This Annual Report represents activities of the South African Medical Research Council from 1 April 2010 to 31 March 2011. The reporting for this annual report (2010-2011) has been extremely eventful on personal, governance and research fronts. From the small beginnings in 1969, the MRC has grown into the foremost health research institution in Africa. This is based on the excellence of the MRC's research and the reach that it has nationally and internationally. MRC researchers (10 in all) representing six of the units, played a major role in the seminal publication, The Lancet Series on Health in South Africa (Volume 374, Issue 9692, 5 September 2009). The contributing researchers highlighted the many challenges facing the health and health research communities in South Africa, as well as proposing solutions and priorities for a way forward. The MRC and its researchers are committed to playing a meaningful role in addressing these challenges. The series serves as a base for the National Department of Health's plans to address the burden of disease and ill-health facing the country.