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.
