UK investment in health (public and private) is falling, from 8% in 2009, to 6.6% by 2021.1 Current expectations of the NHS, to provide comprehensive, modernised, and scientifically founded care have risen alongside greater needs of a growing population living with chronic illnesses. In fact, global efforts to improve health are challenged by similar issues, and most people around the globe are neither seeing nor do they expect comprehensive health coverage. Many countries still do not have appropriate policy and legislation. The current strains on health provision in the UK and other higher-income countries demand actions that perhaps would only have been previously been considered for lower-income countries where, by comparison, there is grossly insufficient investment (see editorial by Sashidharan et al, pp. 3–5); so task shifting and community development innovations from low-income countries are proposed as alternatives to high-quality healthcare in high-income countries. The job of government has become to contain and offset costs to the state by seeking a range of alternative providers, and by driving down the costs of existing provision.