 This study found that Ugandan maternal health policies were largely driven by a small elite group of senior ministry officials, members of cabinet, and health development partners, HDPs, who had more power than other actors. These elites' personal interests often conflicted with the goal of reducing maternal mortality as they tended to draft policies as service standards or program documents to avoid being exposed. To accelerate progress toward achieving the millennium development goals, it is necessary to re-engineer the policy process so that public officials cannot infuse policies with their own interests and allow ideas from the public and front-line workers to percolate upward. This article was authored by Moses Makuru, Susanne Nkuanuka, Lucy Gilson, and others.