Paper short abstract

This multi-level ethnography of the Zambian health system illustrates the importance of top-down accountability, and how it has emerged in a historically neglected sector. Maternal health care indicators are prioritised when they are benchmarked, at district and national levels.

Paper long abstract

This multi-level ethnography of the Zambian health system illustrates the importance of top-down accountability, and how it has emerged in a historically neglected sector. Maternal health care indicators are prioritised when they are benchmarked, at district and national levels. The realisation that Zambia was lagging behind African countries making progress towards MDG 5 (to reduce the maternal mortality ratio by three quarters) appears to have invoked reputational concerns and revealed inspirational possibilities. Growing prioritisation also stems from a change in incentives, with some partner funding being conditional on the proportion of deliveries attended by skilled health personnel.