They didn’t look at what had been happening to health systems in each developing country over the past 100 years to see what progress had been made or why it had been stalled or put in reverse. What they saw were health systems that were falling apart, that they believed had no acceptable system for determining priorites or allocating resources, and that were poorly organised and managed. They had a great sales pitch: they were going to improve ownership and accountability, increase responsiveness to local needs, improve quality and effectiveness, promote equity and cut costs. I support all those good things, just as all of you do -- who wouldn’t?