TY - JOUR T1 - Saving Mothers, Giving Life: Don’t Neglect the Health Systems Element JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 606 LP - 609 DO - 10.9745/GHSP-D-19-00178 VL - 7 IS - 4 AU - Krishna Hort AU - Louise Simpson Y1 - 2019/12/23 UR - http://www.ghspjournal.org/content/7/4/606.abstract N2 - See related articles in the SMGL supplement.We congratulate the authors of the articles in the GHSP supplement on the Saving Mothers, Giving Life (SMGL) project in Uganda and Zambia. The significant reduction in maternal deaths arising from the project is heartening, and we are pleased to see this comprehensive description of the project, its interventions and outcomes, and a range of studies evaluating its impact, all published in full.In this letter, we would like to focus on an aspect of the project that we feel did not receive adequate attention in the supplement, namely, its role as a health systems strengthening (HSS) initiative. To do so, we draw on the literature describing the characteristics of HSS initiatives and seek to highlight the HSS elements of the SMGL program based on the articles in the supplement. Given the relatively sparse literature on HSS characteristics, we also draw on our own experience of HSS in relation to maternal health programs through the Australia-Indonesia Partnership for Maternal and Neonatal Health (AIPMNH) in eastern Indonesia, over the period 2009 to 2015 (unpublished).The SMGL initiative was clearly conceived as an HSS initiative, using a “systems approach, focused at the health district level”1 and addressing 5 elements of the health system in an integrated manner. This systems approach was designed to “create a highly visible, bold initiative that would galvanize global action and financial support”2 and demonstrate that such an initiative “could achieve impressive results in a short time.”1However, literature on HSS emphasizes that it goes beyond simply addressing health system components. HSS involves3:investments in inputs in an integrated and systemic way, but also reforming the architecture that determines how different parts of the health system operate and interact to meet priority health needs through … ER -