Africa has witnessed many successful pilot projects regarding maternal health at the government, private sector and development partner levels. These innovative projects were allowed to wither away without an appropriate framework for scale-up. While scale is very difficult to reach and could take a very long time to materialize, government and other stakeholders should not shy away from this vital responsibility. The strategy is to operate within local organizations to improve the health system and empower populations. Sen/ice providers work on a competitive basis, with better performance rewarded. The system also encourages transparency and accountability of health care centres.