Africa’s maternal and child health challenge demands more than ambitious targets. It requires functioning health facilities, reliable funding, skilled personnel and systems that ensure no preventable death is overlooked. The African Union’s 2026–2030 roadmap for reproductive, maternal, newborn, child and adolescent health seeks to bring these priorities together through three goals: zero home deliveries, zero preventable maternal and newborn deaths, and zero children missing routine vaccinations.
President Samia Suluhu Hassan of Tanzania, appointed AU Champion for the initiative at the 39th Ordinary Session of the Assembly in February 2026, is expected to help mobilise political leadership and accelerate implementation across member states.
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The framework offers governments a shared direction, but its success will depend on whether continental commitments translate into better care for women, newborns and children.
Three Goals, One Health-System Challenge
The first goal seeks to ensure that every birth takes place in a health facility with skilled personnel and the equipment needed to respond to complications. A 2026 study published in Scientific Reports, covering 25 sub-Saharan African countries, reported a pooled prevalence of skilled birth delivery of 67.25%, with substantial differences between countries.
Facility delivery is an important safeguard, but it cannot guarantee survival on its own. Women need access to trained midwives, emergency obstetric care, essential medicines, blood supplies, electricity and functioning referral systems. Where these services are unavailable, reaching a health facility may not be enough to prevent a tragedy.
The second goal addresses preventable maternal and newborn deaths. According to the World Health Organisation, maternal mortality remains a major global health challenge, with sub-Saharan Africa bearing a disproportionate share of the burden. Many deaths associated with severe bleeding, infections and hypertensive disorders can be prevented through timely, quality care.
The roadmap’s emphasis on accountability is therefore critical. Maternal and newborn deaths should prompt confidential reviews that identify avoidable failures and lead to corrective action. Without this process, governments risk counting deaths without addressing the conditions that caused them.
The third goal targets children who have missed routine vaccinations. These children are particularly vulnerable to diseases that immunisation can prevent, while gaps in coverage can leave entire communities exposed to outbreaks. Reaching them requires reliable vaccine supplies, accessible primary healthcare, accurate records and follow-up systems that identify children who have missed scheduled doses.
Financing Must Match the Ambition
The roadmap also raises a fundamental question about domestic financing. The 2001 Abuja Declaration committed African Union member states to allocating at least 15% of their national budgets to health. Progress towards this target has been uneven, and many health systems continue to face shortages of personnel, equipment and essential supplies.
Reproductive and maternal health services require sustained investment rather than short-term funding drives. Governments must protect essential health allocations, strengthen primary healthcare and ensure that approved budgets translate into actual spending at facilities.
The proposed integration of maternal, newborn and child health services with programmes addressing HIV, tuberculosis and malaria could help countries use existing healthcare infrastructure more effectively. Integration, however, must not dilute specialist services or leave facilities without the resources needed to deliver each intervention properly.
Accountability Will Determine the Outcome
The roadmap’s value will ultimately depend on its monitoring arrangements. Annual reporting, country-level progress reviews and a transparent continental scorecard could help identify where implementation is succeeding and where governments need to act.
But reporting must go beyond the publication of targets. It should track skilled birth attendance, maternal and newborn mortality, vaccination coverage, staffing, essential medicine availability and the execution of health budgets. Comparable data and clear definitions will be necessary to distinguish genuine improvements from changes in reporting.
Tanzania’s “Jiongeze Tuwavushe Salama” campaign could offer useful lessons for other countries. To establish its impact, however, the government should publish the indicators, time periods and methods used to assess outcomes, allowing other countries to evaluate what can be replicated.
The African Union’s Three Zeros framework provides a compelling vision for maternal, newborn and child health. Yet its achievement will not be measured by the number of declarations endorsed or meetings convened. It will be measured by whether a pregnant woman can reach emergency care in time, whether a newborn receives treatment when complications arise, and whether a child who misses a vaccination is identified and reached.
Africa has articulated the ambition. The next test is implementation: financing the commitments, strengthening frontline services and holding institutions accountable for results.
