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Sia Sandi, Student midwife from The School of Midwifery in Masuba, Makeni on placement at Makeni Regional Hospital, Bombali District, Sierra Leone. Photo: Abbie Trayler-Smith

Sia Sandi, Student midwife from The School of Midwifery in Masuba, Makeni on placement at Makeni Regional Hospital, Bombali District, Sierra Leone. Photo: Abbie Trayler-Smith


Agents of change: The road to lasting impact through community-led activism in Sierra Leone

Ten years on from its programme start on Sierra Leone, local activists are still building on the E4A approach to improve maternal and newborn health.

24 May 2024
Alice Tilton Christianne Williamson

Steven Abdulai Gibrilla, a former Evidence for Action (E4A)- MamaYe Lead Activist for Koinadugu District, Sierra Leone from 2013 to 2016, has successfully sustained a district-based community activist group under the E4A MamaYe name and logo since the programme ended. Steven’s story shows that programmes can create a lasting impact beyond their existence when they equip a community with the tools to drive change.

It’s June 2015. Steven Abdulai Gibrilla stands outside the district health facility in Koinadugu District, Sierra Leone, facing a large crowd. Steven has just read out the result of the community scorecard, and the crowd is cheering with pride. The scorecard shows that their local hospital is ranked best in the region, a radical turn around after years of neglect and low investment. He is elated at the success of the group’s advocacy efforts as he knows what a tangible difference this will make to saving the lives of mothers and babies in the district.

The crowd that has gathered is an eclectic representation from across the community: health workers, pastors, Imams, traditional birth attendants, market traders and youth. These are the ones that Steven has worked tirelessly to engage and mobilise for years through outreach at all levels of the community – raising awareness of maternal and newborn health and the changes needed to avoid death, and encouraging the community to be the ones that demand changes according to their own needs and perspectives.

Steven was the Lead Activist for Evidence for Action (E4A) – MamaYe, an Options’ programme that ran in Sierra Leone from 2011 to 2017 and that aimed at improving maternal and newborn survival. It brought together government, civil society and health practitioners to identify why women and babies were dying of preventable causes and used this information to inform evidence-based advocacy campaigns and hold decision-makers to account, and ultimately improve emergency obstetric and newborn care (EmONC).

Before joining E4A – MamaYe, Steven was a Blood Donor Promoter in Koinadugu district and well-known for his incessant campaigning. “Our aim was to save the lives of mothers and babies by encouraging people to come to the lab hospital to donate blood,” he remembers. With postpartum haemorrhage as the leading cause of maternal death, he established the “Blood Donor Promoters Club”, which engaged normal people in public spaces to talk about voluntary donation. “I have loved coordinating and organising, ever since childhood. [MamaYe] was perfect for me.” Sowo Tucker, who was appointed to build the E4A MamaYe activist team, agreed with Stephen and quickly identified him as an E4A Lead Activist in Koinadugu: “People trusted him already”.

This community trust and respect across the district were two vital elements to the success of E4A – MamaYe. Stephen was able to work closely with communities to raise awareness and advocate to District Health Management Teams (DHMTs) for improved maternal and newborn health services.

“One of the main tools E4A used was a simple scorecard which communities could easily use to assess the level of care provided by their health services,” Sowo explains. “This was a breakthrough in our communities, creating the space to allow different levels of people to come together and discuss why women were dying and what was needed to change this. Information is power – people might know that this is important, but they need more evidence to be able to talk about issues. That’s what E4A-MamaYe did.”

Stephen represented this evidence-based and community-driven approach: “I was recognised around the community. People called out “MamaYe” when they saw me, they knew what I stood for!”

In 2016, just before the programme was to close, Steven put his hand up to continue this important work. “The idea came to me of transforming E4A MamaYe into a community advocacy network, building on all the trust and influence we had built over the life of the programme.” Steven asked for E4A tools, materials, communications plans, any equipment the programme could leave behind – and for permission to continue using the logo.

And that’s how Steven founded the E4A MamaYe Community Advocacy Group (MCAG). “I brought together 18 community based organisations to form a group and create a constitution. We agreed that we wouldn’t change the E4A MamaYe logo. The community had accepted the idea and it was so well known throughout. We wanted to remain visible and build on this good faith. This was too good to give up.”

In the years since, the network has continued working with different partners, deploying activists to engage the community on a range of issues such as election peace, taxation, women’s food security, adolescent health and well-being, as well as consistently on gender violence and maternal and newborn health. “We came to the fore again during the COVID pandemic, bringing vital health emergency messages to the communities we know so well,” Steven is quick to mention.

He has continued with his advocacy work because he is passionate to empower his community to bring about the change it needs. “Whatever the issue, we use the methods and tools we learnt through E4A MamaYe to equip the community with information, evidence and knowledge to hold authorities and leaders to account, and to change their own behaviours.”

As Sowo notes, “When you empower a community and identify the right person that will sustain the activities, the information will get to the right people, and this will last beyond the life of any programme.” The strength of the activist model helped Steven to secure an INGO grant for three years, focused on supporting adolescent girls to stay at school.

In 2024, he plans to launch an E4A MamaYe community radio station as a new tool for awareness raising and advocacy. He sees it as the natural next step to inform and empower his community, and hopes it will encourage young people to commit to their country and community. “I say to young people to focus on the community themselves. Play your own part – it is essential – change cannot happen without you.”

This is how, ten years on from its introduction in Sierra Leone, it’s still the E4A MamaYe approach helping to improve maternal and newborn health outcomes. “MamaYe never ends in Sierra Leone,” he adds with a smile.

Sierra Leone
Bill and Melinda Gates Foundation
Focus areas
Maternal and Newborn Health

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