Joanna Schellenberg and co-authors of this editorial, published in BMJ Global Health, comment on a study published in the same edition of the journal entitled: ‘Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap‘. The authors of that study suggest that all childbirth care services should be moved to hospitals in all countries, combined with improvements in (1) the quality of care provided in these facilities; (2) transportation from home to hospital; and (3) continuity of care through hub-and-spoke arrangements.

The editorial’s authors agree with the need to shift childbirth care to higher level facilities, but call for an approach that responds to specific local needs and focuses on the capacity of the midwifery providers. Moreover, they highlight, a re-design must be done with a view to strengthening district level health systems in a sustainable and crisis-resilient manner.

Authors underline the need for the continuous involvement of end users, that is women and their families, as well as health care providers and local health managers, in discussions surrounding improvements to ensure these are fit for purpose and for context.