title: Practical lessons from global safe motherhood initiatives: time for a new focus on implementation.
abstract: The time is right to shift the focus of the global maternal health community to the challenges of effective implementation of services within districts. 20 years after the launch of the Safe Motherhood Initiative, the community has reached a broad consensus about priority interventions, incorporated these interventions into national policy documents, and organised globally in coalition with the newborn and child health communities. With changes in policy processes to emphasise country ownership, funding harmonisation, and results-based financing, the capacity of countries to implement services urgently needs to be strengthened. In this article, four global maternal health initiatives draw on their complementary experiences to identify a set of the central lessons on which to build a new, collaborative effort to implement equitable, sustainable maternal health services at scale. This implementation effort should focus on specific steps for strengthening the capacity of the district health system to convert inputs into functioning services that are accessible to and used by all segments of the population.
authors.affiliation: Averting Maternal Death and Disability Program, Mailman School of Public Health, Columbia University, New York 10032, USA. lpf1@columbia.edu
authors.forename: Lynn P
authors.initials: LP
authors.lastname: Freedman
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Graham
authors.forename: Ellen
authors.initials: E
authors.lastname: Brazier
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Smith
authors.forename: Tim
authors.initials: T
authors.lastname: Ensor
authors.forename: Vincent
authors.initials: V
authors.lastname: Fauveau
authors.forename: Ellen
authors.initials: E
authors.lastname: Themmen
authors.forename: Sheena
authors.initials: S
authors.lastname: Currie
authors.forename: Koki
authors.initials: K
authors.lastname: Agarwal
mesh_terms: D036861:Delivery, Obstetric / Q000379:methods* / Q000639:trends; D004632:Emergency Medical Services / Q000379:methods / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008428:Maternal Mortality; D008429:Maternal Welfare; D020380:Needs Assessment / Q000458:organization & administration* / Q000706:statistics & numerical data; D011247:Pregnancy