For the last ten to fifteen years, a comprehensive agenda of health sector reforms and health systems development has engulfed the health system in many countries in structural and organisational changes. Experience with varying degrees and types of reforms have now been reported from many countries. In our paper, we begin by describing some important issues facing the management of RH programs in India, based on our research done in a few states over the last five years. The failures in the management of RH services are complex and multi-factorial, and cannot all be addressed through health system reform. It is therefore necessary to identify which failures in service are attributable to causes, which could be removed or changed by reform in the health system. In our paper, we identify those failures and causes which could be corrected through health system reforms and propose certain concrete steps to expedite the reforms in the health system to enable the improvement of RH services in India.