Going to scale with professional skilled care: Maternal Survival 3

Marge Koblinsky, Zoe Matthews, Julia Hussein, Dileep Mavalankar, Malay K. Mridha, Iqbal Anwar, Endang Achadi, Sam Adjei, P. Padmanabhan, Wim van Lerberghe, Lancet Maternal Survival Series

Research output: Contribution to journalArticlepeer-review

353 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1377-1386
Number of pages10
JournalThe Lancet
Issue number9544
Publication statusPublished - 14 Oct 2006


  • emergency obstetric services
  • continuing medical education
  • UN process indicators
  • cesarean section
  • human resources
  • assess needs
  • program note
  • health
  • delivery
  • birth


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