In 2008 the South Africa health sector was in crisis with an estimated 300,000 deaths from a delayed response to HIV, increasing health inequities, and a public sector unable to cope with the huge burden of disease. Three major reviews of the South African health system were separately commissioned: by the Development Bank of Southern Africa, by the Lancet Journal, and by the Ministry of Health. The findings of these reviews, published in 2009, provided a baseline for major new policy initiatives launched that year. Under the leadership of the Minister of Health, the government laid out a Ten Point Plan for transforming the health sector, announced a massive scaling up of the response to HIV, and set ambitious targets with the Presidency for improving health and the health system. By 2013, the country had seen unprecedented improvements in life expectancy, major reductions in some aspects of child and adult mortality, and had started implementing an ambitious set of health reforms to achieve universal coverage of high quality, accessible health services.