Health care organizations on a global scale are facing unprecedented change. Whether in the US, Europe, Africa, Latin America, Asia or the Middle East, countries are facing the challenges of health reforms aiming to improve the sustainability and affordability of health care. Rapidly aging population, spiraling costs of care, the advancing biological and computational science and their clinical implications, the focus on value based care and expectations of accountability have brought center stage the importance of infra-structure and the role of management. In an increasingly globalizing world, traditional geographic boundaries are opening up to the flow of concepts, opportunities and challenges across the world.Twenty-three years ago the health care organizations in Central and Eastern Europe (CEE) were facing different, but similar issues that were challenging the prevailing infra-structure and managerial capacity. The evolution of nations in the region from client states of the Soviet Union to newly independent states unleashed new thinking about the organization and delivery of health care as well as highlighted the need for change. Issues centered on moving from a highly centralized control and command driven socialist delivery system to decentralization, and institutional accountability of health care organizations within the community setting. Questions of effectiveness and efficiency were being re-evaluated as were approaches by individual organizations to acquiring and adopting new technologies while having to deliver better quality care to people with growing expectations within financial constraints.In 1991, Project HOPE a US based NGO with a long history of engagement in international health development work responded to this challenge in Central and Eastern Europe with the creation of a health care management training program. A program designed to prepare health systems and organizations to address and manage these changes and to bring better health care to the population. The Project HOPE Health Care Management (HCM) program was developed as a corner stone of HOPE’s innovative educational portfolio.