Barriers	Strategies and solutions
Availability  • Lack of efficient and timely deployment of staff  • Geographic maldistribution of the workforce	Availability • Human resources for health strategic planning and human resources management • Streamlined recruitment and deployment procedures • Incentives to work in rural areas
Accessibility Geographic accessibility  • Limited access to transport  • Problems with roads, safety and security  • Poor communication networks  • Lack of integration or referral between primary health care and higher levels  • Impact of natural disasters Financial accessibility/affordability  • High cost of transportation for care or referral  • Cost of health services and medicines,  • Informal payments to access medicine and commodities	Accessibility • Affordable, safe transport for women to get to and return from services • Improved referral and integration • National policy to ensure universal health coverage including health insurance systems
Acceptability  • Care is not respectful and/or culturally appropriate  • A lack of clarity about the role of a midwife as an acceptable care provider	Acceptability • Provision of respectful care – attitudinal change • Inclusion of respectful care in curricula and continuing professional development • Education for women and the community about expectations of respectful care and the role of midwives • Involvement of men
Quality  • Lack of essential supplies  • Limited number of facilities able to provide emergency obstetric care  • Lack of up to date pre-service and in-service education  • Lack of clarity about the roles of certain cadres of SRMNAH worker  • Lack of regulation and licensing for the health workforce	Quality • Up to date and accredited pre-service education programs and teachers • Ensuring adequate clinical experience and practice • Attracting quality students • Essential supplies and commodities available when needed • In-service training and support • Clarity about job descriptions and roles and responsibilities • Regulation, national recognition, standards, licensing and supervision and monitoring • Support for professional associations