The Bill & Melinda Gates Foundation, as well as other international charitable bodies, fund several commendable health care projects in low- and middle-income countries (LMICs). Grand Challenges grant opportunities call for proposals are subtitled "Solving global health and development problems for those most in need". Their focus is primarily on nutrition, vaccines, malaria and tuberculosis, undoubtedly priority issues, but is it enough to really create development? The number one issue in health care is professional training and retention. Keeping qualified workforce is not only about salary but, more importantly, about motivation and career opportunities. Paraphrasing Bill Drayton, founder of Ashoka, Cure2Children is convinced that to really assist sustainable development it's not enough to give out fish or fishing rod,s you need to help creating a competitive fishing industry. We believe that context-appropriate tertiary care is critical for health care strengthening. In parallel with primary care, advanced care aiming at locally relevant and curable disorders, such as severe hemoglobinopathies of childhood, should not be a secondary priority.
Accessibility to care is paramount, and tertiary care should be cost-conscious and based on frugal innovation principles; this does not mean compromising on quality. On the contrary, experience and dedication is what makes a good health professional and large case loads will generate expertise and competitiveness.