I liked all your comments, Lant. But let’s try to dig deeper into the reality. First of all, there is no assertion, or even presumption, that the public sector has a superior technology for producing health care services. The point being made was that there is no good (feasible) alternative to public provision in much of rural/remote/tribal areas of the country as the conditions are not ripe yet. Even if one were to disagree with this, the fact remains that the health policy makers in the country have made a conscious decision to go down the path of strengthening public health facilities in the rural areas. One needs to treat this as a ‘given’ or something that’s non-negotiable. The NRHM -- by investing in public health facilities -- has succeeded in making some difference on the ground: a typical primary health centre in Bihar where daily OPD visits were in single digits has seen visits climbing to over 200, post-NRHM. I am not advocating any “classical strategical blunder” of pouring more resources into an “ongoing rout.” All I am saying is that since the government is pouring greater resources into the sector -- at a time when so little of public funds (a little over 1% of GDP) have been going into it -- and there is so a great need need for it, it must also think of better ways of translating these resources into results. The question then is: how does one improve the efficiency and quality of public health service delivery? In other words, how do we get public health facilities managed professionally? Broadly, there are two approaches: having well-defined and better enforced systems of authority and accountability (the way TN has done) or taking the route where funding is done on the basis of results/performance. Making either of these approaches work will of course require supporting institutional and other reforms. One of the possible paths could be to create a quasi-government entity at state, or even at district, level that runs the provision of health services professionally. In this kind of scenario, your main issue of “getting suitably qualified and appropriately motivated human being into place” could be handled by providing any combination of extrinsic and intrinsic motivation that works. Such a scenario is not totally far-fetched but does require some innovative moves. Regard this as one of the “genuinely new and innovative approaches” that you suggest states should try, just as they are trying RSBY.