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 Saving Women's Lives: The Skilled Care Initiative
Skilled maternity care throughout pregnancy, childbirth, and the postpartum period is globally recognized as one of the most promising strategies for reducing maternal mortality. Rates of skilled attendance at childbirth are being used as the main indicator to measure progress toward the Millennium Development Goal of reducing maternal mortality by three-fourths by the year 2015 (MDG 5).
Currently, almost half of women in developing countries go through childbirth without such care. Moreover, there has been little evidence-based research available to help guide efforts to increase skilled attendance rates. As Miller et al. note in their article, “Where is the E in MCH?” “There is no clear evidence on the best way to ensure appropriate care of women in developing countries who require life-saving interventions in the delivery and postpartum period”. [1]
In 2000, with support from the Bill & Melinda Gates Foundation, FCI launched the Skilled Care Initiative—a five-year operations research project in four rural, under-served districts in Burkina Faso, Kenya and Tanzania where the majority of women do not give birth with skilled providers. The SCI was developed in an effort to strengthen the evidence base for skilled care programming. The objective of the project was to test and evaluate strategies to increase skilled attendance at childbirth. Project strategies focused specifically on:
- Improving the availability and quality of skilled maternity care through health system interventions;
- Promoting utilization of maternity services through facility and community- level behavior change interventions.
SCI included a rigorous evaluation, using pre-test/post-test, quasi-experimental design with purposively selected comparison districts and included health facility and household surveys. Evaluation findings have shown that the intervention package led to significant improvements in the availability and quality of maternity care in all three settings, especially at mid-and lower-level health facilities, which were a major emphasis of the project, given their greater accessibility to women in rural communities. Impressive gains were also seen in women’s use of skilled care—even among the poorest women in some settings. Click here for an overview of the three-country results.
Reports on the full evaluation findings for each country can be accessed below.
A costing analysis, in partnership with Abt Associates, was also conducted in Kenya and Tanzania to determine the cost of the interventions, including the health systems component and community-focused BCC components. The primary objectives of this study were to determine the costs of implementing the SCI package in the intervention districts and the costs of replicating the intervention in other districts in Kenya and Tanzania. Click here to access this document.
[1] Miller, S. et al. “Where is the ‘E’ in MCH? The Need for an Evidence-Based Approach in Safe Motherhood.” Journal of Midwifery and Women’s Health 48, no. 1 (January/February 2003): 10-18.
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Skilled Care: An Equitable Approach
 The skilled care approach decentralizes routine and emergency obstetric care to the lowest levels of the health system that can safely provide these services, thereby reaching those women who are least able to access hospital care, including the poor, uneducated, and those living in remote, rural settings. It aims to prevent obstetric complications through high-quality routine maternity care, and to ensure that complications that do develop are recognized promptly and managed appropriately, either on site or by referral to higher-level care. It promotes the rational use of limited resources in the health sector by easing pressure on district hospitals and ensuring that appropriate services can be provided by mid- and lower-level facilities.
Skilled Care Initiative Delivers Impressive Results
Between 2003 and 2005, FCI worked with Ministries of Health in Burkina Faso, Kenya, and Tanzania to improve the quality and availability of maternity care, improving services for thousands of women. Through an ambitious research effort, FCI evaluated and documented key strategies for increasing skilled care during childbirth. Click here to download an overview of the results from all three countries. To request a hard copy, please contact publications@familycareintl.org.
Film about FCI's Work:
“Changing Lives, Saving Lives.”
“I had months of bleeding with my first 6 deliveries—and 2 babies died—because I delivered at home. In the past, there were no drugs, no proper help from the doctors. But now I can go to this health facility with medicines and helpful doctors.”
—Rose Atieno
Homabay, Kenya
 Rangwe Health Centre in Kenya is one facility that has shown a remarkable change since the beginning of the Skilled Care Initiative.
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The Skilled Care Initiative
