On May 19th, the Strategic Purchasing Africa Resource Center (SPARC) hosted a webinar in the series “Strategic Health Purchasing Progress: Changing the Conversation.” This title raises the question — changing the conversation from what to what? Conversations about strategic health purchasing often center around questions like “what works?”; “does performance-based financing work?”; “did that pilot work?” We think a more useful question is “What drives progress?” What can countries do to build strategic health purchasing functions and systems that get large-scale, sustainable results? That brings us to the topic of the first webinar in the series: Strategic Health Purchasing Progress — a Theory of Change and Practical Steps.