One of the ironies of the current health landscape is that, as many in the public health community moved away from vertical interventions towards broader approaches the GPG perspective has helped to fuel the proliferation of specific infectious disease-targeted programs. Yet the experiences of programs in immunization, malaria control, and tuberculosis control demonstrate that impacts are limited by sector-wide weaknesses such as lack of a cold chain, shortages of skilled personnel, insufficient resources for operating vehicles, etc. The plethora of new vertical initiatives may contain the seeds of its own failure if health systems are not generally strengthened (including the crucial human resources aspect) [20] . The danger is that the GPG agenda will promote focused interventions easy to "sell" to voters at home because they address an identifiable menace, at the expense of broader health system strengthening. One response is to identify the health system as a prime 'access good' -not a GPG itself, but a fundamental requirement for the provision of GPGs [11] .