Good accessible healthcare is something we all need. Without it many of us would be unlikely to recover from serious diseases, infections or wounds. In an ideal world everyone should have access to good, affordable primary healthcare. No government would claim otherwise. However, the reality is often different…

I vividly remember a discussion about healthcare with a group of village elders in Barr Parish, northern Uganda. They told of high charges for healthcare introduced in recent years, of how local clinics had closed, of the cost of transport to Lira and the huge charges payable there for treatment and medicines. One lady turned to me with tears in her eyes, thinking of friends who had suffered and died, and said ‘We have no health services now. When our people become sick, all we can do is pray for them. Please tell others how we are suffering.’

This issue looks at ideas to help healthcare become sustainable. Many governments continue to cut back funding for health services, often because of the huge debt repayments they have to make. This means that local healthcare increasingly has to raise funding from local people, who themselves may have very low incomes. In such a desperate situation, the need to share good ideas which have worked in one area becomes more and more important. Both health experts and readers from many countries have contributed good ideas for this issue.

However, health is not just freedom from disease. It concerns well-being in all areas of life. Improvements in sanitation, water supplies, nutrition and housing will be reflected in better health in the community. Such improvements can only be achieved by helping people to work out their own priorities and take their own action in tackling poverty.

The case studies in this issue all reflect the need to let people first establish their own health priorities. Several of these studies are from the Democratic Republic of the Congo where recent years have seen huge upheavals – including civil wars, the overthrow of the previous head of state, Mobutu, and huge movements of refugees. With virtually no government funding for healthcare, any health systems able to function well are of considerable interest.

Healthcare is something we all need. Let’s work together to improve our own local situation.

Isabel Carter