It reflects poor quality and high cost, a lack of mechanisms to insure against major illness and the simple inability of poor people to pay for health care. Improvements in health and health services can be reversed. The discovery of antibiotics and many effective medical technologies led to complacency during the second half of the 20 th Century. We came to expect that health would inevitably improve around the world. Events over the past few years have shown this to have been an illusion.
Renewed effort is needed to maintain public health.
The creation of a health sector is a developmental task. Previous health development strategies have not taken adequate account of the need to establish an institutional framework to translate buildings, equipment, personnel and drugs into effective services. Attempts to transfer models that work well in one environment to quite different economic and social contexts have often failed. In some countries the public sector has become degraded and health services are in severe crisis. There is growing understanding that something must be done, but it is important to avoid quick fixes that may do more harm than good.