The most relevant aspects of nutritional, reproductive and health management are the three pillars of flock efficiency, production and sustainability regarding the intensification of production in sheep and goats. In small ruminants, reproductive management is dependent on seasonality, which in turn depends on breed and latitude. Nutrition represents the major cost for flocks and greatly affects their health, the quality of their products and their environmental impact. High-yielding sheep and goats have very high requirements and dietary intake, requiring nutrient-dense diets and sophisticated nutritional management that should always consider the strong interrelationships among nutrition, immunity, health, reproduction, housing and farm management. The reproductive pattern is to a great extent assisted by out-of-season breeding, facilitating genetic improvement schemes, and more recently by advanced reproductive technologies. In highly producing systems, nutrition, genetic and hazard factors assume a complex interrelationship. Genomic and management improvement research and technological innovation are the keys to sustain sheep and goat production in the future.