In 1997, Zambia became one of the first countries in sub-Saharan Africa to launch a national hospital accreditation program. In mid-2000, a team of researchers was organized to assess the milestones and successes of the Zambian accreditation program and document the challenges it faces. This documentation included reviewing relevant documents and budgets, interviewing key policy-makers and stakeholders, and examining accreditation survey data. To assess the performance of the program, the report referred to a framework of seven vital elements for an accreditation program's success. The research team compiled 10 milestones of the Zambia program: 1) recognizing the need to improve quality; 2) choosing the right accreditation model; 3) setting up the formal structure; 4) developing and testing standards; 5) training surveyors; 6) conducting consultative surveys; 7) refining policies and procedures; 8) developing the database; 9) conducting full accreditation surveys; and 10) interpreting findings and making accreditation decisions. They also noted that the program is at a critical juncture and urgently needs to resolve some important issues. Most important of these is to finalize the accreditation manual for hospitals, to achieve legal status and an administrative structure for the Zambia Health Accreditation Council, to communicate the results of the first round of accreditation surveys, and to determine how to assist hospitals that do not achieve accreditation status.