Peru has made some advances in health outcomes, particularly in the area of infant mortality, which has now reached the Latin American average. There have also been some aggregate improvements in access, with an increase in the number of trained deliveries, immunizations, and, importantly, increasing coverage of health insurance for the poor. However, despite these aggregate improvements, income and geographic inequalities persist in health outcomes and access. A key factor limiting improvements in the delivery of care by the public system is a lack of goals and standards. Goals and standards are vital to the ability to appropriately monitor health outcomes and sector performance and for informing future reforms and policy changes in the sector. A lack of data and information on the sector further impedes the ability to monitor and evaluate. Without this capacity, accountability is also undermined in the system. Further compromising accountability are weak or absent channels and processes to ensure performance and outcomes. Although some channels and processes for accountability do exist on the supply side (i.e., at the level of health care professionals and facilities) they are weak, particularly between the regulation and financing of the sector, and between policy-makers/administrators and users/patients. While additional capacity and financing issues remain, unless further progress is made on setting standards and developing channels of accountability, further capac- ity investment will not yield anticipated results. Recommendations are developed around four key areas: goals and standards, accountability, financing, and capacity.