This paper provides an estimation of out-of-pocket medical expenses to women and families for maternity care at all levels of the health system in Burkina Faso, Kenya and Tanzania.

This report summarizes the findings from the Skilled Care Initiative, a program launched in 2001 by the Ministry of Health and Social Welfare (MOHSW) and Family Care International, in Igunga district, Tabora Region, Tanzania

This technical brief provides an overview of the activities supported by Family Care International to strengthen district health systems as part of the Skilled Care Initiative, describing some of the challenges faced and lessons learned through the process of carrying out these changes.

Training in Life-Saving Obstetric Care or Postabortion Care (PAC) must be supported by an ongoing system of follow-up and support visits. Training health care providers without adequate follow-up has been shown repeatedly to have a limited effect. The objectives of follow-up visits to trainees are to: 1) Help maintain and improve provider competence and confidence in performing lifesaving obstetric care and PAC through on-the-job training, support, and guidance; 2) Reinforce health care provider knowledge and skills; 3) Identify and resolve problems or challenges that limit application of the training content; and 4) Monitor performance of the life-saving obstetric care and PAC functions and ensure safety and quality of services. The following tools are available below: 1) Life-Saving Obstetric Care Follow-up Tool 1: Supervisory Questionnaire; 2) Postabortion Care Follow-up Tool 1: Supervisory Questionnaire; and 3) Follow-up Tool 2: Follow-up Summary

What progress has the Safe Motherhood Initiative made since it was launched 20 years ago? These 2 reports (a full review and an executive summary) provide an overview of the positive trends and achievements of the last 20 years as well as challenges and opportunities which exist today in the field of safe motherhood.The full report also includes in-depth country profiles of Bolivia Indonesia, Lao People’s Democratic Republic, Malawi, Mali and Tanzania as well as info on international advocacy and media attention; development agency and donor commitment to safe motherhood; financial trends and allocations; and the development of national policies and programs for safe motherhood.

This technical brief provides an overview of the activities supported by Family Care International to strengthen district health systems as part of the Skilled Care Initiative, describing some of the challenges faced and lessons learned through the process of carrying out these changes.

Keeping up new skills is often hard for providers when they return to their workstations, especially in obstetric care because obstetric complications are relatively rare events, and many providers do not get regular practice managing these cases. The Life-Saving Obstetric Care Self-Directed Learning Guide is designed to help trained providers remember and retain their new skills. By using this tool, providers trained in life-saving obstetric care skills can continuously improve their skills so that they can provide the highest possible quality of maternity care and save the lives of women and babies. The Learning Guide covers all the topics of life-saving obstetric care training. For each topic, the Learning Guide includes: 1) Learning objectives, 2) Self-study questions; 3). Self assessment questions and 4). Reflection and Self-Improvement Goals.

Supervision is a management function that is planned and carried out in order to guide, support and assist staff in carrying out assigned tasks. It involves on-the-job transfer of knowledge and skills between the supervisor and the one being supervised. The aim of supervision is to determine staff performance in relation to quality and standards in implementing planned activities. The objectives of supervision are to: 1) Assist staff to improve their performance; 2) Ensure uniformity to set performance standards; 3) Identify and solve problems; 4) Maintain and reinforce the administrative and technical link between higher and lower levels; 5) Follow up on decisions reached during prior supervision visits; and 6) Identify staffing needs.Facilitative supervision is a system of management whereby supervisors at all levels in an institution focus on the needs of the staff they oversee. The most important part of the facilitative supervisor’s role is to enable staff to manage the quality-improvement process, to meet the needs of their clients, and to implement institutional goals. This approach emphasizes mentoring, joint problem solving, and two-way communication between the supervisor and those being supervised.

To provide good-quality skilled care during pregnancy and childbirth, skilled attendants must have a range of skills and perform them competently. This technical brief reviews the international definition of skilled birth attendants and describes the challenges of matching internationally defined criteria with the job description and de facto competencies of specific cadres of maternal health providers at the country level. The brief also provides an overview of approaches for gauging provider competencies and describes FCI’s experience in the three SCI countries.

This guide is a tool to help share some of the most important lessons from Life-Saving Obstetric Care training which focuses on four main themes: Antenatal Care, Emergency Preparedness, Infection Prevention, Care for Women in Labor, and Record-keeping.

Assessment guide to quantify the human and material resources needed for successful Postabortion Care.

The Health Impact of Unsafe Abortion is a report of a regional meeting held in September 2003 in Kuala Lumpur, Malaysia and organized by the Safe Motherhood Inter-Agency Group. Bringing together decision-makers and planners from selected countries in the Asia region, the meeting aimed to promote discussion and dialogue on the health impact of unsafe abortion within the context of safe motherhood, and to exchange information, experiences, and strategies.

This technical brief describes the (Client-Oriented, Provider-Efficient) COPE® for Maternal Health Services methodology; the process of implementing COPE® in the Skilled Care Initiative project districts and some of the key challenges encountered; and its adaptation for use in mid-level health facilities.

A comprehensive resource for individuals and organizations working to ensure that every woman has access to skilled care during childbirth. Contains a Policy Brief, Information Booklet, and Country Profiles. The Policy Brief presents arguments for why governments should invest in skilled care, defines key terms, and outlines the impact skilled care can have in reducing maternal deaths. The Information Booklet outlines the main issues that need to be considered when designing and implementing policies and programs to expand skilled care during childbirth, including essential competencies of skilled care providers; laws, policies and infrastructure; training and supervision; and monitoring and evaluation. The Country Profiles describe the strategies utilized by Botswana, Malaysia, Sri Lanka, and Tunisia in lowering maternal mortality and improving coverage of skilled care during childbirth.

This technical brief describes the process used to develop the Skilled Care Initiative behavior change communication strategy; illustrates the main barriers and constraints for increasing use of skilled care; and outlines the specific interventions that have been implemented to change attitudes and behaviors, and mobilize rural communities in support of skilled care.

As part of a three-country effort to improve maternal health outcomes and raise the proportion of births attended by skilled personnel, Family Care International (FCI) and the Ministry of Health, with assistance from The CHANGE Project launched the Skilled Care Initiative in these two underserved districts in Nyanza Province in early 2001. The Project is a unique effort to reduce maternal death by focusing specifically on improving skilled care for all women during pregnancy, childbirth, and the postpartum period. Over five years, the project aims to increase skilled attendance during childbirth by at least ten percent, through a three-tiered action plan.

Assessment guide to quantify the human and material resources needed for successful Emergency Obstetric Care.

Project NOVA is a five-year national initiative aimed to improve maternal and child healthcare access in rural Armenia.  This guide provides information on family planning and contraception options.

This brief provides an overview of the activities implemented by Family Care International to strengthen maternity care providers’ interpersonal communication and counseling skills, with a special focus on ensuring caring, compassionate treatment of clients.