Systems strengthening for
MNCH & malaria elimination.
RFLD's strategic framework for radical reduction of the 1.78 million annual under-5 deaths in West and Central Africa. Combining implementation science and operational research with last-mile clinical capacity, supply-chain reinforcement, and rights-based community mobilisation across the eight highest-burden Francophone states.
Programmatic targets
West and Central Africa bears a disproportionate share.
The region carries a massively disproportionate burden of global maternal and child mortality. The figures below — published in UNICEF's 2025 West and Central Africa Snapshot — establish the crisis context for RFLD's strategic framework. They are not RFLD's own data. They are the regional baseline against which our 2028 targets are set.
SDG acceleration required
Progress must accelerate 8× for maternal and neonatal mortality, and 6× for under-5 mortality, to meet 2030 SDG 3.1 and 3.2 targets.
The conflict multiplier
Children born in fragile or conflict-affected countries in WCAR are 3 times more likely to die before age 5 than in non-fragile settings.
Burden concentration
Just three countries — Nigeria, DR Congo, and Chad — account for 74% of maternal deaths and 67% of under-five deaths in the region.
Where we work.
RFLD targets the highest-burden Francophone states identified in the UNICEF WCAR Snapshot 2025. Clinical scale-up, operational research, and security protocols are tailored to each country's specific fragility profile and mortality drivers. Conflict-affected countries receive low-profile logistics and adapted duty-of-care protocols; the operational hub in Benin pilots innovations before regional scale-up.
Niger
Records the highest neonatal (NMR), under-5 (U5MR), and 1–59 month mortality rates in the region. Also ranks extremely high for climate risk to maternal-health services.
- Sahel operational security protocols
- Decentralised WAFF Fund regranting
- DƆNÙESÈ offline tracking integration
DR Congo
Accounts for a massive share of the region's absolute deaths, ranking second overall for under-5 deaths, newborn deaths, and stillbirths in WCAR.
- EmONC facility readiness
- Supply chain reinforcement
- Malaria RDT/ACT last-mile delivery
Chad
Suffers from severe institutional fragility. Ranks third highest across the entire region for absolute maternal deaths, with extremely high stillbirth rates.
- Midwife clinical upskilling
- PPH and eclampsia simulation drills
- DHIS2 interoperability
Central African Republic
Remains in the top tier globally for maternal mortality ratio and stillbirth rates, due to prolonged conflict and degraded health-system infrastructure.
- Inpatient newborn care units (INCUs)
- Push EmONC kit deployment
- Scaling essential medicines
Mali
Faces compound threats from regional conflict and extreme climate risk, severely disrupting care-seeking behaviours for women and children, particularly in rural northern regions.
- Community women leaders engagement
- Low-profile clinical logistics
- Operational research on care delays (malaria)
Burkina Faso
Mass displacement and conflict have shattered health infrastructure, leading to critical spikes in malaria transmission and unassisted home births.
- Rapid emergency supply kits
- Seasonal Malaria Chemoprevention (SMC) support
- Staff safety and duty-of-care protocols
Cameroon
High absolute mortality rates and fragile delivery systems, particularly in regions affected by ongoing internal conflicts in the Anglophone North-West and South-West.
- Antenatal Corticosteroids (ACS) and MMS scaling
- Male health activist engagement
- Operational research on ITN utilisation
Benin
While more stable, Benin maintains a high MMR (over 400 per 100,000). Serves as the operational hub where RFLD pilots clinical innovations and quality-improvement protocols before regional scale-up.
- Ministry of Health policy alignment
- PDSA quality improvement audits
- Domestic resource advocacy
Core innovation priorities.
Six strategic levers, deployed in combination across the eight priority countries. Each addresses a documented gap in clinical capacity, supply chain integrity, community health-seeking behaviour, or evidence generation. None of these levers works in isolation — the framework's value is in their integration.
Operational & biomarker research
Implementation science, barrier mapping, and biomarker research to close critical knowledge gaps and localise globally-validated interventions to Francophone WCAR contexts. Three peer-reviewed OR papers targeted by 2028.
Evidence-based medicines
Scaling high-impact prophylactics, Antenatal Corticosteroids (ACS) for preterm birth, and Multiple Micronutrient Supplements (MMS) for pregnant women across our partner facility networks.
