Mr. Ahmad, When I look at your picture I see a father to us. Thank you so much for your gracious submission. It was so eloquent and yet full of strength and zest. I had the opportunity to tour clinics and hospitals in various African countries. I concur with you that if governments in partnership with donors build a good health infrastructure we can be well on our way. That is the most ideal situation. Let us go back to all the news bulletins on allafrica.com...the situation is dismal. However, I did manage to learn about some past sub-Saharan African health care systems that once were the envy of the African continent. Under the late Hon Minister of Public Health in Nigeria, Prof Olikoye Ransome Kote, the country enjoyed the foundations of what could have been one of the best public health infrastructures...in Africa. Admittedly, since I am forbidden to use the "C" word in this forum, these infrastructures and gains are almost totally lost. What is evident in the 90's and the 21st century is the rising IMR, MMR, Under 5 mortality and decreasing LE. In some communities in Nigeria the MMR stands at 1500 mothers per 100,000. In March 2003, shortly before my first official visit to Nigeria, Prof collapsed and was found dead in his hotel room while attending a WHO mtg in 2003 in London. Under successive regimes not much has changed even though some indicators like vaccinations in Primary Health Care improved somewhat. They still face massive challenges. Prof was known as the father of Primary Health Care Strategies and Medicine. I adore professor with all my heart. A friend invited me to meet this famous/modest Minister of Health. Because of his bold speech on Primary Health Care Strategies on April 2, 1998 at 6pm at the University of South FL in Tampa my life was never the same. He told me I was the right one that will transform Africa. This professor had such a profound impact on my life for the 1 hr in that lecture hall that 4 mths later I was admitted in the Epidemiology/Infectious Diseases Program. Singlehandly, Prof is responsible for changing my life forever. I never had a chance to personally thank him in person as I had planned to do on my maiden voyage to Nigeria, but sure I am calling his name because I owe him my deepest respect. 3 other African Professor/guardian angels at USF discovered my infectious passion and excitement for knowledge, learning and development and became my fathers that kept me in the straight and narrow while I soared like an eagle. Around that same time period in the middle 80s, Cote d'Ivoire used to be the medical mecca where everyone used to go and do their surgery and recuperate fairly well. What we see now is that the country has been embroiled in conflict and may have lost all those gains as evidenced by the IMR, MMR, Under 5 mortality and decreasing LE. Then we have South Africa that suddenly announced a few weeks ago that they don't have 5 million infected but 7.1million with HIV/AIDS. There healthcare system is overstretched and will crumble. How can we get Africa back on track with all the "C" going on in all sectors? The once promising health care infrastructure that was present in some countries has gone to waste. For those with a high income and insurance you can get pretty decent health care in Africa. For the poor there is no chance. I fully concur with you and Asima will also support me on this: "For this purpose, capacity of the service providers and institutions must be built on the one hand and awareness and participation of the population be raised in a parallel effort, through communication and functional literacy programs. In both of these efforts, government’s long term commitment should be assured. By following this policy, countries will slowly but surely overcome not only the current pandemics, but will also build up their ability to handle other urgent needs of public health that are threatening now or in the future. If nothing else, Global Fund through its policies and approach can take specific measures that target the overall improvement of public health including health education via institution building for the three chosen diseases. That will be a start and a worthwhile goal". SSA's basic healthcare infrastructure is vastly crumbling. If donors don't take a bold step to hold governments 100% accountable for their "C actions" with frequent warnings, auditing and spotchecking, and demands for refunds of stagged monies with some forms of sanctions, we will not see the marked progress that will support the communication and functional literacy initiatives. You did a fantastic job and I am happy you understand where I am coming from. Best Regards, Fenna