From examination of studies and reports published between 1995 and 2009, weidentifi ed the effects of health-system reforms in the 1990s on the performance of programmes to control tuberculosis. We also reviewed evidence from reports published between 1995 and 2009, NTP reviews undertaken during 2006–09, and case studies on health systems and tuberculosis control during 2009–10. This information was used to identify challenges faced by health systems, within and beyond tuberculosis control, and innovations made to address these challenges, both globally and in individual countries.