Okuonzi argues that the introduction of market reforms, into the Ugandan health system has been a failure.1 However, health systems are extremely complex and, as the debate about the British internal market shows, attribution of cause and effect is far from easy. The situation in Uganda is equally complex, with reforms taking place against a background of regional conflict, growing inequalities, and changes in other sectors. Furthermore, while Okuonzi focuses on hospitals, it is equally important to look at primary care, which the Ugandan reforms have sought to strengthen.

Can we gain insights about market reforms from other low and middle income countries? It is important to distinguish …