In 2020, the National Emergency Medical Service (NEMS) was gradually handed over to the country’s health authorities, who have been running it independently since 1 October 2020. However, Doctors with Africa CUAMM has continued to support the service’s management body. To cope with the Covid-19 pandemic, NEMS was reinforced to guarantee emergency transfers tied to infectious disease and sample transfers via dedicated ambulances. Despite the effects of the pandemic, which partially reduced use of the services, including maternal services, Doctors with Africa CUAMM continued to support Sierra Leone’s largest maternity unit in Freetown, attending more than 6,200 deliveries (including over 3,000 obstetric emergencies) and continuing the gestational diabetes screening and activities at the HDU (High Dependency Unit). In 2020, additional HDUs were also opened in the regional hospitals of Makeni, Bo and Pujehun. These facilities provide intensive care for critical patients and improve the level of care offered. In 2020, assistance for Lunsar Hospital concluded with the completion of the three-year project to support the SJOG maternity hospital and several peripheral health facilities in the district. Doctors with Africa CUAMM continued to support the country’s most remote health districts – Bonthe and Pujehun – by providing training and assistance in maternal and child health services. As part of this programme, CUAMM helped develop 14 blood banks (3 regional and 11 at district-level) by providing solar refrigerators and equipment to improve the management of blood transfusions. In Bonthe, we continue to encourage boat referrals for women living in the river areas who would not otherwise be able to reach the hospital to give birth. Our work has continued at the hospital in Pujehun, where a baby care unit has been set up to care for newborns with diseases; the referral back system is also being reinforced with vouchers to take the most fragile paediatric patients who have just been discharged from hospital back to their home villages to help the recovery process.