This paper describes the direction of health reform taking place in Saskatchewan. The rationale underlying the shift to a needs-driven, outcome-oriented, locally controlled health system is discussed. This shift is in concert with nationally recognized directions in improving health status, maintaining standards, ensuring a more cost-effective system, and providing a continuum of services characterized by a shift from institutional to community-based services, health-related public policy and health promotion. Included is a discussion of the process of change and some of the elements of the newly constituted delivery system, such as district boards, needs assessment, core services, and provincial components such as the Health Services Utilization Review Commission and the Provincial Health Council. Some implications for issues such as stroke prevention are noted.