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China’s rural health system has experienced major problems in adapting to the emerging market economy. The central government has recognised that it needs to take action to ensure more equitable access to services. This policy briefing paper summarises lessons from a ten year project that piloted strategies for addressing these problems in 97 poor counties, home to 46.78 million people. One dramatic outcome was a 40 per cent fall in maternal mortality. This was achieved by combining activities across a range of system components, including human resources, infrastructure, fi nancing and institutional capacity development, oriented towards meeting clearly defi ned targets for priority health programmes. This brief describes these interventions and explores evidence on the effects made on improving maternal and child health outcomes. It is based on evaluations by internal and external teams.