Deaths of children under 5 have dropped by nearly 20 percent in just two years in a poor, rural district in Madagascar—despite the island nation having the lowest health-spending level in the world. This transformation echoes the strength of results seen across the last decade in rural Rwanda, where under-5 mortality dropped 60 percent between 2005 and 2010 in Southern Kayonza and Kirehe districts.

Both achievements were products of grassroots movements to build and strengthen health systems founded on principles of public partnership, data science and universal access to care for all.

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