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The contribution of the District Clinical Specialist Teams (DCSTs) to improving maternal and child health outcomes in South Africa, through strengthening the four pillars of clinical governance, is reflected in innovative work presented at a ‘Promising Practices’ symposium and at various conferences. Of the 24 identified DCST innovations, 21% reflected the clinical effectiveness pillar, 17% clinical risk management, 41% staff development, and 21% user-related considerations. In order to ensure scale-up, the submitted best practices/ innovations were reviewed using the World Health Organization quality standards and ExpandNet parameters for likely scalability. Here we describe one case study from each pillar, illustrating the contribution of the innovations to improved patient outcomes. The development and scale-up of innovations needs to be institutionalised and must include effective support and action from the relevant health managers.