The Oxfam letter seems to indicate that the efforts to hold governments and providers accountabble for results will hurt the efforts to raise more resources for health systems. I do not think these are mutually exclusive. If the MOH and service providers are held accountable for results, Ministry of Finance and donors are more likely to invest in health. As far as I know, there is not any example in which genuine and effective efforts to fight corruption and improve accountability have resulted in less funding for the sector. Rather, it is the lack of such efforts that leads to less confidence by financiers and less investment. Obviously, the health sector need certain inputs to produce results and the health financing level in many African countries is still inadequate. However, even in the currently constrained environment, there is still room to improve the performance of providers, especially public providers. This is evidenced by studies showing that in Uganda, mission hospitals produce much better results than public hospitals, although both are operating in the same difficult environment, and health professionals working in mission hospitals are paid less than those in public facilities. Yes, African health systems need more investment. But at the same time, they ALSO need more accountability.