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Louise, thanks for your comment. You are right that we need to make sure the system works properly before removing user fees. But simply ensuring that sufficient health workers are trained and deployed may not be enough. As we see from the Das et al. work, better trained health workers don't necessarily provide better service. And we know from the absenteeism studies that simply deploying health workers doesn't mean they are actually present (absentee rates in India are about 40 percent). We need to make sure that health workers have incentives to delivery quality health services to poor people. This is a tall order, but one that we should attempt to meet. Shanta