This item describes the work of the Association for Social Development in Pakistan, a non-governmental organization which was established to help implement a DFID-funded randomized controlled trial of directly observed treatment for tuberculosis. Since then it has grown significantly (it now treats more than 200,000 TB patients every year), participated in further DFID-funded research programmes, and expanded to cover a variety of other health programmes as well as tuberculosis. Capacity in both research and health service provision have been enhanced. Products such as training materials and guidelines are used by other organizations throughout Pakistan. All this work has helped Pakistan reach its targets of 70% TB case finding and 85% successful treatment outcome (approximately double the baseline figures). Novel aspects of the research and reasons for its success are listed.