"Countries striving to provide universal health care coverage and achieve the Millennium Development Goals are increasingly implementing close-to-community (CTC) health services. There is a need for health systems to understand the context and conditions in which these services operate in order to realise their potential. Working with some of the most respected and widely quoted close-to-community services we will identify how CTC services can best be delivered and document generic lessons for system development and strengthening. Building on a strong and exciting partnership, we aim to maximize the equity, effectiveness and efficiency of CTC services in rural and urban slum areas of six countries: Indonesia, Bangladesh, Mozambique, Ethiopia, Kenya and Malawi. We will conduct a situation analysis to guide development of research frameworks. This will be adapted and applied to produce a comprehensive inventory of potential constraints for CTC services. This baseline will guide cycles of interventions for service improvement. We will build capacity on three levels: at practitioner level to enable improved service to be delivered; at researcher level to empower the next generation of researchers in health systems; at policy level to enable transfer of research experience into policy, planning and practice. The interventions will be assessed using the framework to find out what works, in which context and why and what can be improved. Our impact on equity, efficiency and effectiveness will be evaluated using a combination of outcome and process indicators and multiple methods. Analyses will include community and policy maker perspectives and elaboration of CTC providers’ voices in health planning. Through conducting a robust inter-country analysis we will build much needed transferable policy and practice recommendations to strengthen CTC services and empower providers, researchers and policy makers."