Recognizing the critical importance of placing communities at the center of MNCH service delivery, this project was conceived with experiences from pilot interventions from Tanzania and Indonesia. Community-driven approaches are often used to encourage citizen involvement in improving public health; however, evidence of impact of such approaches is mixed and incomplete. The T4D project therefore was initiated in order to meet this knowledge gap, testing whether community-led transparency and accountability can improve health in multiple countries – and when and how improvements occur.

Many of the persistent problems in maternal and newborn health occur at the local level, and many have touted the potential of community-led approaches such as community scorecards and social audits to overcome many of these health system breakdowns.

As a matter of fact, Sierra Leone has made significant progress in promoting human development since the end of its 11-year civil war; however, the country is still striving to improve health care delivery. Confronted with maternal and under-five mortality rates among the highest in the world, the Government has made significant investments in the health sector but much remains to be visible to sustain improved health outcomes. The country’s health system even before the Ebola outbreak was weak; the EVD only weakened and exposed the already fragile health system that existed.

Download T4D Final Intervention Report