Although new technologies and public and private financial commitments have powered tremendous advances in global health in recent years, insufficient human capital and the lack of strong institutional systems limit progress. Countries that have done the most to improve the health of their people have benefited from determined political leaders who set aspirational goals, mobilize resources, and implement cross-sector strategies. Whether it is preventing malaria, reducing child mortality, or broadening access to primary care, committed leadership and effective management lie at the heart of change.