**1. Introduction**

This chapter draws from the international agendas, Millennium Development Goals (MDGs) for 2000–2015 and the Sustainable Development Goals (SDGs) for 2015–2030 to highlight the role of leadership in promoting maternal and child health (hereafter, MCH) in sub-Saharan Africa (SSA). These perspectives set out to ensure acceptable levels of MCH outcomes across regions and countries, and within countries. For instance, under MDGs, the international agenda aims at reducing child mortality (MDG-4) and improve maternal health (MDG-5) [1]. However, only six countries (Botswana, Cape Verde, Eritrea, Malawi, Mauritius, and Seychelles) were on track to achieve Millennium Development Goal (MDG)-4, to reduce under-five mortality rate (U5MR) by two-thirds by 2015 [2]. Similarly, evidence showed many SSA countries were making insufficient progress in achieving MDG-5 of reducing

the maternal mortality ratio (MMR) by three-quarters by 2015 [3]. It is therefore not surprising that research about maternal, newborn, and child health (MNCH) remains a top priority in the post-2015 development agenda. The new development agenda specifically sets out in goal 3 to "ensure healthy lives and promote well-being for all at all ages" including reducing MMR to 70 per 100,000 live births and neonatal mortality to as low as 12 per 1000 live births and under-five mortality to as low as 25 per 1000 live births. Worldwide, SSA countries are the greatest contributors of most preventable maternal and child deaths [4], yet an improvement of MCH in this region could lead to substantial reduction of maternal and child morbidity and mortality. In sum, most SSA countries did not reach MDG-4 and MDG-5, and likely they will not reach SDG-3. Therefore, this chapter answers the following overarching question: "Why SSA countries might not achieve SDG-3?" It posits that envisioned leadership, which is of paramount importance to achieving this goal, is crucially lacking in the region.