Clinical capacity · EmONC
High-fidelity simulation drills training 800+ frontline midwives on active management of postpartum haemorrhage (PPH), eclampsia, and neonatal resuscitation. Inpatient newborn care unit (INCU) commissioning in CAR.
Community systems
Deploying Male Health Activists and an Essential Newborn Care Corps (upskilled traditional birth attendants) directly into hard-to-reach last-mile villages, with referral pathways into RFLD-supported facilities.
Digital & AI diagnostics
AI-powered rapid diagnostic interpretation and predictive geospatial tracking of maternal and child mortality risk, integrated through RFLD's DƆNÙESÈ Data Center infrastructure with offline-first capability for fragile contexts.
Rapid financing · WAFF Fund
The WAFF Fund · Women's Activist Funding Facility sub-grants direct, unrestricted cash to 15+ grassroots feminist NGOs running localised maternal-health and malaria-prevention campaigns — bypassing bureaucracy to fuel agile, community-led delivery.
Holistic health integration.
Maternal and child mortality cannot be addressed in the delivery room alone. The framework integrates vaccination, nutrition, and water/sanitation/hygiene (WASH) interventions to close the prevention envelope around clinical care. Each pillar carries quantified targets aligned to Gavi, WHO, and UNICEF benchmarks for the region.
Strengthening the immunisation safety net
Strengthening immunisation coverage and prophylactic care to block preventable infectious pathways. Strict 2–8°C cold-chain monitoring across all RFLD-supported facilities, with offline temperature-log integration into DƆNÙESÈ.
Maternal & infant nutrition
Directly addressing malnutrition to reduce maternal morbidity (anaemia, eclampsia risk) and infant developmental stunting. Daily iron and folate supplementation for all pregnancies across RFLD-supported antenatal care services.
WASH & infection control
Upgrading essential hygiene infrastructure and protocols at health facilities to combat fatal hospital-acquired neonatal infections. Hand-hygiene compliance audits and water-point upgrades at all priority facilities.
Community education
& awareness.
Beyond clinical capacity, the framework invests heavily in community-level behavioural change. Mothers, caregivers, and male partners are trained to recognise the danger signs of obstetric and paediatric emergencies — fever, convulsions, prolonged labour, neonatal lethargy — and to seek immediate facility-based care. By shifting deeply entrenched social norms, the framework targets ≥85% facility delivery across priority districts and a 25% reduction in critical care-seeking delay (the gap between symptom onset and facility arrival).
Unmatched value for money.
High-impact MNCH interventions in West and Central Africa are remarkably affordable per life saved. The figures below — UNICEF's 2025 published commodity costs and programmatic estimates — establish the cost benchmark against which RFLD's framework can be evaluated by donors. Strategic capital deployed in the priority countries listed above saves lives at a fraction of comparable global costs.
Connected resources.
Maternal, newborn, and child health does not stand alone in RFLD's continental architecture. It connects to the SRHR programme, the BRAVE flagship on bodily rights, the Maputo Protocol's Article 14 guarantees on women's right to health, and the EmpowerHer Health Hub's interactive education modules on pregnancy, childbirth, and infant mortality.
Sexual & Reproductive Health and Rights
The full RFLD SRHR / DSSR programme — policy advocacy, service-delivery partnerships, comprehensive sexuality education, and continental coordination on women's reproductive rights.
Bodily Rights And Violence Eradication
RFLD's flagship programme on bodily autonomy and the eradication of gender-based violence — the rights-based foundation underpinning all clinical maternal-health work.
Maputo Protocol Hub
Article 14 of the Maputo Protocol guarantees women's right to health, including reproductive and maternal health. Continental ratification tracker and full text in working languages.
EmpowerHer Health Hub
RFLD's interactive SRHR education platform with 12 modules — including Pregnancy & Childbirth, Infant Mortality, and Maternal Conventions — and 180+ quiz questions for community learning.
Get in touch.
For partnerships on the MNCH and malaria framework, requests for clinical-site visits, operational research collaborations, applications to the WAFF Fund maternal-health regranting window, journalist enquiries, or to flag implementation issues — please reach the appropriate channel below.