Government In Norway Research Articles

Critical Insights Into Public Health Interventions: Partnership, Cultural and Racial Tensions, and Vaccine Hesitancy Within Somali Communities in the Upper Midwest, USA, and Western Norway.

As the COVID-19 pandemic recedes, SARS-CoV-2 vaccination is crucial for reducing transmission and severity, but vaccine hesitancy remains a challenge. The study explored community actions and initiatives addressing vaccine hesitancy among Somali immigrant communities in cities in the Upper Midwest, USA, and Western Norway, focusing on trust factors and comparing members of the Somali diaspora in two distinct social and cultural contexts. Qualitative collective case studies were conducted, involving 14 semi-structured interviews with key informants from the Upper Midwest and Western Norway knowledgeable about initiatives designed to address SARS-CoV-2 vaccine hesitancy. Data were coded in NVivo 12 and analyzed thematically, guided by the Bergen Model of Collaborative Functioning and the Socioecological Model to identify basic and organizational themes. The findings illustrate critical sociopolitical influences on vaccine hesitancy, like racial tensions following George Floyd's murder in Minneapolis and mistrust toward the government in Norway. Effective strategies in the Upper Midwest included maintaining long-term community relationships and culturally tailored outreach and communication to reduce hesitancy. Conversely, Western Norway's less community-centric approach, focusing on translation services without deeper engagement, faced challenges in trust-building. The study highlights the essential role of culturally affirming and community-centric approaches in addressing health challenges in immigrant communities. Trust, fostered through community involvement and understanding sociopolitical contexts, is pivotal in addressing vaccine hesitancy. This research offers insights into designing and implementing effective health promotion strategies tailored to immigrant populations' unique needs. It emphasizes the necessity of integrating socioecological perspectives and community-specific interventions in health promotion practice and policy.

A landscape analysis of investors in the global breast milk substitute industry to target for advocacy.

The International Code of Marketing of Breast-milk Substitutes and subsequent resolutions (the Code) was adopted to address increases in mortality and morbidity resulting from the practices of the breast-milk substitute (BMS) industry. The lack of success in ensuring company compliance with the Code has prompted advocates to consider engaging with investors to shape the governance of BMS companies. To support these efforts, this paper aimed to identify prominent investors in the global BMS industry and explore their Code-related policies and practices. Using multiple methods and data sources, we developed a novel approach to identify and rank investors in the world's leading publicly listed BMS companies. We also examined the policies and voting behaviour of a sample of investors using publicly accessible materials from 2020 to 2022. We found that a small number of large investors, led by BlackRock and Vanguard, hold a substantial share in the global BMS industry. Of the top-10 ranked investors, only Norway's Government Pension Fund (NBIM) reported policy information relating specifically to BMS marketing. Most of these large investors also opposed the sample of public health-related shareholder proposals analysed. In addition, we identified several investors that have reported engaging with BMS companies on Code-related issues, including NBIM, Pictet, and UBS, along with several potential investor targets for future advocacy efforts, including some North American public pension funds. The inclusion of Code-related issues as part of broader policies, disclosures and regulations related to environmental, social and governance oriented investment warrants increased attention.

From party politics to governing instruments: an analysis of letters of allocation to the Norwegian and Swedish heritage agencies

ABSTRACT Over the last decade, heritage researchers have investigated the relationship between heritage and politics from various theoretical, methodological, and disciplinary angles. While much of this research has focused on international heritage governance, the results have highlighted that we need to reexamine the relationship between heritage organizations and politics at national level. Yet few studies have looked at the instruments used to transact authority between the political level of government and the state agencies that coordinate national heritage sectors. This article examines this relationship in Sweden and Norway. By intertextually analysing governing parties’ political programs and ‘letters of allocation’ issued from the government to heritage agencies, combined with a survey on the perceptions of civil servants, we show how these letters can serve as policy space where transactional authority can be practiced. The genre and political signals in the letters indicate that heritage governance in Norway is more politically responsive than in Sweden, and that governance reform is more successfully transacted through this governing instrument than heritage polices.

