Thirty years since the Alma Ata declaration, and all four speakers agree that "We need to start looking for new solutions" if basic health systems can rise to the new global heath challenges. This session highlights how innovations are taking place as different actors are responding to different pressures. The role of the informal health sector in Bangladesh and the rapid changes in the health systems in South Africa in response to lack of human resources for the scale up of ARV (Anti Retro Viral) as specific perspectives are presented. The experience from health promotion efforts in South Asia shows the relation between socio political changes, strengthening governance systems and health.