Chest infections in African children. Respiratory rate poor predictor of hypoxaemia.

ally, the quality of care suffers.The need for change is acute.The government needs to adopt flexible approaches to the delivery of health care.For instance, some clinics could be held in the evenings.Allied medical staff, who are currently underused, could share greater responsibility.We believe that direct regulation by the government of the quality of care is impractical.Rules are easier to make than to enforce.The existing medical bodies need to play a larger part.For a start, they could issue realistic guidelines on standard practice, which could serve as a bridge between local realities and recommendations by the World Health Organisation, which often seem distant.Professional registration could be made time limited and renewal contingent on a system of continuing medical education credits.In India, for instance, existing state run health insurance schemes currently restricted to state employees could be expanded with the help of the private sector.The concept of "managed care" could also be explored.2The impending changes in the Indian Consumers Act 1986 should, we hope, stimulate the growth of patient advocacy groups.3It would be best, however, for the medical profession to reform itself.