By-passing the National Level? Municipalities as Legal Actors in Multi-Level Governance in Norway and Sweden

This article aims at illuminating the role of Swedish and Norwegian municipalities as legal actors in multi-level governance. The research question is threefold: What is the role of Swedish and Norwegian municipalities as legal actors in relation to the European level? How do these roles affect local autonomy at the national level? What is the impact of the different affiliations at the European level, Sweden's full membership, and Norway only being a party to the EEA Agreement on these questions? Previous research has shown that municipalities have been able to magnify their influence, both externally and internally, through the intermediary of the European Union. The ability to magnify their influence will depend on the national constitutional framework and the formal affiliation to the European level, among other things. In this study, the role of the municipalities in Norway and Sweden is described by analysing the constitutional position of municipalities at the national level, the municipal influence on the drafting of EU legislation, the Nordic municipalities as actors before the ECJ and the EFTA Court and the municipal implementation of EU/EEA law. On a general level, the study found that the constitutional structures are mainly monolithic, although there are polycentric features. The ability of Norwegian and Swedish municipalities to by-pass national authorities is visible but cannot be described as strong. The role of the municipalities in acting at the European level is noteworthy, but the legal framework does not allow for a significant increase in local autonomy. The EEA affiliation of Norway implies that the municipalities have a weaker position at the European level.

Protocol for a multi-country implementation research study to assess the feasibility, acceptability, and effectiveness of context-specific actions to train and support facilitators to deliver sexuality education to young people in out-of-school settings

Comprehensive sexuality education (CSE) is a well-established component of the package of interventions required to improve adolescent sexual and reproductive health and rights. As the international community has increased its emphasis on equity and leaving no-one behind with the Agenda for Sustainable Development, attention has been drawn to the need for complementary CSE programmes to reach young people who are not in school, or whose needs are not met by in-school CSE programmes. CSE in out-of-school contexts presents unique considerations, especially those related to facilitation. In this manuscript, we present the protocol for a multi-country implementation research study in Colombia, Ethiopia, Ghana, and Malawi to assess the feasibility, acceptability, and effectiveness of context-specific actions to prepare and support facilitators to deliver CSE in out-of-school settings to defined groups of young people with varying needs and circumstances. This study will be led by the World Health Organization and the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, in partnership with local research institutions. It will be nested within a multi-country programme led by UNFPA, in partnership with local implementing partners and with financial support from the Government of Norway. This study will shed new insight into what it takes to effectively deliver CSE in out-of-school contexts, to enhance progress towards the achievement of SDG 3 “Ensure healthy lives and promote wellbeing for all at all ages” and SDG 5 “Achieve gender equality and empower all women and girls”.

The effects of a peripartum strategy to prevent and treat primary postpartum haemorrhage at health facilities in Niger: a longitudinal, 72-month study

Primary postpartum haemorrhage is the principal cause of birth-related maternal mortality in most settings and has remained persistently high in severely resource-constrained countries. We evaluate the impact of an intervention that aims to halve maternal mortality caused by primary postpartum haemorrhage within 2 years, nationwide in Niger. In this 72-month longitudinal study, we analysed the effects of a primary postpartum haemorrhage intervention in hospitals and health centres in Niger, using data on maternal birth outcomes assessed and recorded by the facilities' health professionals and reported once per month at the national level. Reported data were monitored, compiled, and analysed by a non-governmental organisation collaborating with the Ministry of Health. All births in all health facilities in which births occurred, nationwide, were included, with no exclusion criteria. After a preintervention survey, brief training, and supplies distribution, Niger implemented a nationwide primary postpartum haemorrhage prevention and three-step treatment strategy using misoprostol, followed if needed by an intrauterine condom tamponade, and a non-inflatable anti-shock garment, with a specific set of organisational public health tools, aiming to reduce primary postpartum haemorrhage mortality. Among 5 382 488 expected births, 2 254 885 (41·9%) occurred in health facilities, of which information was available on 1 380 779 births from Jan 1, 2015, to Dec 31, 2020, with reporting increasing considerably over time. Primary postpartum mortality decreased from 82 (32·16%; 95% CI 25·58-39·92) of 255 health facility maternal deaths in the 2013 preintervention survey to 146 (9·53%; 8·05-11·21) of 1532 deaths among 343 668 births in 2020. Primary postpartum haemorrhage incidence varied between 1900 (2·10%; 2·01-2·20) of 90 453 births and 4758 (1·47%; 1·43-1·52) of 322 859 births during 2015-20, an annual trend of 0·98 (95% CI 0·97-0·99; p<0·0001). Primary postpartum haemorrhage morbidity and mortality declined rapidly nationwide. Because each treatment technology that was used has shown some efficacy when used alone, a strategic combination of these treatments can reasonably attain outcomes of this magnitude. Niger's strategy warrants testing in other low-income and perhaps some middle-income settings. The Government of Norway, the Government of Niger, the Kavli Trust (Kavlifondet), the InFiL Foundation, and individuals in Norway, the UK, and the USA. For the French translation of the abstract see Supplementary Materials section.

