In their article in this issue, Lavis et al. (1) propose a framework for assessing country-level efforts to link research to policy and action, with the goal of informing dialogue about various options, strategies and approaches. They do not aim to give a systematic review of past efforts, and therefore their article does not reflect the long-standing history of this important issue. It should be noted, however, that the question of dissemination, translation, utilization and implementation of knowledge in general and of research findings in particular has been placed high on both national and international agendas for more than two decades, notably by the Commission on Health Research for Development in 1990 (2) and by international bodies including WHO, UNESCO, UNDP, the World Bank, the International Health Policy Program, the International Clinical Epidemiology Network, the Alliance for Health Policy and Systems Research and the Agency for Healthcare Research and Quality. The International Conference on Health Research for Development held in 2000 (3) concluded that, for health research to contribute effectively to equitable development, a national health research system with clearly defined goals and based on shared values is needed. Knowledge management, which includes knowledge production and utilization, was defined as one of the four major functions of such a system. Linking research to action and using knowledge for better health was also in the spotlight at the Ministerial Summit on Health Research held in Mexico City in 2004. (4) This issue of the Bulletin situates itself within the same stream of debate, but has enlarged the scope from research utilization to the broader concept of knowledge translation. We draw the following lessons from knowledge translation initiatives. The systems context is paramount. Linking research to action (knowledge translation) is an essential component of the research process (or knowledge management system), and the construction, management and maintenance of this process are the raison d'etre of the national health research system. Any attempt to landscape knowledge translation at country level should therefore be defined, framed and developed within the context of the functions of an evolving national health research system. Continuity is important. Past, current and future initiatives related to research and knowledge utilization have been trying to advise countries how to make better use of research in policy, practice and action. They have not always respected the limited critical mass and absorptive capacity in many low- and middle-income countries to undertake multiple and competing initiatives; more importantly, they have failed to build on existing efforts and to establish continuity and synergy among them. …