Hon Bangura  Photo Credit The Lancet

When Haja Zainab Bangura, Sierra Leone's Health and Sanitation Minister, returned home from a trip to Ethiopia a month ago, she was exhausted and went right to bed. In the middle of the night, her phone rang. A friend was in labour at the Princess Christian Maternity Hospital in Freetown, and she was bleeding profusely.

Bangura made some calls and a Ministry consultant, who was a medical doctor, arrived at the hospital just as she did. They learned her friend had fallen off a hospital bed, bled to death, and lost her baby. Moments later, Bangura encountered another distressed woman in labour nearby, just outside the operating room. No doctor was on call. The Ministry consultant stepped in, delivered a stillborn baby, but saved the mother's life. In the span of roughly an hour, the Minister had witnessed three deaths.

Furious, she marched around the wards, checking staffing records. Bangura found that about 60—70% of the hospital staff had not come to work that night. The next morning, she called President Ernest Bai Koroma, and they ordered an investigation into the management of the hospital, which is the country's only referral hospital for complicated births. The hospital's senior managers have been put on paid leave until the investigation is over.

Such are the trials of working life for 51-year-old Bangura, who grew up in poverty in a village without running water or a school, ran anti-corruption non-governmental organisations, and became the country's Foreign Minister from 2007 until the end of 2010 when she took over the Health and Sanitation Ministry. She inherited a Ministry that had been without a Minister for more than a year, but had also pulled off a big win in April, 2010, when it launched a free health-care initiative for pregnant women, breastfeeding mothers, and children aged under 5 years. The early results were impressive. Three times as many children were being treated for malaria as before the initiative, while the percentage of women giving birth in health facilities was nearly 80%, up from roughly 50%.

But success is relative here, in a country climbing out of years of conflict that had corroded its systems of health, education, transportation, and so much more. Sierra Leone's health system, while opened for the first time to hundreds of thousands of children and young women, still wasn't functioning properly. President Koroma chose Bangura, who is regarded as a tough, no-nonsense manager, to build on the foundation of the free health-care initiative.

To read more of Donnelly's narrative, please see The Lancet's orginal article.