Partisanship and science advice: Do the right prefer economists and the left social scientists?

It is often claimed that parties on the left and right have different preferences for scholarly knowledge. However, little research has addressed whether partisanship actually matters for science advice preferences, particularly in the European setting. Drawing on original data on governmental appointments of academic scholars to more than 1400 public advisory commissions in Norway between 1969 and 2020, this article examines whether the left–right divide matters for cabinets’ consultation of economists and social scientists. The findings reveal that left-wing governments in Norway have consulted scholars of social science—such as sociologists and political scientists—more frequently than right-wing governments. In contrast, partisanship seem to matter less for the consultation of economic scholars, as economists have been extensively used as advisors by both blocs in the period studied. Overall, the article contributes theoretical and empirical knowledge to the politics of science advice.

Effects of a school-based intervention on levels of anxiety and depression: a cluster-randomized controlled trial of the MindPower program in ten high schools in Norway

BackgroundThe previous decades have shown increased symptoms of depression and anxiety among adolescents. To promote mental health and reduce mental illness, the government of Norway has, as in other countries, pledged that all schools must incorporate life-skills education. We report results from an evaluation of MindPower, a modification of the Coping With Depression (CWD) course, delivered universally in the classroom to secondary high school students, aged 15–16 years, in one county in Norway. The aim of the study was to evaluate the effect of MindPower on symptoms of depression and anxiety.MethodsWe utilized a two-groups` delayed intervention design where 110 first year high school classes were randomized into one of two intervention groups (IG1 and IG2). IG1 participated in MindPower while IG2 served as a control group for four months until the intervention started also in this group. IG1 and IG2 responded to questionnaires before and after the eight weeks course, at the start of the first and the second booster session, and at the five months follow up. Questionnaires, including online versions of the Hopkins Symptom Checklist (SCL-8) and the Reynolds Adolescent Depression Scale (RADS-2:SF), were administered to 1673 out of a total of 2384 students. SCL-levels were also compared with those from a large population study (UngData).ResultsAccording to mixed model analyses, SCL-8 and RADS-2:SF showed significant baseline differences between IG1 and IG2. In IG1 and IG2, both SCL-8 and RADS-2:SF showed a small but significant increase in mean scores throughout the study period, with markedly lower mean scores among boys. The SCL-levels were first lower for both girls and boys and then after the completion of MindPower the SCL-levels, equal to the SCL-levels in UngData.ConclusionsNo effects of the intervention were found. This large universal school-based trial suffered from considerable drop-out of participants. Experiences from implementation and evaluation of universal mental health promotion and preventive school interventions are thoroughly discussed, including, preparation, resources, support, time, realistic expectations, teacher selection and training, implementation, research designs and more. Several empirically based, practical advices are presented.Clinical Trial registration27/08/2018. Registration number NCT03647826.

A Review of the Active Management of Norway's Government Pension Fund Global

A Review of the Active Management of Norway's Government Pension Fund Global

Comparative Analysis of Schumpeter and Dahl: A Case Study of Norway's Government

Comparative Analysis of Schumpeter and Dahl: A Case Study of Norway's Government

Международно-правовая охрана тюленей

The article gives a brief description of the various species of seals. In the city of Arkhangelsk there is a monument to a seal. Two species of seals live in the coastal waters of Russia: the Steinger seal and the European seal. They are listed in the Red Book.&#x0D; The article analyzes the conventions and agreements on the protection of seals: Convention for the Conservation of Antarctic Seals 1972, the Agreement on the cooperation in research, conservation and management of marine mammals in the North Atlantic 1992, the Agreement between the Government of the USSR and the Government of Norway on Measures to regulate fishing, sealing and protection of seal stocks in the Northeast Atlantic 1957. The decisions of the 51st session of the Joint Norwegian–Russian Fisheries Commission are analyzed. The article ends with an outline of the contribution of the Russian Federation to the rational seal fishery.

