Improving Skilled Attendance at Delivery: A Preliminary Report of the SAFE Strategy Development Tool

Authors

  • Jacqueline Bell RGN, MSc,

    1. The authors are at the Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom. The SAFE International Research Partnership comprised members of the University of Aberdeen Research Team: Jacqueline Bell, Colin Bullough, Wendy Graham, Marion Hall, Vanora Hundley, Julia Hussein, Birgit Jentsch, Alice Kiger, Emma Pitchforth, Caroline Reeves, Graham Scotland, Sally Stearns, Christine Smith, Edwin van Teijlingen; SAFE Advisory Board: Oona Campbell, Fariyal Fikree, Marge Koblinsky, Paul van Look, Affette McCaw-Binns, Susan Murray, Ann Phoya; SAFE collaborators and researchers from partner countries: Bangladesh: Anita Chowdhury, Mushtaque Chowdhury, Yasmin Ali Haque, Faisa Kamal, Amina Mahbub, A.K.M. Shahabuddin; Ghana: Mercy Abbey, Sam Adjei, Alex Nazzar, Gloria Joyce Quansah; Jamaica: Deanna Ashley, Georgiana Gordon-Strachan; Malawi: Lennie Kamwendo, Mrs T Rashidi; Mexico: Bernardo Hernández, Liliana Montejo, Ana Langer; and Macro International Inc: Sian Curtis, Silvia Alayon.
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  • Julia Hussein MSc, MRCOG,

    1. The authors are at the Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom. The SAFE International Research Partnership comprised members of the University of Aberdeen Research Team: Jacqueline Bell, Colin Bullough, Wendy Graham, Marion Hall, Vanora Hundley, Julia Hussein, Birgit Jentsch, Alice Kiger, Emma Pitchforth, Caroline Reeves, Graham Scotland, Sally Stearns, Christine Smith, Edwin van Teijlingen; SAFE Advisory Board: Oona Campbell, Fariyal Fikree, Marge Koblinsky, Paul van Look, Affette McCaw-Binns, Susan Murray, Ann Phoya; SAFE collaborators and researchers from partner countries: Bangladesh: Anita Chowdhury, Mushtaque Chowdhury, Yasmin Ali Haque, Faisa Kamal, Amina Mahbub, A.K.M. Shahabuddin; Ghana: Mercy Abbey, Sam Adjei, Alex Nazzar, Gloria Joyce Quansah; Jamaica: Deanna Ashley, Georgiana Gordon-Strachan; Malawi: Lennie Kamwendo, Mrs T Rashidi; Mexico: Bernardo Hernández, Liliana Montejo, Ana Langer; and Macro International Inc: Sian Curtis, Silvia Alayon.
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  • Birgit Jentsch MA(Hons), PhD,

    1. The authors are at the Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom. The SAFE International Research Partnership comprised members of the University of Aberdeen Research Team: Jacqueline Bell, Colin Bullough, Wendy Graham, Marion Hall, Vanora Hundley, Julia Hussein, Birgit Jentsch, Alice Kiger, Emma Pitchforth, Caroline Reeves, Graham Scotland, Sally Stearns, Christine Smith, Edwin van Teijlingen; SAFE Advisory Board: Oona Campbell, Fariyal Fikree, Marge Koblinsky, Paul van Look, Affette McCaw-Binns, Susan Murray, Ann Phoya; SAFE collaborators and researchers from partner countries: Bangladesh: Anita Chowdhury, Mushtaque Chowdhury, Yasmin Ali Haque, Faisa Kamal, Amina Mahbub, A.K.M. Shahabuddin; Ghana: Mercy Abbey, Sam Adjei, Alex Nazzar, Gloria Joyce Quansah; Jamaica: Deanna Ashley, Georgiana Gordon-Strachan; Malawi: Lennie Kamwendo, Mrs T Rashidi; Mexico: Bernardo Hernández, Liliana Montejo, Ana Langer; and Macro International Inc: Sian Curtis, Silvia Alayon.
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  • Graham Scotland BSc(Hons), MSc,

    1. The authors are at the Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom. The SAFE International Research Partnership comprised members of the University of Aberdeen Research Team: Jacqueline Bell, Colin Bullough, Wendy Graham, Marion Hall, Vanora Hundley, Julia Hussein, Birgit Jentsch, Alice Kiger, Emma Pitchforth, Caroline Reeves, Graham Scotland, Sally Stearns, Christine Smith, Edwin van Teijlingen; SAFE Advisory Board: Oona Campbell, Fariyal Fikree, Marge Koblinsky, Paul van Look, Affette McCaw-Binns, Susan Murray, Ann Phoya; SAFE collaborators and researchers from partner countries: Bangladesh: Anita Chowdhury, Mushtaque Chowdhury, Yasmin Ali Haque, Faisa Kamal, Amina Mahbub, A.K.M. Shahabuddin; Ghana: Mercy Abbey, Sam Adjei, Alex Nazzar, Gloria Joyce Quansah; Jamaica: Deanna Ashley, Georgiana Gordon-Strachan; Malawi: Lennie Kamwendo, Mrs T Rashidi; Mexico: Bernardo Hernández, Liliana Montejo, Ana Langer; and Macro International Inc: Sian Curtis, Silvia Alayon.
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  • Colin Bullough MD, MSc, FRCOG,

