The regional crisis · UNICEF WCAR Snapshot 2025
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.
Maternal deaths · annual
135,000
>50% of global burden
Maternal Mortality Ratio of 629 per 100,000 live births — the highest globally.
Under-5 deaths · annual
1.78 million
40% of global burden
1 in 12 children die before age 5 (U5MR: 86 per 1,000). 1.2M deaths occur between 1–59 months.
Newborns & stillbirths · annual
1.13 million
27% of global burden
~630,000 neonatal deaths (1 in 33) and over 500,000 stillbirths (1 in 43) annually.
Leading cause of U5 death
Malaria
19% of U5 deaths
Followed by lower respiratory infections (18%), diarrhoea (12%), prematurity (11%), and asphyxia (9%).
Source. All figures in this section are from UNICEF's West and Central Africa Snapshot 2025 on maternal, newborn, and child mortality, published by UNICEF Regional Office for West and Central Africa. RFLD's strategic framework is calibrated against these baselines; the targets shown in the dashboard above are RFLD's own programmatic commitments for the eight priority countries listed below, not regional averages.
Eight priority countries · highest-burden Francophone states
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.
Conflict zone
Niger
Highest regional mortality
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.
RFLD intervention focus
- Sahel operational security protocols
- Decentralised WAFF Fund regranting
- DƆNÙESÈ offline tracking integration
Conflict zone
DR Congo
Critical absolute burden
Accounts for a massive share of the region's absolute deaths, ranking second overall for under-5 deaths, newborn deaths, and stillbirths in WCAR.
RFLD intervention focus
- EmONC facility readiness
- Supply chain reinforcement
- Malaria RDT/ACT last-mile delivery
Fragile state
Chad
Maternal crisis epicentre
Suffers from severe institutional fragility. Ranks third highest across the entire region for absolute maternal deaths, with extremely high stillbirth rates.
RFLD intervention focus
- Midwife clinical upskilling
- PPH and eclampsia simulation drills
- DHIS2 interoperability
Conflict zone
Central African Republic
Severe maternal risk
Remains in the top tier globally for maternal mortality ratio and stillbirth rates, due to prolonged conflict and degraded health-system infrastructure.
RFLD intervention focus
- Inpatient newborn care units (INCUs)
- Push EmONC kit deployment
- Scaling essential medicines
Conflict zone
Mali
Sahel vulnerability
Faces compound threats from regional conflict and extreme climate risk, severely disrupting care-seeking behaviours for women and children, particularly in rural northern regions.
RFLD intervention focus
- Community women leaders engagement
- Low-profile clinical logistics
- Operational research on care delays (malaria)
Conflict zone
Burkina Faso
High displacement impact
Mass displacement and conflict have shattered health infrastructure, leading to critical spikes in malaria transmission and unassisted home births.
RFLD intervention focus
- Rapid emergency supply kits
- Seasonal Malaria Chemoprevention (SMC) support
- Staff safety and duty-of-care protocols
Conflict zone
Cameroon
Complex health disparities
High absolute mortality rates and fragile delivery systems, particularly in regions affected by ongoing internal conflicts in the Anglophone North-West and South-West.
RFLD intervention focus
- Antenatal Corticosteroids (ACS) and MMS scaling
- Male health activist engagement
- Operational research on ITN utilisation
RFLD operational hub
Benin
Systemic policy integration
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.
RFLD intervention focus
- Ministry of Health policy alignment
- PDSA quality improvement audits
- Domestic resource advocacy
Strategic levers · six innovation priorities
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.
Lever 01 · Research
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.
Lever 02 · Clinical
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.
Lever 03 · Training
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.
Lever 04 · Mobilisation
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.
Lever 05 · Technology
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.
Lever 06 · Funding
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.
Beyond the delivery room · holistic integration
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.
Pillar 01 · Vaccination & prevention
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.
Measles & DTP coverage
≥90%
ITN access · under-5s
≥70%
ANC4+ coverage
≥75%
Strict 2–8°C cold-chain monitoring across all sites
Pillar 02 · Nutrition
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.
Exclusive breastfeeding · 0–6 mo
≥60%
Maternal anaemia reduction
↓20%
Vitamin A · high-dose 6–59 mo
Universal
Daily iron and folate for all pregnancies in supported services
Pillar 03 · WASH
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.
Neonatal sepsis
↓15%
Under-5 diarrhoea
↓20%
Hand hygiene compliance
≥90%
Upgraded water points and latrines at every supported facility
Behavioural change & advocacy
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).
The investment case · cost per life saved
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.
<$1
Per essential medicine dose
Treatment for malaria, pneumonia, and diarrhoea — the three largest causes of under-5 mortality in the region.
$0.30
Per antibiotic dose
Injectable antibiotics for neonatal infections and severe paediatric pneumonia.
$0.19
Per DTP vaccine
Diphtheria, tetanus, and pertussis. Measles vaccine is $0.42. Both are among the most cost-effective public health interventions in existence.
$4M
Lifesaving care at birth · 10M newborns
Sufficient to provide vital lifesaving care at the moment of birth to 10 million newborns across the region.
$4M
Neonatal resuscitation · 670,000 newborns
Equips clinical services to deliver neonatal resuscitation for 670,000 newborn infants experiencing birth asphyxia.
Source. Commodity prices and programmatic costing figures in this section are drawn from UNICEF's published 2025 supply-cost catalogues and the UNICEF West and Central Africa Snapshot 2025 investment-case analysis. These are regional benchmarks against which RFLD's framework is calibrated, not RFLD-proprietary cost estimates. RFLD's framework deploys these globally-validated commodities through its clinical capacity, supply-chain, and community-mobilisation infrastructure across the eight priority countries.
Engage with this work
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.