Transforming socio-technical configurations through creative destruction: Local policy, electric vehicle diffusion, and city governance in Norway

Transforming mobility systems in sustainable directions will likely rely on several niche-innovations outperforming incumbent regimes that support non-sustainable ways of upholding personal mobility. One prominent driver in these developments is policy, which through creative destruction could serve to destabilise regimes surrounding internal combustion engine vehicles (ICEVs) while also promoting regimes surrounding battery-electric vehicles (EVs). The diffusion of EVs receive substantial attention in policymaking and research, and EV policies are studied extensively in a range of scholarly disciplines. Most studies, however, tend to focus on the role of national-level policy. In contrast, this study explores how local policy can promote the diffusion of EVs. Specifically, we discuss how creative and destructive elements of local policy in two Norwegian cities might have enhanced the relative advantage of EVs through shaping socio-technical configurations that surround the EV niche and the ICEV regime. We find that local policy can enhance the relative advantage of EVs in many ways, especially through shaping infrastructure, user practices, and normative rules. The latter could in particular take research on EV diffusion further, by increasing our understanding of the controversy of EVs even in markets with high diffusion.

Managing Animal Welfare in Food Governance in Norway and Sweden: Challenges in Implementation and Coordination.

Simple SummaryAnimal welfare is an important issue in society, and having a strong animal welfare legislation is per se important. However, in addition to a strong legislation, it is necessary to create a system that can enforce the legislation and to have a public administration in place in order to achieve a coordinated implementation. Both Norway and Sweden have received some criticism for their coordination of animal welfare control efforts. However, they have reacted to this criticism in different ways. Norway has centralised the coordination, making the Norwegian Food Safety Authority (NFSA) solely responsible for animal welfare control. Sweden, on the other hand, has instead focused on developing better guidelines to be used by the 21 regional County Administration Boards in order to improve uniformity. In this study, we have compared the Norwegian and Swedish ways of coordinating animal welfare control and identified challenges and relevant organisational preconditions for achieving uniform and consistent compliance. The results show that Sweden’s organisation may need more coordination between multiple organisational units, while Norway has better preconditions for achieving uniformity in animal welfare administration. However, in Norway, the safeguards for the rule of law might be an issue, due to NFSA acting as de facto “inspector”, “prosecutor” and “judge”.A key issue in food governance and public administration is achieving coordinated implementation of policies. This study addressed this issue by systematically comparing the governance of animal welfare in Norway and Sweden, using published papers, reports, and legal and other public information, combined with survey and interview data generated in a larger research project (ANIWEL). Governing animal welfare includes a number of issues that are relevant across different sectors and policy areas, such as ethical aspects, choice of legal tools, compliance mechanisms and achieving uniform control. Based on the challenges identified in coordinating animal welfare in Norway and Sweden, relevant organisational preconditions for achieving uniform and consistent compliance were assessed. The results showed that Sweden’s organisation may need more horizontal coordination, since its animal welfare management is divided between multiple organisational units (Swedish Board of Agriculture, National Food Agency and 21 regional County Administration Boards). Coordination in Norway is managed solely by the governmental agency Norwegian Food Safety Authority (NFSA), which has the full responsibility for inspection and control of food safety, animal health, plant health, as well as animal welfare. Thus, Norway has better preconditions than Sweden for achieving uniformity in animal welfare administration. However, in Norway, the safeguards for the rule of law might be an issue, due to NFSA acting as de facto “inspector”, “prosecutor” and “judge”.

Long‐run Effects of Local Government Mergers on Educational Attainment and Income*

AbstractLocal government mergers are an important policy issue in many countries, yet empirical evidence of the effects of merging and of local government size on the production and quality of local public services is scarce. We use the spatial and temporal variation in forced mergers between cities and their surrounding local governments in Norway to provide quasi‐experimental evidence of the effect on long‐run student outcomes. We find that the mergers increase students’ educational attainment by about 0.1 years and income by about 4%, suggesting that mergers improve long‐run student outcomes through increased school productivity.

