This book reviews the challenges of sustaining primary health care in poor developing countries, focusing on the role and impact of aid in the health sector. It discusses the complexities of health system development, the factors that influence health policy, and the interactions between different stakeholders. The book uses case studies from Uganda, Ghana, Nepal, Pakistan, and Vietnam to illustrate the opportunities and obstacles faced by governments and donors in the health sector. The author, Anne LaFond, provides a broader definition of sustainability, emphasizing the capacity of the health system to function effectively over time with minimal external input. The book highlights the tensions between ministries of health and donor agencies, and the strategies that both adopt in response to financial insecurity and budget pressures. The final chapter links investment practice and sustainability, analyzing the contradictions between the two and considering strategies to improve the quality of investment and ensure sustainability in the health sector. The book is accessible and interesting, with insightful examples from the case studies that form the backbone of the book. It is recommended for anyone concerned about the relationship between aid and effectiveness, as it provides a clear understanding of the complexities of the policy environment in which health decisions are made. The book is written by G. Walt from the London School of Hygiene and Tropical Medicine.This book reviews the challenges of sustaining primary health care in poor developing countries, focusing on the role and impact of aid in the health sector. It discusses the complexities of health system development, the factors that influence health policy, and the interactions between different stakeholders. The book uses case studies from Uganda, Ghana, Nepal, Pakistan, and Vietnam to illustrate the opportunities and obstacles faced by governments and donors in the health sector. The author, Anne LaFond, provides a broader definition of sustainability, emphasizing the capacity of the health system to function effectively over time with minimal external input. The book highlights the tensions between ministries of health and donor agencies, and the strategies that both adopt in response to financial insecurity and budget pressures. The final chapter links investment practice and sustainability, analyzing the contradictions between the two and considering strategies to improve the quality of investment and ensure sustainability in the health sector. The book is accessible and interesting, with insightful examples from the case studies that form the backbone of the book. It is recommended for anyone concerned about the relationship between aid and effectiveness, as it provides a clear understanding of the complexities of the policy environment in which health decisions are made. The book is written by G. Walt from the London School of Hygiene and Tropical Medicine.