Women Building for Women: Breaking Gender Barriers and Building Health Equity

The future Maternal Center of Excellence will break barriers for what is possible for women’s health care in Sierra Leone, and the women leading the facility’s construction are breaking barriers of their own.

Hawa Baryoh (left), Florence Saffea (center), and Jenneh Abu (right) are just 3 of the women who make up the BHI MCOE construction team. As of November 1st, 2022, the MCOE construction team has equal numbers of male and female staff.

On August 1, 2022, Florence Saffea was hired as the Tool Depot Manager on the Maternal Center of Excellence construction project and became the first woman to join the MCOE construction team. Managing a tool depot, and working on a construction site, was not something Florence had ever done. Still, she was excited to begin her construction career on a high-impact and highly anticipated project in the Kono community. The MCOE is a public-private partnership between Partners in Health and the Government of Sierra Leone to expand the Koidu Government Hospital in the Kono District. Build Health International designed the state-of-the-art facility and is now leading the multi-year construction project. In Sierra Leone, 1 in 20 mothers will die prematurely from pregnancy-related causes, and 10% of children will die before their 5th birthday. The new 166-bed maternal teaching hospital will address these inequities head-on by doubling maternal and newborn healthcare coverage in the region and beyond.

Throughout her first few weeks on the BHI team, Florence hit the ground running, dedicating herself to working with vendors and tracking all the essential equipment used on the project. Beyond her day-to-day responsibilities, Florence also felt a unique responsibility as the first woman on the construction team, an uncommon field for women in Sierra Leone. In turn, Florence quickly sought out additional capable, driven women to join the team. “I have understood that it’s not only men that can do construction work”, Florence shared, “but we, as women, can also stand up for our rights and do this type of work that is considered to be for men only in Sierra Leone.”

Tool Depot Manager, Florence Saffea poses with a tool list and photos to familiarize herself with all the names and functions of the tools in the MCOE equipment storage room. As part of her role, Florence is responsible for taking inventory and working with vendors to source equipment.

With this commitment in mind, within one month of starting her position, Florence recruited Hawa Bayoh as the Tool and Machinery Coordinator and Jenneh Abu as the Depot Assistant / Safety and First Aid Coordinator. In the short time since joining the MCOE team, Florence, Hawa, and Jenneh already feel that their work has been instrumental in their personal and professional development. “From day one that I started working here, I feel so proud of myself,” shared Jenneh. “I have learned so much about construction, tools, safety, and teamwork.” Hawa echoed this sentiment, adding, “[this job] has also given me a focus — it has proved to myself that I have value and I can do things I never thought possible.”

Beyond supporting their own professional growth and confidence, involvement in the MCOE construction has also allowed these women to become more economically independent and provide for their families. Florence, Jenneh, and Hawa each come from challenging backgrounds, and the money they have earned from working on the MCOE project has already made a meaningful difference in their livelihoods. Previously, Florence held a job as a security guard, but the salary was barely enough to get by, as the majority of her salary went towards transportation to and from work.

Construction staff work together to position rebar columns at the MCOE construction site.

For Florence, her new job on the MCOE team means independence and freedom. “Now that as a woman I earn my own money, I will not allow any man to use or abuse me,” shares Florence. “I have a second chance to be free, educate myself, and support my family and my son. I don’t depend on someone else’s salary anymore. I depend on what I am able to earn and provide for myself and my family.”

With a strengthened sense of financial independence, Florence views her job as a way to give back to those around her. She shares, “I take a percent of my salary every month and give it to my family and friends. The Krios (creole) have this saying, ‘Nor forget usai you brok yu fut’ (don’t forget where you broke your foot), meaning, don’t forget where you came from and the people that supported you along the way.”

Like Florence, working on the MCOE also allows Jenneh the opportunity to independently support herself and others, something that she never thought possible before this job. As the oldest daughter in her family, when Jenneh’s mother died in 2017, much of the economic burden of the household also fell on her shoulders. With several younger siblings, her father was no longer able to support her, as he needed to feed her younger brothers and sisters. With her new career in construction, Jenneh is now able to both meet her basic needs and contribute to her family’s needs as well.

Hawa (pictured above preparing a Q.C. report) measures rebar at the MCOE Construction site. MCOE Site Supervisor John Chew shares, “I noticed right away that Hawa had a knack for learning and using tools. She is a very fast learner and masters things very quickly. She has learned a basic knowledge of reading the drawings, and she is my right-hand person that helps with all the layout and quality control reports of the buildings.”

