In low-income countries, formal health systems are stretched thin, and rural and underserved areas often lack adequate primary healthcare coverage, delaying essential interventions and leaving populations vulnerable to preventable diseases. Mozambique was no exception. The country had particularly poor health outcomes among its peers, with high rates of stunting (40%) and malnutrition, as well as one of the highest rates of child marriage and adolescent fertility in the world. Its share of deaths from communicable diseases and maternal, perinatal, and nutritional conditions was 62% - three times the global average. Only half of births were attended by a skilled professional, and the neonatal mortality rate was 27.9 per 1,000 live births. But the problem went beyond reach and access: providers had weak competencies, clinical guidelines were often not adhered to, and there were high levels of dropout for child immunization. To improve health outcomes, Mozambique would have to increase both coverage and quality of service.