Ellen M. Themmen, MPH¹, Johnmark Opondo, MD, MPH², Ann Starrs³, Ellen Brazier, MA⁴, Pamela L. Bolton, MHS⁵, and Heather E. Kelly, MPA⁴. (1) Africa Program, Family Care International, 588 Broadway, Suite 503, New York City, NY 10012, (212) 941-5300, ethemmen@familycareintl.org, (2) Skilled Care Initiative, Family Care International, 588 Broadway, Suite 503, New York City, NY 10012, (3) Family Care International, 588 Broadway, Suite 503, New York, NY 10012, (4) Anglophone Africa Program, Family Care International, 508 Broadway, Suite 503, New York, NY 10025, (5) Francophone Africa Program, Family Care International, 588 Broadway, Suite 503, New York, NY 10012

Family Care International (FCI)'s Skilled Care Initiative (SCI) is a five-year project designed to increase by at least ten percent the number of women who receive skilled care at childbirth. SCI is being implemented in four districts in Burkina Faso, Kenya and Tanzania, and promotes skilled care throughout pregnancy, childbirth and in the postpartum period, as a strategy for reducing maternal mortality and morbidity.

Skilled attendance/care is defined as the presence of a qualified provider during childbirth. In fact, however, a skilled provider can have only limited impact if he or she is not supported by an enabling environment, which includes:

1. adequate supplies, equipment and infrastructure 2. effective systems of communication and referral 3. a supportive political and policy context

SCI's baseline research identified a range of deficiencies in the healthcare delivery environment, including inadequate infrastructure, lack of communications and transport systems for referral, and shortages of supplies, essential equipment and qualified staff. National laws and policies do not generally promote skilled care, and community members do not adequately prepare for childbirth.

To address these barriers, SCI's multi-pronged approach works at the facility, community and policy levels. Facility-level activities include provider training, physical renovations, purchase of essential supplies and equipment, and the installation of communication and transport systems. SCI's advocacy efforts work to strengthen policies and programs supporting skilled care during childbirth. Lastly, to increase utilization of services, SCI initiates behavior change and community mobilization interventions at the district level.

Learning Objectives:

• At the conclusion of this session, participants will be able to recognize the critical role of the enabling environment for skilled care during childbirth.

Keywords: Access and Services, Safe Mother Program

Related Web page: www.familycareintl.org

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Family Care International
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.