Increasing Access to Skilled Care: From Pilot Project to National Policy

Background: Women in Burkina Faso face some of the highest rates of maternal death in all of Africa, with estimates ranging from 484 to 1,400 maternal deaths per 100,000 live births. Nationally, only about a quarter of all births take place in a health facility. At the same time, the government of Burkina Faso is very committed to safe motherhood and has adopted national policies to improve maternal health.

Materials and Methods: The SCI was a unique effort to reduce maternal death by focusing specifically on ensuring skilled maternity care for all women. Implemented in Ouargaye district, a rural, disadvantaged area, the project aimed to increase skilled attendance rates by making high-quality obstetric care available and accessible, and by promoting preparations for childbirth and the use of services. Activities were implemented by the Ministry of Health and an NGO, Family Care International.

Results: End-of-project results showed dramatic improvements in the availability and accessibility of essential obstetric care, and significant increases in skilled attendance rates, from 24% at baseline to 55% at endline. In response to project results, in its 2003 National Health Development Plan, the Government of Burkina Faso shifted its national maternal health strategy to focus on skilled care rather than traditional birth attendants. The Government is incorporating elements of the intervention package into district health plans throughout the country. In addition, tools developed through the project, such as obstetric protocols and flowcharts are now being used nationally.

Conclusions: Close collaboration between government and non-governmental partners and solid evaluation evidence can lead to changes in national policies and strategies.