This discussion paper brings together evidence and experience from around the world focusing on making health systems more gender responsive. There is a need to examine the various barriers as well as opportunities in order to make health systems work better for women, which has been a special concern for several decades now, by using a gender equality and health equity perspective. The paper uses a framework that combines WHO's six building blocks for health systems and the primary health care reforms propounded in the World Health Report 2008 on primary health care. Furthermore, the paper provides examples of what has worked and how, and ends with an agenda for action to strengthen the work of policy-makers, their advisers and development partners as well as practitioners as they seek to integrate gender equality perspectives into health systems strengthening, including primary health care (PHC) reforms.