RECESSION, debt and oil crisis are common features of the present decade, which crippled the economy of many countries. The decade expe rienced very little stimulation and support to the health system. It is within this context that interes in the sustainability of healthcare in developing counte emerged, and questions were raised about the quality of investment in the field of health.

The health ministries of the developing countries work under extremely adverse economic and politiCal conditions. Thus, the sus tainability dilemma focused on finding ways to generate more of local resources health. Using case studies from Nepal, Pakist Vietnam, Ghana Uganda, the book analyses conditions that are criti to health system sustainability. These condition include the system providing international assistance of health systems in developing countries, the influencele of local, political and bureuecratic interes groups and the market for health care services.

The basic question regarding sustainability is to determine what kind of investments are best suited for maintaining and improving the total system. study basically examines investment dynamics and their relationship to sustainability of health systemp in developing countries. It illustrates how investment takes place on the ground in different countries and how this process influences capacity building for long term effectiveness and selfreliance.

The author has successfully reflected upon the patterns of past investments as well as government's role in the health sector as both provider and overseer. it is suggested that investment must be reoriented to focus on making two requirements a reality for the poor countries. They are, a renewable resource base and an institutional capacity to use resources effectively and efficiently for meeting health needs on a continuous basis.

In this context Lafond emphasises that the longterm partnership between governments and donors, in which external inputs can be coordinated to support the gradual strengthening of local capacity to raise, prioritise and manage resources for sustainable health care for the coming years.