This report presents the findings of a 2006 assessment of three types of facilities that provide maternal and newborn care in six representative districts in Kenya. Providers were given a 50-question knowledge test, and their skills were assessed as they performed five delivery and neonatal procedures on anatomical models: active management of the third stage of labor (AMTSL), manual removal of the placenta, bimanual uterine compression, immediate newborn care, and neonatal resuscitation with ambu bag. Facilities were assessed in the areas of human resources, infrastructure, care standards, and drugs and equipment. The report concludes that health provider competency at performing basic, life-saving skills was quite low, and the tendency to refer patients with complications was all too common despite weak referral and counter-referral mechanisms. The findings indicate a need for strengthening, in particular, hand washing practices and bimanual uterine compression skills. Recommended interventions to improve poor skills include competency-based training, supportive supervision, and coaching. The report’s findings also call attention to the need to improve infrastructure at a basic level and ensure availability of all necessary supplies and equipment to ensure safe deliveries in health facilities. Appendices provide the knowledge test and answer key, observation instruments for the skill assessments, the facility assessment instrument, and a list of equipment and supplies needed to perform the entire assessment.