This toolkit presents a process and tools that can be used to conduct facility-level site assessment and strengthening (SA/S) with the goal of improving essential maternal and newborn care services.  The SA/S activity is based on the performance improvement process defined by the USAID Performance Improvement Consultative Group, and adapted by JHPIEGO as a performance and quality improvement (PQI) approach. The source material adapted to form Part 1 of this toolkit is the reference manual Supervising Healthcare Services: Improving the Performance of People (Garrison, K et al. JHPIEGO 2004). The manual describes in more detail aspects of the PQI process from a supervisory perspective, including how to set performance standards, use assessment methods, and work with the community as a stakeholder.  The assessment tools presented in Part 2 were developed by the MNH Program and have been used during the past 6 years in more than a dozen countries. Because the tools use evidence-based, internationally recognized standards, they can be used by any organization working in the field of maternal and newborn care. Part 3 of the toolkit contains the report Using Performance and Quality Improvement to Strengthen Skilled Attendance JHPIEGO/MNH Program 2003). This report documents how the use of the PQI process has helped to improve skilled attendance in MNH Program countries, and shares some lessons the Program has learned about how best to use PQI in safe motherhood programs.  Taken together, this toolkit provides an overview of how the PQI process can be used to strengthen facility and individual performance and how it can be easily and effectively incorporated into the operating norms of any facility. Using the PQI process described in this toolkit, staff can continually assess and strengthen individual and facility-level performance.