health care system.” Training that advocates collaboration and regular involvement in clinic duties, increases the number of referrals and improves communication. The World Health Organization’s Strategies and Interventions for Obstetric Referrals: An adequately resourced referral facility. Communications and feedback systems. Designated transport. Protocols for identifying complications that are specific to the setting. Personnel trained in the use of these protocols Teamwork between referral levels. A unified records system. Mechanisms to ensure that patients do not bypass levels Tools to improve communication and transportation to maternal health facilities “Most maternal deaths from direct causes (such as hemorrhage, obstructed labor, infections, eclampsia, or unsafe abortions) could be prevented if women received timely care at critical moments.” On average, half of deliveries in the developing world have a skilled birth attendant present. With many deliveries outside of the health center, and an estimated 9-15% of deliveries requiring intervention, access to transportation and communication are critical to improve maternal and infant outcomes. Major contributing factors to maternal death are: “delay in recognizing danger signs, deciding to seek care, reaching care, and receiving care at health facilities”. Transportation programs Malawi: Communities have employed bicycle ambulances and oxcarts to transport pregnant women to health facilities. There were issues during the rainy season. The program later added ambulances, targeted information, education, maternity waiting, and focused education activities for decision makers in the family. The maternity waiting homes were rare because they required funds collected by the community. Sierra Leone: The Ministry of Health used a radio system in conjunction with four-wheel-drive vehicles. This program has seen success. The program increased emergency referrals and the case fatality dropped. Uganda: Stationing two ambulances at a referral facility was not effective. Communication and lack of planning for fuel price hikes and shortages were cited as the causes for poor results. UNFPA used four-wheel-drive vehicles, a designated referral point and a standard for referral care. Reports of fuel shortages threaten the success of the program. Honduras: Improved roads, communication, ambulances, and increased staffing and equipment increased referrals and reduced maternal mortality. Sri Lanka: The Sri Lankan government provided three to five ambulances at each hospital. The program gave health workers the authority to organize, pay, and receive reimbursement for privately organized transportation. Nigeria: Community leaders negotiated a contract with a local bus union to transport women with obstetric emergencies. The drivers received training and were reimbursed for fuel by a community