A common approach to reform has been to identify problems in the system which cause inefficiencies, ineffectiveness, and insufficient coverage, and then define solutions. The approach applied in Zambia has rather been to define standards for a cost-effective system which would be financially sustainable, and then to determine how to move from the existing system to the more cost-effective one envisioned. This has resulted in an approach notable for its comprehensiveness, the extent to which every aspect of the system has been open to consideration, and the unique partnership formed with the donor community. Zambia's health care system offers tangible evidence that national commitment can spur the transition from rhetoric to actual reform.