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I can't agree with you more about the hard choices, although from my experience of working in "the field", it's even harder to say to the parents "sorry, your daughter's heart surgery is not our country's health priority now". But in reality, that is how most countries have dealt with allocation of resources - by focusing on the most immediate needs. Not sure if those were deliberate or instinctive decisions. We actually did some research (unscientific) and came up with a few health, socioeconomic and demographic characteristics a country would need in order to support sustainable pediatric cardiac services and economic development combined with good health and education policies were at the top of the list. As for your point about doing more with the existing health resources, I have read both of those posts and I don't agree as much. There is acute lack of variety of medical specialists around the world and your blog post about India's quality of care proves it - poor regulation and very little time to spend with patients (because there are not enough doctors) result in bad quality of health service. Ultimately, it's a fine balance between quality and efficiency and the hard truth is that unless there are strong policies in place, many countries suffer from inefficient public sector and poorly regulated and poor quality private sector. And there will be no one size-fits-all approach, each country will have to figure out their own way to provide wider coverage for its citizens. As you quote Ms Manuelyan Atinc in your blog post, Better health should be what we’re all about. I really enjoy your blog posts, thank you!