This paper highlights the key changes to the health system over the past 20 years, including the impact of the Organic Law on Provincial Governments and Local-level Governments, the politicization of the system, the changing balance between government and development partners in financing the health system, and the development of a sector-wide approach in the Papua New Guinea health sector. It discusses reform efforts at bureaucratic and regulatory level to address these problems. Key health sector policy issues and lessons learned over the past two decades are highlighted. The paper concludes with an examination of what is needed to 'get back to basics' through mobilizing all health sector partners with the aim of getting the health system delivering improved health outcomes.