I just returned from Bangkok, Thailand where over 400 professionals representing 13 countries in the Asia and Middle East Region came together to wrestle with the complex issue of scaling up family planning and maternal and child health best practices. The USAID Extending Services Project organized this week-long meeting to galvanize country-led efforts to identify, plan for and put in place evidenced-based, cost-effective practices that can greatly reduce maternal, infant and child mortality. I was repeatedly struck by the impressive results being achieved throughout the region, and by the incredible enthusiasm, commitment and courage voiced by our country colleagues – whether it was the Director of the Tamil Nadu, India National Rural Health Mission describing how their government is investing in quality emergency obstetric services; the Deputy Minister of Health of Yemen explaining how they have greatly increased coverage of post-partum family planning; or the Director General for Health Services of the Ministry of Health of Nepal sharing their experience in supporting over 48,000 community health workers who offer key maternal and child health interventions that have led to increased child survival rates countrywide.

These and other sessions throughout the week articulated the key factors for success as well as the challenges inherent in scaling up evidence-based programs. Not surprising, a major barrier to scaling up quality services for nearly all countries relates to the health workforce. The issues vary, from insufficient numbers of skilled health workers to ensuring that community-based health workers are well-trained, supervised, motivated and on the job. I had the opportunity to present task-shifting as one operational strategy for addressing shortages of skilled workers as part of a broader health systems strengthening panel. One comment from the audience during that panel summed up nicely the broader health systems issues we face in global health today: “Too often we set unrealistically high targets and demand rapid results that require bypassing the system and reducing our ability to have sustainable impact. We need to prioritize investments into interventions that we know work, building on and reinforcing the existing systems.”