This review suggests that the reforms should aim at higher international competitiveness, improved leadership, clearer roles and organisational safeguards to complement efforts towards greater autonomy. International competitiveness translates into more attractive positions, international recruitment and the creation of critical mass. Stronger leadership implies empowering rectors, directors, dedicated committees and leaders at all levels with respect to organisational and budgetary matters, while at the same time increasing accountability. Clearer roles and organisational safeguards make autonomy work: MHEST needs a strong and clear governance model and should actively support the process of change.