BACKGROUND Life-saving orphan drugs are some of the most expensive medicines. European Union governments aim to accommodate their provision within stretched healthcare budgets but face pressure to reduce funding of such treatments. Patients struggle to retain or gain access to them as their special status is questioned, causing distress and in some cases, fears of premature death. In the UK and...

D evelopment agencies want their interventions to be sustainable. The Offi ce of Sustainable Development of the Bureau for Africa of the United States Agency for International Development defi nes sustainability as " the ability of host country entities (community, public and/or private) to assume responsibility for programs and/or outcomes without adversely affecting the ability to maintain or...

INTRODUCTION Community health worker (CHW) programmes have low costs per person served and are central to achieving universal healthcare. However, their total cost is high and the target of one million CHWs for sub-Saharan Africa by 2015 was not met. We consider the affordability of rural CHW programmes by estimating total programme costs relative to national healthcare expenditure at different...