Local engagement has been crucial for promoting and improving maternal, neonatal, and child health in Ethiopia in recent decades. The centerpiece program underlying advancements is the Health Extension Program, the impact of which can be seen on improved indicators across a range in services ranging from family planning, to antenatal care, in-facility delivery, and postnatal care. While disparities persist subnationally, Ethiopia’s health system has been optimized to include rural populations, contributing to shrinking or mitigated equity gaps between urban and rural communities. Ethiopia’ rapid trajectory from high baseline mortality levels make the country a strong Exemplar, yielding learnings that have relevance for peer nations looking to replicate this success.