Going to scale with professional skilled care

Lancet. 2006 Oct 14;368(9544):1377-86. doi: 10.1016/S0140-6736(06)69382-3.


Because most women prefer professionally provided maternity care when they have access to it, and since the needed clinical interventions are well known, we discuss in their paper what is needed to move forward from apparent global stagnation in provision and use of maternal health care where maternal mortality is high. The main obstacles to the expansion of care are the dire scarcity of skilled providers and health-system infrastructure, substandard quality of care, and women's reluctance to use maternity care where there are high costs and poorly attuned services. To increase the supply of professional skilled birthing care, strategic decisions must be made in three areas: training, deployment, and retention of health workers. Based on results from simulations, teams of midwives and midwife assistants working in facilities could increase coverage of maternity care by up to 40% by 2015. Teams of providers are the efficient option, creating the possibility of scaling up as much as 10 times more quickly than would be the case with deployment of solo health workers in home deliveries with dedicated or multipurpose workers.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Africa South of the Sahara
  • Asia, Southeastern
  • Female
  • Health Services Needs and Demand*
  • Humans
  • Maternal Health Services* / economics
  • Maternal Health Services* / organization & administration
  • Maternal Health Services* / statistics & numerical data
  • Maternal Mortality*
  • Midwifery / statistics & numerical data*
  • Postnatal Care / statistics & numerical data
  • Pregnancy
  • Quality of Health Care*
  • Rural Health Services / trends