The focus of the first year of the MM intervention is enhanced clinical skills in the intra-partum and postpartum periods and thus assessments of actual clinical practices are important. However, data on actual practices in the intrapartum and postpartum periods will be difficult to collect by observation during this baseline (especially those with complications). Most of the PHCs conduct only a few deliveries each week, and it will be therefore almost impossible to obtain a representative sample of observations. Therefore we will assess intrapartum and postpartum clinical practices largely though the audit of case sheets and registers. However, these case sheets are currently either not available or not used. Thus our strategy necessitates delay of this part of the second phase of the baseline until after the update training where all staff will be given and instructed in the use of new and improved case sheets. All sites will be given the opportunity to practice using these patient case sheets for one month before they are collected by project staff and used as a basis for assessing both compliance with the new case sheets, adequacy of reporting, and actual case management. Actual case observations will be done during routine MM visits where possible. The post intervention phase of the assessment will take place in all sites once year after the first (planned 6) MM visits and will repeat the baseline survey.