Sub-Saharan Africa confronts wide ranging challenges, reflecting the diversity of progress and needs across the region. Weak institutions, inadequate attention to the emerging non-communicable disease crisis, problems around defining healthcare benefits and beneficiaries, and donor exit exemplify the myriad issues. Some are unique to the region, while others mirror obstacles elsewhere. Aceso Global’s efforts in the region include rethinking health system structure, raising efficiency in service delivery and supply chain management, institutional strengthening and anti-corruption, and supporting sustainability and donor transition.