A multi-partner effort in Uganda and Zambia employed a districtwide health systems strengthening approach, with supply- and demand-side interventions, to address timely use of appropriate, quality maternity care. Between 2012 and 2016, maternal mortality declined by approximately 40% in both partnership-supported facilities and districts in each country. This experience has useful lessons for other low-resource settings.

The Saving Mothers, Giving Life initiative used 3 coordinated approaches to reduce maternal deaths resulting from a delay in deciding to seek health care, known as the “first delay”: (1) promoting safe motherhood messages and facility delivery using radio, theater, and community engagement; (2) encouraging birth preparedness and increasing demand for facility delivery through community outreach worker visits; and (3) providing clean delivery kits and transportation vouchers to reduce financial barriers for facility delivery. These approaches can be adapted in other low-resource settings to reduce maternal and perinatal mortality.

The Saving Mothers, Giving Life district health systems strengthening approach provides a sustainable model for reducing maternal mortality at scale. Lessons from the learning districts demonstrated increased efficiency in allocation of resources for maternal and newborn health, better use of strategic information, improved management capacities, and increased community engagement.

a on behalf of the Saving Mothers, Giving Life Working Group A multi-partner effort in Uganda and Zambia employed a districtwide health systems strengthening approach, with supply-and demand-side interventions, to address timely use of appropriate, quality maternity care. Between 2012 and 2016, maternal mortality declined by approximately 40% in both partnership-supported facilities and districts in each country. This experience has useful lessons for other low-resource settings.

Liberia's national community health program went from dispersed pilots to nationwide scale within 4 years. n A network of policy entrepreneurs from the Liberian government, donors, and implementing partners capitalized on several windows of opportunity to achieve this success. * First, they seized the evidence from a series of pilot projects and-during a point of significant global momentum around community health-evaluated the agenda. * Second, they leveraged the impact of the community health workers during the Ebola virus disease outbreak to propel forward a consolidated, paid cadre with significant political and financial backing. n Policy makers and program managers should consider coalition building and identifying diverse champions as an essential ingredient for impacting large-scale change, even in the face of significant challenges. n Liberia's community health program is bolstered by significant research and evidence. However, the policy entrepreneurs who brought the community leaders, Government of Liberia stakeholders, donors, and partners around the table to buy into a common program has been the "secret sauce" of the program's success.

A comprehensive district-strengthening approach to address maternal and newborn health was estimated to cost US$177 per life-year gained in Uganda and $206 per life-year gained in Zambia. The approach represents a very cost-effective health investment compared to GDP per capita.

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