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With support from USAID, the Population Council’s Frontiers in Reproductive Health (FRONTIERS) project supported the scaling up of a community-based model in Kenya that enabled women to give birth safely at home or be referred to a hospital when attended by a self-employed skilled midwife living in the community. To strengthen the sustainability of this approach FRONTIERS engaged a microfinance NGO to develop a training curriculum on basic business skills and financial literacy, and encouraged the community midwives (CMs) to form clusters or informal associations so that they could be trained in business skills. Following these interventions, CMs proved more likely to make a profit and succeed in being reimbursed for the services rendered. This experience with scaling up the model throughout four districts of Western Province has demonstrated that the community midwifery approach in Kenya is feasible and acceptable to the women, the community midwives themselves, and to the Ministry of Health, and is effective in increasing the proportion of women having a delivery by a skilled attendant and in increasing access to FP methods. Recommendations for future implementation of the model include: supporting skills development for maintenance of quality of care; supporting community midwives to achieve financial sustainability; strengthening business skills; and strengthening and supporting the linkages between the CM and the formal health sector.






Frontiers in Reproductive Health