In addition to financial security, the roles on the BHI construction team also have provided these women with a newfound sense of social support and independence. As Florence shares, “My community used to look down on me; they did not think I was someone with the capacity to grow and earn a living independently. But as of now, anywhere I go in my community, everyone takes notice of me.” This sense of community and familial pride is also reflected in Jenneh’s experience, as she shares, “People condemn and judge you really quick…and that’s so harsh and hard to deal with. My whole family thought of me as a failure. But look how things have turned around.”

Florence (right) trains Jenneh (left) and Hawa (center) on how to fill out the pre and post-checklist for the site generator. Hawa reflects, “The managers that we have really take their time to teach us well. Especially Florence, she teaches us everything about her role too. I am happy about that because I didn’t come here to sit around. Florence ensures that everything that she knows she passes it down to us, so the day she is not around the work can continue as normal.”

Because of the personal and financial freedom that the MCOE project has brought them, Jenneh and Hawa also feel compelled to help other women enter the construction field, as Florence had helped them. Jenneh expressed that in Sierra Leone it can be daunting to apply for a construction job, as construction is traditionally a male profession, but she wants women to know that there is a place for them in this field. “I was so doubtful as a woman about how to apply for a job”, shared Jenneh. “I saw that some jobs were around, but I did not know how, as a woman, we can find the courage to apply for them.” Luckily, through the support and encouragement of Florence, Hawa and Jenneh were able to overcome self-doubt and societal norms by joining the MCOE team. “Florence fought and vouched for me, and she has helped me greatly,” shared Hawa, “so I also need to try my best to help my fellow women.” Since the three women were initially hired, the MCOE construction team has grown to around 20–25 weekly women strong and counting.

Some of the women working on the MCOE project gather at the construction site. These women represent some of the 25 women who have been hired for the project to date.

John Chew, Build Health International’s Site Supervisor who manages the day-to-day operations of the MCOE, has been amazed by the strong and ever-growing female construction team. Having worked in construction for over 35 years, John shares, “In all my years of working in construction around the world including the US, I have never seen so many women interested in working in construction. Not only interested but who are doing a great job. Not only doing labor work, but mastering the operation of the small equipment, such as compactors, concrete vibrators, and concrete mixers … and in many cases out-working the men.”

Isatu Jalloh, who has been hired to assist in the tool depot, conducts one of MCOE’s routine Monday and Thursday morning safety and pre-work meetings.

Once it opens, the Maternal Center of Excellence will continue to have transformative impacts on women, children, and families across the region, as the hospital will lead to a 121% increase in facility-based deliveries and a 400% increase in family planning visits. These clinical results will be enabled through several intentional design elements, including a large-scale oxygen plant, blood bank, 50-bed staff housing unit, a maternal critical care unit (ICU), a neonatal intensive care unit (NICU), and surgical suites.

Just as the construction of the MCOE is providing technical workforce development in the community, once opened the MCOE will also help develop the next generation of local clinicians. As an accredited national teaching hospital, the MCOE will serve as an epicenter for providing high-quality medical education across Sierra Leone and within the West African College of Physicians, and the Economic Community of West African States (ECOWAS).

As the Maternal Center of Excellence will be a revolutionary hospital that will expand access to dignified, affordable, and accessible women’s healthcare in Sierra Leone, it is only fitting that a strong team of local women is leading the construction of the facility. “We are immensely proud to be building this hospital for our people,” remarks Florence. “I know that most women in our communities will be blessed to give birth here.”

Male and female construction workers line up to pass concrete blocks. John Chew shares, “Due to the fact that the women work as hard and sometimes harder than the men, they have earned the respect of the men, and they all have joined forces to work together as a team. It is nice to see the men encouraging the women as they join forces to get the job done every day.”

Construction of the Maternal Center of Excellence has only just begun, but it is already having a rippling positive impact on the women of Kono, Sierra Leone. John reflects, “As the old saying goes, give a woman a job, and she will feed her kids, family, and community. It has truly been a blessing to have the opportunity to work with all the women on the MCOE job site. It is encouraging to see their growth week after week. This has been a decision I will never regret, and I know it will have a life-changing impact on these women and their families and communities.”

After hearing about employment opportunities, women from the community of Kono line up at the construction site at the beginning of the day, seeking work.

Olivia Duggan is a Global Health Consultant at BHI and a Global Health Master's student at University College London (UCL). She writes about the intersections of health and infrastructure, with a focus on the impact of BHI’s work on health systems in resource-poor settings.

Carlos Velázquez is a Global Health practitioner based in Sierra Leone, where he works as a program specialist for the social justice NGO Partner in Health. He writes about Sexual and Reproductive Health, Gender Equality, and Youth Participation in development.