Insufficient reductions in maternal and neonatal deaths and stillbirths in the past decade are a threat to achieving the Sustainable Development Goal 3. Overcoming the knowledge-do gap to ensure implementation of known evidence-based intervention during the intrapartum period – the period from onset of labour to immediately after childbirth – has the potential to avert at least 2.5 million deaths in mothers and their offspring annually. Our ALERT approach targets this period and will develop and evaluate a multifaceted health system intervention to strengthen the implementation of evidence-based interventions and responsive care in Sub-Saharan African hospitals, where 40-50% of all births in the region take place. The ALERT intervention will include four main components: i) end-user participation through narratives of women, families and midwifery providers to ensure co-design of the intervention; ii) competency-based training; iii) quality improvement, supported by data from a clinical perinatal e-registry; iv) empowerment and leadership mentoring of maternity unit leaders complemented by district based bi-annual coordination and accountability meetings. We will apply a gender lens to explore constraints in intrapartum care in the context of the multidisciplinary teams providing maternity care. Repositioning midwifery with its preventive, promotive and curative aspects is a cross-cutting theme. We will evaluate the intervention through a stepped-wedge design, the primary outcome being in-facility perinatal (stillbirths and early neonatal) mortality. Our nested realist process evaluation will help to understand what works, for whom and under which condition. An economic evaluation will report on scalability and costs. Our research aims to inform programming for the Sustainable Development Goals and Every Women Every Child Agendas of the United Nations to support Universal Health Coverage and patient-centred care which will be relevant beyond the project focus