This article outlines the findings from a contemporary review of the evidence base on system leaders and system leadership. This article provides analysis, commentary, and insights about system leaders and system leadership based on a review of the current evidence. The review also includes insights from country experts and offers country-specific examples of system leaders and leadership in action. This is not a systematic review of the literature but rather an overview of findings from a contemporary exploration of the evidence base, over a specified period (2010-2020). The review encompasses peer-reviewed articles, books, chapters, and the grey literature. It focuses on the roles, responsibilities, actions, functions, and outcomes of system leaders and highlights the origin of the system leadership concept.