title: Going to scale with professional skilled care.
abstract: 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.
authors.affiliation: ICDDR,B, Centre for Health and Population Research, Dhaka, Bangladesh. margek@icddrb.org
authors.forename: Marge
authors.initials: M
authors.lastname: Koblinsky
authors.forename: Zoë
authors.initials: Z
authors.lastname: Matthews
authors.forename: Julia
authors.initials: J
authors.lastname: Hussein
authors.forename: Dileep
authors.initials: D
authors.lastname: Mavalankar
authors.forename: Malay K
authors.initials: MK
authors.lastname: Mridha
authors.forename: Iqbal
authors.initials: I
authors.lastname: Anwar
authors.forename: Endang
authors.initials: E
authors.lastname: Achadi
authors.forename: Sam
authors.initials: S
authors.lastname: Adjei
authors.forename: P
authors.initials: P
authors.lastname: Padmanabhan
authors.forename: Bruno
authors.initials: B
authors.lastname: Marchal
authors.forename: Vincent
authors.initials: V
authors.lastname: De Brouwere
authors.forename: Wim
authors.initials: W
authors.lastname: van Lerberghe
mesh_terms: D017954:Africa South of the Sahara; D001210:Asia, Southeastern; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008427:Maternal Health Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D008428:Maternal Mortality; D008880:Midwifery / Q000706:statistics & numerical data*; D011181:Postnatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011787:Quality of Health Care; D019035:Rural Health Services / Q000639:trends