Why do some low and middle income countries manage to achieve better health outcomes while others fail? What factors drive improvements in the health system and in access to primary health care? These questions are relevant today as in 1985 when the Rockefeller Foundation published what was to become a seminal report - Good health at low cost. This new edition draws on a series of new case studies from Bangladesh, Ethiopia, Kyrgyzstan, Tamil Nadu and Thailand provides fresh insights into the role of effective institutions, innovation and country ownership in catalyzing improvements in health. New challenges such as increasing urbanization, a growing private sector and an upsurge in non-communicable diseases suggest that both learning from the past and new thinking are required to strengthen health systems. This edition provides both and is a vital source for academics, policy-makers and practitioners grappling with how to improve health in low and middle income countries.