A seminar organised by Oxford Policy Management in June 2017 brought together practitioners and policy makers to exchange insights on practical challenges for the implementation of social health protection (SHP) programmes, and social health insurance (SHI) in particular. Kicked-off with a presentation of recent experiences from Bangladesh and Pakistan, the discussion touched on a range of issues, including how to reach and incorporate the poor and non-poor in the informal sector, working with private providers and moving towards strategic purchasing. There was agreement that SHI means far more than raising contributions, as it is sometimes construed, and reaches into deep health sector reforms. These require careful staging, sustained political commitment and a focus on good governance, but also a continued engagement with core principles of universal health coverage (UHC), primarily equity. Nevertheless, some of the implementation challenges faced today are not new. Investing further in the existing health system learning mechanisms, formal and informal, will be key to avoid repeating implementation failures of the past.