PIP: Health policies worldwide have changed dramatically over the past few decades. Currently, practically every country is engaged in or considering health sector reform. The authors reflect upon those changes, highlight current trends, and identify key issues and challenges. They comment upon the concepts of health and policy and the historical developments which have influenced policy. The context in which health policies in low-income countries are formulated and implemented is discussed, including macropolitical and macroeconomic developments, health needs and determinants, financing, approaches to health planning and priority setting, and the key international health policy actors. An overview of the content of current health policy proposals in less developed countries is presented, with key issues identified for the future. Reference is made to the 1993 World Bank Development Report, Investing in Health, and other health sector reform efforts.