata Bah, and Francess Kamara during an electronic medical record (EMR) training session for nurses, midwives, and doctors on July 30, 2025. The training placed a strong emphasis on the practical application of the EMR system in supporting the care delivery across the clinical work flow at the Maternal Center of Excellence. Photo by Sean Andrew Bangura / PIH

In the months leading up to the MCOE's opening, staff training ramped up, ensuring teams were fully prepared to deliver care at the new facility.

"The building is beautiful, the systems and equipment are first class, but none of that matters without the medical professionals to run it, just like when I began at Wellbody," says Kamara.

As one of the MCOE training facilitators, Kamara ensured staff trainings ran smoothly, topics were adequately covered, and most importantly, that staff felt confident and prepared ahead of welcoming patients.

That training was both formal and practical: before the move into the MCOE, staff were given time to practice operating equipment and become comfortable using it.

They were also supported through simulations, theoretical teaching with the use of written protocols, checklists, and visual aids, and scenario-based exercises, while senior midwife mentors helped train colleagues on the job.

Preparation Meets Reality

PIH Sierra Leone staff prepare for the first patients on the morning of Feb. 14, 2026 in the triage area of the MCOE. From left: Francess Kamara, senior midwife mentor for PIH Sierra Leone ; Sarah Meyer, emergency and critical care practice specialist for PIH; Cory McMahon, chief nursing officer for PIH; and Vicky Reed, executive director of PIH Sierra Leone, coordinate final protocols before the facility opened its doors. Photo by Caitlin Kleiboer / PIH

When the MCOE opened its doors to the first patients on Feb. 14, 2026, the facility welcomed 27 patients, with a total of 13 babies born in the first 24 hours. As of April 30, the MCOE has supported 2,871 women with care and helped deliver 901 babies.

Kamara is one of approximately 200 clinical staff working at the MCOE today-a steep increase since Kamara's early days at the facility, and a number that will grow as the facility continues its phased opening to ensure quality and efficiency.

Patients have come from every district in Sierra Leone to seek care at the new facility, as well as from neighboring countries.

When 35-year-old Fatmata Jalloh, a Kono District resident, arrived at the MCOE, she was 42 weeks pregnant and past her due date. The clinical team assessed her at triage and found that the protective fluid around the baby had become dangerously low, and an emergency C-section was needed. Jalloh was worried; she had hoped and planned to deliver her baby vaginally.

During this tense time, Kamara was on hand in the triage room to reassure Jalloh, standing by her bedside to carefully explain the care that the team would provide and the risks of inducing labor past her due date.

Later that day, Jalloh underwent a C-section in the operating theater, and she delivered a healthy baby boy.

Fatmata Jalloh holds her newborn daughter outside the postnatal ward of the MCOE on Feb. 17, 2026. Jalloh, a businesswoman who sells fruit, stayed at the maternal waiting home at PIH-supported Wellbody Clinic when her labor was flagged during a routine antenatal appointment on February 16. She was transported by ambulance to the MCOE's antenatal ward and delivered a healthy baby girl without complications. Photo by Sean Andrew Bangura / PIH

Training the Next Generation

To ensure the MCOE workforce continues to grow in the years to come, both in size and skillset, the creation of a dedicated training site and dormitory, a 10-minute drive from the MCOE, is underway. Equipped with lecture halls and simulation labs, it will provide a dynamic environment where clinicians can learn, grow, and thrive for decades to come.

For Kamara, this will be invaluable. To her, the most important legacy of the MCOE will be the people it helps train.

"The future of the MCOE looks bright to me," she says. "I already do a lot of mentoring, and I will continue to do that. Those mentees will then do their own mentoring. Each person passes their experience along to the next, and that builds a great future for everyone."