The content and landscape of global child health is increasingly complex. There is strong evidence for the effectiveness of local, national and institutional leadership in reducing child mortality, but this has not been a focus of global health initiatives. Interventions to strengthen health systems should include support for local leadership: building-up institutions of training, empowering national paediatric professional associations, creating opportunities for contribution and leadership at national, provincial and local level, and networks of support for staff working in child health in remote areas. In the poorer high mortality burden countries of the Pacific, to meet the clinical and public health gaps, there is a need for increases in the education of child health nurse practitioners, and development of systems of continuing professional development for paediatric doctors and nurses. Involvement in local research, especially that which contributes directly to critical issues in child health policy or strengthening national data systems builds capacity for leadership.