Improving the efficiency of livestock production is a fundamental challenge facing humanity, and maintaining the health of livestock is key to ensuring this. Systems for farming small ruminants such as sheep must meet the global need for food security while being economically, environmentally and socially sustainable. Nowadays, sustainable agriculture is threatened by a global reduction in land resources and water and hitherto irresponsible use of drugs and chemicals. This chapter describes efficient small ruminant livestock production, examining its ecological impact and the effects of advances in genetic improvement and other technologies. The chapter describes how managing the health of sheep flocks through health planning, nutritional management and ensuring biodiversity can ensure efficient production, and includes case studies addressing lamb growth rates and controlling parasitic infections. The chapter concludes that effective biosecurity, good nutrition, protection from infectious pathogens and endemic disease management in sheep flocks are essential for global food security.