Gabon is an upper middle income country, with reasonable spending on health, however, its health outcomes resemble that of a country that is low / low-middle income. Where has Gabon gone wrong, and what are the challenges that Gabon is facing in improving health outcomes? Gabon is an emerging economy, while it has achieved high economic development it still has not achieved living standards and health outcomes seen in upper middle income countries. Gabon faces low life expectancy (63 years), levels as seen in other low income countries. It is in an early stage of an epidemiological transition. Fertility rates remain high, and mortality rates are starting to decline. It has a high burden from communicable diseases. While HIV incidence and tuberculosis incidence has started to show positive results, Malaria incidence continues to remain high. There are cost-effective interventions available to prevent many of the communicable diseases the country faces. These interventions require multi-sector approaches, behavioral change programs, outreach services, community development, and a primary health care focus.