AbstractA hospital staff training program was conducted in Guatemala to improve outcomes for patients with obstetrical and neonatal complications. This study examines the effect of the training program on the subset of women referred to the hospital by traditional birth attendants (TBAs). The program's goals were to institute standards of care for obstetrical and neonatal patients as well as to improve relations between hospital staff and TBAs. The training program was evaluated by comparing changes in the number of referrals, patient satisfaction, patient management, as well as Apgar scores and perinatal mortality. Evaluations were based on 756 questionnaires administered to TBA referred mothers. There was a significant increase in the overall numbers of referred women as well as improvement in patient satisfaction and decreased waiting time between admission and treatment. Apgar scores and perinatal mortality also improved, but changes were not statistically significant.