Global lessons on transforming strategy into action to save mothers' lives

Although many countries remain far from achieving the reduction in maternal mortality stipulated by Millennium Development Goal (MDG) 5, 13 are on track to achieve this goal-despite experiencing similar fiscal, workforce, and other constraints as lower-performing peers. The present article assesses existing literature and successful local examples to allow health leaders to learn from these global success stories. A key lesson is that clinical interventions are not enough. Basic care provision must be supplemented with interventions that stimulate demand for services and ensure that they are both affordable and physically accessible. At US $1-6 per woman, comprehensive programs need not exert unsustainable pressure on health budgets. But perhaps more important is how this "ecosystem" of interventions is implemented. We identify 5 principles that characterize successful implementation: embedding maternal health as a top priority; focusing on targeted effective initiatives; fostering strong local ownership; maximizing efficiency and use of available resources; and creating a tough system of national accountability. Together, they offer policymakers and health leaders principles with which to accelerate progress toward MDG 5. With so many women's lives at stake, there could hardly be a greater incentive to do so.