A lot is happening in this space of “Health systems strengthening” in the Pacific with a focus on Primary care and some specialties like Palliative care put aside, even ignored despite a population health status that suggests palliative care should be alongside primary care. From the perspective of a primary care clinician living and working in Samoa, I would like to share some thoughts into this space around why palliative care should be a key focus in strengthening health systems in pacific island nations like Samoa.