This essay is part of a PLoS Medicine series on maternal, neonatal, and child health in Africa.
This PLoS Medicine series began by outlining how much we fail mothers, newborns, and children in Africa by not implementing effectively what we know saves lives and improves health. It is clear that countries in Africa are falling behind not only on improving maternal, newborn, and child health but on the Millennium Development Goals 4, 5, and 6 more generally. Why is there such a wide gap between what we know and what we do? While technical knowledge about what could be done is available, actual implementation is neither straightforward nor easy in the often difficult circumstances on the ground. The many competing priorities—along with limited logistic capacity, a lack of political will, and inadequate infrastructure—also constrain the extent to which effective health packages are delivered to those who need them most.