This session will explore challenges and obstacles to accessing MNCH services in multiple contexts. Barriers to seeking care at a community level, delays in reaching health care and quality of health care services will be explored by presenting experiences from Madagascar, Nepal, Djibouti, Bolivia, Nigeria and Zambiaequitable access to health care for rural populations. Three international NGOs (JSI Research & Training, Manoff and Transaid) will present their unique experiences on overcoming these delays and their relevance for collaborating to implement a new community based integrated health programme (MAHEFA) with USAID support in Madagascar. #1 Services may be inaccessible to their intended users for multiple and complex reasons . The Manoff Group has developed a “quick and clean” methodology for discovering these. Its use is intended to lead to locally appropriate, effective programmatic responses to accessibility barriers. The first step is conducting a situational analysis, beginning with a literature review (including materials from other projects) and discussions with gatekeepers. Based on unanswered questions after the first step, formative research--usually qualitative and often ethnographic--is conducted to fill in gaps and learn more about the local situation. This surfaces potential clients’ as well as providers’ and administrators’ meanings, viewpoints, and constraints. Through organizing the results by behavior in strategy matrices, the most effective steps to address the barriers become clear. We discuss how this ‘Behavior-Centered Programming’ process generated programmatic recommendations, strategies and activities to address inaccessible maternal and child health services in Madagascar, Djibouti, and Bolivia and how these approaches are being used in the MAHEFA program. #2 Transaid will address the challenge of accessing health facilities when there is a lack of transport, particularly in rural and underserved areas. This unavailability of transport in rural communities, the long distances people often live from health care facilities and the high cost of transport, all contribute the delay in reaching health care. Finding practical solutions to this lack of timely transport is an often overlooked area. Transaid will share their experience of implementing innovations to overcome this ‘delay’in Nigeria and Zambia where emergency transport schemes and Community Health Worker mobilisation programmes have been implemented at a community level. Transaid’s innovations have had considerable success in ensuring improved community access to health care facilities through ensuring transport services are available, timely and affordable. #3 The lack of qualified, well supported and motivated health workers, available year round, at peripheral health facilities, is a major obstacle to the delivery of quality services for rural populations. JSI has decades of experience in multiple countries with engagement of community health workers to prepare and support them to provide basic primary health care in complex settings. This experience is not limited to provision of counselling and referral but the delivery of services and Nepal is one of the most successful examples. The presentation will highlight Nepal's pioneering work for community-based management of pneumonia and neonatal sepsis, use of chlorhexidine to prevent umbilical infections in newborns and misoprostol to prevent postpartum haemorrhage, with life-saving results. The synergy between increased and improved services at the community-level and improvement in the motivation and credibility of facility-based health workers is an additional benefit of a strong community-based program. #4 This presentation will highlight how the experiences of the three implementing partners and the findings of a barrier analysis and needs assessment survey have been used to design the MAHEFA program. The paper will outline the steps that the MAHEFA program will take to overcome the barriers identified, working with CHWs and other community-based entities and utilizing the relevant partner experiences.