Problem Vertical, disease-oriented arrangement of health service delivery. Weak gatekeeping at the primary level. Outdated health system infrastructure due to limited public investment. Inefficient use of health system resources and high out-of-pocket expenditures for patients. Low population health literacy and limited patient decision-making in care. Solution highlights A health sector reform project was launched by the Government of Azerbaijan with the financial and technical support of the World Bank, leading to the adoption of a comprehensive National Master Plan for health in 2008. A strong understanding of the political context and environment proved important in determining an acceptable pace for proposed reforms. Top-down leadership from the Ministry of Health ensured national ownership over internationally-supported reforms; strengthening the stewardship capacity of the Ministry was important. Investment in human resources, including formalizing medical training and developing new medical specializations, was critical to driving sustainable change.