Key health indicators in Pakistan remain relatively intransigent. While there has been some improvement at intermediate outcome and process levels, several challenges remain, including an inattention to health systems strengthening. Within this context the NGO Heartfile has worked to bring about changes at a health policy and systems level through creation of a policy-level institutional mechanism for systems strengthening and a national health reform agenda based on systems strengthening and an intersectoral approach to health. By generating evidence, Heartfile has also assisted in strengthening the evidence–policy linkage, and in developing contemporary concepts for health policy and planning and service delivery.