USAID’s ten-year vision is rooted in health system strengthening (HSS) approaches that are based on whole-of-society engagement, locally-driven solutions, and social and behavior change. Our new vision shifts the focus from strengthening individual functions—inputs or building blocks—of the health system to a focus on the health system outcome goals of equity, quality, and resource optimization. It also sets priorities and direction for USAID’s investments in HSS and represents a significant step forward in programming.