Domesticating circular economy? An enquiry into Norwegian subnational authorities’ process of implementing circularity

ABSTRACT This article focuses on the introduction of the concept of circular economy into a Norwegian context by concentrating on two levels of subnational authorities against the backdrop of the national level. By drawing on recorded qualitative data collected in the region of Trøndelag and Oslo, we deploy the concept of domestication to analyse how the diffusion of CE as a political, future-oriented concept is appropriated, i.e. through symbolic, practical and cognitive dimensions. Additionally, we consider the performativity of the future as a component in the adoption of the concept. Our findings suggest that the adoption of CE at these levels of governments in Norway is an ongoing process where the co-construction of the dimensions happens concurrently. Relating to the future, the national level takes a translative approach and goes after an increased interest and activity by private actors. At the first subnational level, in the case of the Trøndelag county, the public sector operates as a channel between knowledge of best practices and private actors who can mobilise action. Meanwhile, at the third subnational level, we find at the municipality of Trondheim, a public authority that proactively changes specific practices and regulates (or normalizes) the CE through their own means.

SCALAR POLITICS AND NETWORK RELATIONS IN THE GOVERNANCE OF HIGHLY SKILLED MIGRATION

ABSTRACT Recently, migration scholars have started to examine the roles of nonstate actors in migration governance. This is also the case in highly skilled migration, as they try to shape local and national migration policies to attract and retain global talent. This article brings together literatures on scalar politics and policy networks to investigate the roles of nonstate actors in highly skilled migration governance in Norway’s petroleum industry. The article makes three arguments. First, national state actors have clearly delineated the spheres of influence in highly skilled migration policymaking. These boundary-setting practices ensure that the state remains in charge of key domains related to international migration and employment. Second, place shapes the (re)scaling and networking practices of public and nonstate actors. Third, new, nonstate actors have emerged that transcend scalar hierarchies through public-private partnerships. The most influential state actors, however, refrain from these alliances to remain neutral in politically charged issues.

Best Practices and Lessons Learned in the Implementation of Global Framework for Climate Services—Adaptation Programme in Africa: Tanzania-Experience

This paper provides an analysis and a description of the best practices and lessons learned in the implementation of the Global Framework for Climate Services Adaptation Program in Africa (GFCS-APA) focusing on Tanzania country’s activities. GFCS-APA was the first multi-agency initiative implemented under the Global Framework for Climate Services (GFCS) in two African countries, namely Tanzania and Malawi with funding from the Royal Government of Norway. In Tanzania, the programme was implemented in two phases from the year 2014 to 2021 in the three pilot districts of Kondoa, Longido and Kiteto located in Dodoma, Arusha and Manyara regions, respectively. The overarching goal of the programme was to enable better management of the risks caused by climate variability and change at all levels, from end-users to policy level, through development and incorporation of science-based climate information and prediction services into planning, policy and practice. The programme focused on bridging the gap between providers and users of climate information and products through development of user-driven climate services for food security, health and disaster risk reduction. This paper aimed to analyze lessons learned and best practices in the course of the implementation of the GFCS-APA phase I and II in Tanzania. A qualitative approach was employed to analyze the lessons learned and best practices, by extracting them and exploring further on their contribution to the enhancement of climate services, as well as their applicability and potentiality for scaling out in other regions within Tanzania, and in other countries. The results indicate the identified best practices and lessons learned contributed significantly in enhancing climate services, particularly in understanding, availability, accessibility, utilization, ownership and sustainability of climate services among users (farmers and pastoralists) of various gender, as well as intermediaries and decision-makers. Results also indicate the lessons learned and the documented best practices could influence the effectiveness of climate services in other areas, to address existing challenges in access, uptake and sustainability of climate services. The best practices and lessons learned could be considered for integration in the future projects or operational activities in other regions within the country and other countries, particularly in the developing world, including Sub-Saharan Africa.

Knowledge Claims and Struggles in Decentralized Large Carnivore Governance: Insights From Norway and Sweden