    1. The authors are at the Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom. The SAFE International Research Partnership comprised members of the University of Aberdeen Research Team: Jacqueline Bell, Colin Bullough, Wendy Graham, Marion Hall, Vanora Hundley, Julia Hussein, Birgit Jentsch, Alice Kiger, Emma Pitchforth, Caroline Reeves, Graham Scotland, Sally Stearns, Christine Smith, Edwin van Teijlingen; SAFE Advisory Board: Oona Campbell, Fariyal Fikree, Marge Koblinsky, Paul van Look, Affette McCaw-Binns, Susan Murray, Ann Phoya; SAFE collaborators and researchers from partner countries: Bangladesh: Anita Chowdhury, Mushtaque Chowdhury, Yasmin Ali Haque, Faisa Kamal, Amina Mahbub, A.K.M. Shahabuddin; Ghana: Mercy Abbey, Sam Adjei, Alex Nazzar, Gloria Joyce Quansah; Jamaica: Deanna Ashley, Georgiana Gordon-Strachan; Malawi: Lennie Kamwendo, Mrs T Rashidi; Mexico: Bernardo Hernández, Liliana Montejo, Ana Langer; and Macro International Inc: Sian Curtis, Silvia Alayon.
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  • Wendy Graham DPhil(Oxon)

    1. The authors are at the Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen, Scotland, United Kingdom. The SAFE International Research Partnership comprised members of the University of Aberdeen Research Team: Jacqueline Bell, Colin Bullough, Wendy Graham, Marion Hall, Vanora Hundley, Julia Hussein, Birgit Jentsch, Alice Kiger, Emma Pitchforth, Caroline Reeves, Graham Scotland, Sally Stearns, Christine Smith, Edwin van Teijlingen; SAFE Advisory Board: Oona Campbell, Fariyal Fikree, Marge Koblinsky, Paul van Look, Affette McCaw-Binns, Susan Murray, Ann Phoya; SAFE collaborators and researchers from partner countries: Bangladesh: Anita Chowdhury, Mushtaque Chowdhury, Yasmin Ali Haque, Faisa Kamal, Amina Mahbub, A.K.M. Shahabuddin; Ghana: Mercy Abbey, Sam Adjei, Alex Nazzar, Gloria Joyce Quansah; Jamaica: Deanna Ashley, Georgiana Gordon-Strachan; Malawi: Lennie Kamwendo, Mrs T Rashidi; Mexico: Bernardo Hernández, Liliana Montejo, Ana Langer; and Macro International Inc: Sian Curtis, Silvia Alayon.
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  • The SAFE International Research Partnership is funded by the European Commission and the Department for International Development, London, United Kingdom.

Jacqueline Bell, Dugald Baird Centre for Research on Women's Health, University of Aberdeen, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen AB25 2ZL, Scotland, United Kingdom.

Abstract

Abstract: Background:  Increasing the proportion of births with skilled attendance is advocated by international agencies as a key factor in reducing maternal and perinatal mortality and morbidity. The SAFE Strategy Development Tool is designed to enable policy makers and planners to gather and interpret information systematically to develop strategies for improving skilled attendance at birth.

Method:  Five modules were developed with partners in Bangladesh, Ghana, Jamaica, Malawi, and Mexico to guide the identification of problems related to skilled attendance, the collection of primary and secondary evidence, and the synthesis of this evidence to formulate strategies. The involvement of key players, including policy makers, is emphasized throughout the application of the tool and is vital to its success.

Results:  The SAFE Strategy Development Tool was field tested in five collaborating countries. The methods employed by this tool were found to be feasible and produced evidence that will be useful in the formulation of strategies. Application of the tool can be completed in 3 to 5 months, and was estimated to cost between US$12,938 and US$15,627 for applications at district or subdistrict level. The final strategy options developed from the findings were presented at an international workshop in Aberdeen, Scotland, in February 2003.

Conclusion:  The SAFE Strategy Development Tool is now available to governments, organizations, and institutions involved in the implementation of maternal health programs. (BIRTH 30:4 December 2003)

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