In 1983, Project HOPE was invited by Zhejiang Medical University to collaborate in developing a neonatal intensive care unit (NICU) at the Children's Hospital in Hangzhou, China. The initial approach involved renovating facilities, purchasing equipment and supplies, placing short-term consultants in the unit as teachers, and bringing selected leaders to the United States for brief fellowships. An evaluation at 18 months disclosed poor organization and leadership, inconsistent clinical care, and unsatisfactory utilization and maintenance of facilities and equipment. Therefore the strategy was revised to include long-term physician and nursing consultants, establishment of ties with HOPE Biomedical Engineering projects, and development of formal education programs. The unit was transferred to the Chinese after 4 years and an evaluation 1 year after transfer revealed an actively functioning independent NICU with evolving effective leadership, established purchasing and preventive maintenance programs, and continuing formal education activities. Unsatisfactory progress was found with the development of a transport system, some laboratory capabilities, adherence to admission and discharge policies, and various other administrative issues. Although the goal of establishing an independent NICU was realized, perhaps the most lasting accomplishment was the establishment of a facility and a format for development of a transportable education program aimed at improving neonatal care practices throughout a larger region of China.