Keywords: large carnivore management1, pastoral communities2, decentralization3, knowledge spheres4, conflicts5. Ensuring sustainable carnivore populations while simultaneously sustaining active and viable pastoral communities creates conflicts that are difficult to resolve. This article examines how different knowledge systems meet and interact in large carnivore governance in Norway and Sweden. Drawing on a broad range of sources, including observations in meetings, public documents, reports and interviews, in addition to local and national newspaper clippings and Internet sites, we study two processes of regional carnivore management (Nordland, Norway and Jämtland, Sweden). We explore how different forms of knowledge have been mobilized, reproduced, transferred and legitimized in policies and regulations in these two processes. Further, we examine the interplay between scientific and experience-based knowledge at different levels and scales in both of the countries. In Norway, ‘clear zoning’ has been established as a basic management instrument to achieve national ‘population goals’ for carnivores. We show how the locally situated knowledge – in our account represented through the Regional Large Carnivore Committee, which includes political parties’ and Sami Parliament representatives – experiences real barriers by being overrun by the national Ministry of Climate and Environment, in their process of revising the carnivore management plan. In Sweden where the management of large carnivores is devolved to regional authorities and stakeholder-based Wildlife Management Delegations, attempts to regionally solve conflicts are often overthrown by the national environmental protection agency or through court cases initiated by the environmental movement. Hence, compromises that potentially could solve conflicts are undermined. The analysis shows that while carnivore governance in both countries are founded on decentralized management authority at the regional level, local actors struggle for their views, experiences and knowledge to be acknowledged and counted as valid in the management process. While the decentralized management model opens for inclusion of different knowledge systems, this system has yet to acknowledge the challenges of knowledge being dismissed or marginalized across governance levels and scales.

Multi-stakeholder initiatives, policy learning and institutionalization: the surprising failure of open government in Norway

ABSTRACT Global multi-stakeholder initiatives (MSIs) promote policy to national governments according to a voluntary model that is often criticized for failing to produce formal policy outputs. This article proposes an analytical framework for policy learning to understand how MSIs can influence the informal institutionalization of policy in sub-national institutions, and formal policy outputs by extension. This framework is applied to Norwegian participation in one such MSI, the Open Government Partnership, and tests for the influence of those processes on the formal and informal institutionalization of policy related to civic participation and digital technology. Results validate a policy learning framework for assessing MSI contributions to informal policy outcomes, highlight the important role of institutional context in limiting the influence of this mechanism, and provide the foundations for developing a predictive theory of MSI policy influence through learning.

Saving Mothers, Giving Life: It Takes a System to Save a Mother (Republication).

Ending preventable maternal and newborn deaths remains a global health imperative under United Nations Sustainable Development Goal targets 3.1 and 3.2. Saving Mothers, Giving Life (SMGL) was designed in 2011 within the Global Health Initiative as a public-private partnership between the U.S. government, Merck for Mothers, Every Mother Counts, the American College of Obstetricians and Gynecologists, the government of Norway, and Project C.U.R.E. SMGL's initial aim was to dramatically reduce maternal mortality in low-resource, high-burden sub-Saharan African countries. SMGL used a district health systems strengthening approach combining both supply- and demand-side interventions to address the 3 key delays to accessing effective maternity care in a timely manner: delays in seeking, reaching, and receiving quality obstetric services. The SMGL approach was piloted from June 2012 to December 2013 in 8 rural districts (4 each) in Uganda and Zambia with high levels of maternal deaths. Over the next 4 years, SMGL expanded to a total of 13 districts in Uganda and 18 in Zambia. SMGL built on existing host government and private maternal and child health platforms, and was aligned with and guided by Ugandan and Zambian maternal and newborn health policies and programs. A 35% reduction in the maternal mortality ratio (MMR) was achieved in SMGL-designated facilities in both countries during the first 12 months of implementation. Maternal health outcomes achieved after 5 years of implementation in the SMGL-designated pilot districts were substantial: a 44% reduction in both facility and districtwide MMR in Uganda, and a 38% decrease in facility and a 41% decline in districtwide MMR in Zambia. Facility deliveries increased by 47% (from 46% to 67%) in Uganda and by 44% (from 62% to 90%) in Zambia. Cesarean delivery rates also increased: by 71% in Uganda (from 5.3% to 9.0%) and by 79% in Zambia (from 2.7% to 4.8%). The average annual rate of reduction for maternal deaths in the SMGL-supported districts exceeded that found countrywide: 11.5% versus 3.5% in Uganda and 10.5% versus 2.8% in Zambia. The changes in stillbirth rates were significant (-13% in Uganda and -36% in Zambia) but those for pre-discharge neonatal mortality rates were not significant in either Uganda or Zambia. A district health systems strengthening approach to addressing the 3 delays to accessing timely, appropriate, high-quality care for pregnant women can save women's lives from preventable causes and reduce stillbirths. The approach appears not to significantly impact pre-discharge neonatal mortality.