TY - JOUR T1 - Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap JF - BMJ Global Health JO - BMJ Global Health DO - 10.1136/bmjgh-2020-002539 VL - 5 IS - 10 SP - e002539 AU - Sanam Roder-DeWan AU - Kojo Nimako AU - Nana A Y Twum-Danso AU - Archana Amatya AU - Ana Langer AU - Margaret Kruk Y1 - 2020/10/01 UR - http://gh.bmj.com/content/5/10/e002539.abstract N2 - Large disparities in maternal and neonatal mortality exist between low- and high-income countries. Mothers and babies continue to die at high rates in many countries despite substantial increases in facility birth. One reason for this may be the current design of health systems in most low-income countries where, unlike in high-income countries, a substantial proportion of births occur in primary care facilities that cannot offer definitive care for complications. We argue that the current inequity in care for childbirth is a global double standard that limits progress on maternal and newborn survival. We propose that health systems need to be redesigned to shift all deliveries to hospitals or other advanced care facilities to bring care in line with global best practice. Health system redesign will require investing in high-quality hospitals with excellent midwifery and obstetric care, boosting quality of primary care clinics for antenatal, postnatal, and newborn care, decreasing access and financial barriers, and mobilizing populations to demand high-quality care. Redesign is a structural reform that is contingent on political leadership that envisions a health system designed to deliver high-quality, respectful care to all women giving birth. Getting redesign right will require focused investments, local design and adaptation, and robust evaluation. ER -