266. Thus it is clear that there has been a rapid increase in coverage of ANC. However, there are ongoing concerns about the stage at which women present for their first ANC visit. The WHO recommends that the first visit take place before 20 weeks of pregnancy. In 2008 only 30 percent of women reported having attended before 20 weeks (no later data is available as to the relevant rates in more recent years) (Statistics Sierra Leone & MoHS, 2009). In addition, there is concern about the quality of the services provided. In 2010, only 50 percent of women who visited ANC clinics received the full basic set of services recommended by the WHO – that is to say a blood test, urine test and blood pressure assessment. 267. Further challenges include persistent inequalities in terms of access to, and the quality of services received by women based on their socio-economic status and geographic location. Many especially vulnerable women have not benefitted equally from the expansive advocacy and programmes driving these increases. Women with no or little education, women in rural areas, women in certain districts and regions and women living in the poorest quintiles are consistently less likely than their counterparts to access quality early ANC services or the support of a skilled attendant at birth and/or in a health facility – with their access rates lower than the national average in many instances. Inequities in access have been driven by the inequitable distribution of scarce infrastructure and qualified human resources. In 2010 only 57 percent of health facilities were set up to provide skilled care during delivery in terms of infrastructure and qualified personnel, with inadequacies particularly acute in rural and poorer areas (Statistics Sierra Leone and UNICEF, 2011). 268. The GoSL has sought to address these inequities and inadequacies through a longterm multi-pronged strategy aimed at improving maternal, infant and child survival rates, particularly in marginalized and more remote areas and among women and children living in poverty. It includes the provision of the Free Health Care Initiative for pregnant women and children under the age of five years, the training of personnel on maternal, obstetric and neonatal care, and infrastructure development. In regard to the latter initiative, a key strategy for improving maternal and neonatal health is the long-term goal to equip all hospitals and community health centres with the inputs required to provide quality emergency obstetric and neonatal care. To this end, the GoSL has implemented the Facilities Assessment Tracking (FIT) system which monitors progress in compliance at facilities (13 hospitals and 65 community health centres) with essential enablers for the provision of Basic, Comprehensive and Emergency obstetric and neonatal care. The FIT initiative is not only a monitoring, but quality improvement tool as it provides an opportunity to work with district leadership on coordinating support and planning actions to improve the quality of care (Ministry of Health and Sanitation, Sierra Leone, 2012). 269. Together, the FIT, FHCI and human resource development initiatives have improved the availability of, and access to, basic and emergency obstetric and neonatal care. The FIT initiative recorded an increase in the proportion of BEmONC facilities to achieve the status of basic emergency obstetric and neonatal care from 47% to 82% between November 2010 and July 2013 (Ministry of Health and Sanitation, Sierra Leone, 2013). 270. The following tables reflect progress in access to essential maternal and neonatal care, however they also show that the geographic and socio-economic inequities persist and that work in equalising opportunities to access quality care must be scaled up. 7. Health and Welfare  73