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Similar to developing countries elsewhere, during the 1990s, Central American countries faced pressures to improve the performance of their health systems. In most countries, there was a consensus that the systems were failing to live up to their potential. Rather than take on system-wide change, each country opted to step into reform through launching innovations to address specific problems or deficiencies in a particular program, function or intervention of the system.'Health Systems Innovations in Central America' reports on how these experiences fared a hospital in Panama, a nutrition program in Honduras, primary care extension in Guatemala, a subset of hospitals and primary care units in Costa Rica and a social security-managed health care program in Nicaragua. The studies report on the performance of the innovations, the policy environment in which they were developed as well as nuts-and-bolts features and processes incorporated into their design and implementation.