This report presents the findings of a 2006 assessment of three types of facilities that provided maternal and newborn care within six representative districts in Kenya. Providers were given a 50-question knowledge test, and their skills were analyzed as they performed five delivery and neonatal procedures on anatomical models: active management of the third stage of labor (AMTSL), manual removal of the placenta, bimanual uterine compression, immediate newborn care, and neonatal resuscitation with ambu bag. Facilities were assessed in the areas of human resources, infrastructure, care standards, and drugs and equipment. The report concluded that health provider competency at performing basic, life-saving skills waslow, and the tendency to refer patients with complications was high, despite weak referral and counter-referral mechanisms.

The findings indicate areas needed for improvement, in particular, hand washing practices and bimanual uterine compression skills. Recommended interventions for addressing inadequate skill levels included competency-based training, supportive supervision, and coaching. The report’s findings also indicate the need for strengthening infrastructure at a basic level and for ensuring the availability of all necessary supplies and equipment, which are critical for safe deliveries in health facilities. Appendices provide the knowledge test and answer key, observation instruments for the skill assessments, the facility assessment instrument, and a list of equipment and supplies needed to perform the entire assessment.