It is now forty years since 179 health ministers met with WHO and UNICEF and followed a rational health policy approach to develop and consent to the Alma Ata Declaration (WHO 1978). The Declaration called for a global commitment to achieving Health for All by the year 2000. It was based on the principles of equity and community participation in health planning and policy making through an intersectoral approach. My present research builds on a 20-year research portfolio, focusing on SSA and South east Asia, to determine and address barriers to timely health service utilisation, through services that are free at point of access and supported by concurrent investments in social safety nets, education, water and sanitation and nutrition services. Specific research on achieving gains in fragile states in conflict or post conflict and emergencies. Methodologies include exploring how to actively include the voices of the beneficiaries and health workers in health service and policy planning, implementation and evaluation. The increasing voice of private sector and JPPIs in the prioritising and planning of health investments and actions is of increasing concern and research into the impact of this is relation to health sector governance is also being explored.