A key challenge in maternal health today is the incongruity
between ‘successes,’ invariably reported at discrete project level,
and the collective disappointing progress in global maternal mortality
rates. Evaluations of large numbers of maternal health projects,
worth billions of dollars, consistently suggest a
preponderance of successful interventions (Bhushan and Slahub,
2014; Velthausz and Donco, 2015; Riggs-Perla et al., 2016; Putney
et al., 2014; Trevant et al., 2014). Yet, 69 out of 75 high burden
countries failed to achieve their MDG-5 targets (Victora et al., 2016).
Globally, the 44% reduction in maternal mortality rate from 1990 to
2015, while not insignificant, also fell short of its 75% target (World
Health Organization, 2014). Projects are an important element of
maternal health service delivery, and while they may not be the
only factor responsible for reducing maternal mortality (falling
fertility rates, improving education and declining poverty also play
significant roles), they draw upon considerable resources. When
projects do not achieve their intended impact, they represent lost
opportunities.