title: Opportunities and challenges in implementing community based skilled birth attendance strategy in Kenya.
abstract: BACKGROUND
  Availability of skilled care at birth remains a major problem in most developing countries. In an effort to increase access to skilled birth attendance, the Kenyan government implemented the community midwifery programme in 2005. The aim of this programme was to increase women's access to skilled care during pregnancy, childbirth and post-partum within their communities.
  
  
  METHODS
  Qualitative research involving in-depth interviews with 20 community midwives and six key informants. The key informants were funder, managers, coordinators and supervisors of the programme. Interviews were conducted between June to July, 2011 in two districts in Western and Central provinces of Kenya.
  
  
  RESULTS
  Findings showed major challenges and opportunities in implementing the community midwifery programme. Challenges of the programme were: socio-economic issues, unavailability of logistics, problems of transportation for referrals and insecurity. Participants also identified the advantages of having midwives in the community which were provision of individualised care; living in the same community with clients which made community midwives easily accessible; and flexible payment options.
  
  
  CONCLUSIONS
  Although the community midwifery model is a culturally acceptable method to increase skilled birth attendance in Kenya, the use of skilled birth attendance however remains disproportionately lower among poor mothers. Despite several governmental efforts to increase access and coverage of delivery services to the poor, it is clear that the poor may still not access skilled care even with skilled birth attendants residing in the community due to several socio-economic barriers.
authors.affiliation: Ministry of Health and Sanitation, Freetown, Sierra Leone, West Africa. mtmannah@yahoo.co.uk.
authors.forename: Margaret Titty
authors.initials: MT
authors.lastname: Mannah
authors.forename: Charlotte
authors.initials: C
authors.lastname: Warren
authors.forename: Shiphrah
authors.initials: S
authors.lastname: Kuria
authors.forename: Adetoro A
authors.initials: AA
authors.lastname: Adegoke
mesh_terms: D000328:Adult; D057191:Capacity Building; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration*; D004496:Education, Continuing; D004864:Equipment and Supplies; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D007630:Kenya; D008297:Male; D008875:Middle Aged; D008880:Midwifery / Q000193:education / Q000458:organization & administration*; D016730:Program Development; D036301:Qualitative Research; D060926:Remuneration; D012449:Safety; D012959:Socioeconomic Factors; D014186:Transportation; D000078329:Workforce; D016526:Workload