Visitors to the Hands Up for Health Workers website may learn about the importance of community midwives, which Merlin describes as women selected from remote communities with at least 9 years of formal education who are trained for 18 months in the theory and practice of managing normal deliveries and recognising and referring complications early. Information available on this site is designed to help people understand why maternal mortality is so high in fragile states, and why the Millennium Development Goal (MDG) for maternal health (#5) will not - according to Merlin - be reached without urgent investment in health workers.

One item spotlighted here is Merlin's report All Mothers Matter, which it launched on May 5 2009 to mark International Day of the Midwife. The report advocates for an overhaul of how health is currently funded to ensure maternal mortality is tackled effectively. It insists on increased political will to tackle maternal health challenges, and resources to ensure that midwives and the communities they serve are included in policy, service planning, and monitoring and evaluation.

All Mothers Matter (as well as the Hands Up website) includes vignettes illustrating Merlin's strategy for building the skills base needed to stop mothers dying needlessly in childbirth. For instance, Merlin supports two community midwife training schools in two remote provinces, which have so far trained 89 midwives, all of whom are committed to working back in their rural communities for at least 3 years. Although reportedly Merlin staff found it difficult to recruit trainees, they overcame community mistrust by involving villagers at every turn. Communities were central in establishing the criteria for trainee selection. Merlin also maintained a strong sense of cultural norms when planning the programme. In part due to these efforts, Afghanistan increased the number of women delivered by skilled attendants from 6% in 2002 to 19.9% in 2006, and skilled attendant numbers rose from 467 in 2003 to 2,200 in 2008. Reportedly, the programme is proving to be empowering for the trained community midwives in that they gain independence, enjoy respect from their communities, and earn their own money.

By "signing up to make change happen", anyone may join the Hands Up campaign and learn how to take action.

Maternal Health, Development Assistance.

According to Merlin, "Currently huge amounts of aid are spent tackling diseases such as malaria and TB in isolation; yet such diseases, which contribute to high levels of maternal mortality, cannot be prevented, treated or cured without sufficient numbers of trained health workers." The report calls for 50% of all global health funding to be channelled into strengthening health systems, with 25% of that to be used to train and retain health workers.

Merlin's specific focus on Hands Up for Health Workers is on fragile states, which in 2007 received only 38.4% of overseas development aid despite suffering the highest levels of maternal mortality. All Mothers Matter addresses this disparity by calling for targeted investment of £2.4 billion for health in fragile states. The hope is that this support could double the health workforce, including rapid scale up of midwifery training to ensure there is one skilled birth attendant for every 175 women. It would also provide all the medical supplies and drugs needed plus incentives for staff working in underserved and rural areas.