Dear Aleem, thank you for this well articulated post. Responding to your question Where should we start?, My thoughts are: 1) Look at specific problems (e.g HIV) facing specific geographical areas 2) Find out from "action parties" what is been done about it. (effective actions not good intentions) 3) Build capacity of willing volunteers to carry out base line studies of the impacted population. (I just conducted one in Bodo, Gokana Local Govt Area, Rivers State Nigeria). The results were shocking to put it mildly. 4) Work with govt and other accountable agencies to make the solutions practical enough to reach the bottom of the pyramid. I'd like to share briefly the findings from the survey I conducted recently. Over 96% of the Bodo village population still have unprotected sex and share sharp objects freely. This percentage don't know their status but are willing to know About 4% still DON'T believe in HIV Facts about HIV efforts there. The campaigns are not done effectively in the rural areas The Heart to Heart centres are located too far away from this people The people who know their status can't afford the cost of getting to the centres. There are more youth obituaries now than ever. Quick solution: Stregthen health care policies and make them effective Decentralise the heart to heart centers to enable the villagers access care. Step up the campaigns in the villages (not just on TVs and Radios) which they DON't have access to.