International Midwife Assistance is incredibly effective. IMA focuses on the project on the ground. Most all the resources go to supporting the clinic in Uganda and how to do the job better and better. The work is very direct, support moves quickly from the donors to the very needy people who are served. Also, participation by the locals in management of the project is critical. The people express their needs and priorities rather than being told by the organization what they need. Local buy-in makes the difference, the projects are shaped by the communities they serve, so that real sustainable change happens. Many women's lives are saved, and many women gain control of their fertility, through IMA's work.