Improving maternal health: Getting what works to happen

Abstract

Maternal mortality reduction in many countries is unlikely despite the availability of inexpensive, efficacious interventions that are part of official policy. This article explores the reasons why, based on research on maternity services in Bangladesh, Russia, South Africa and Uganda. A simple dynamic responses model shows that the key to understanding challenges in implementation lies in the reflexive, complex and dynamic responses of health workers and community members to policies and programmes. These responses are "dynamic" in that they arise due to forces from within and outside the system, and in turn exert forces of their own. They result in the difference between the health system ..