What about replicability? Can other states reorganise their health systems along the lines of Tamil Nadu and reap the major health benefits that seem to accrue? Yes, they can. The administrative foundations are similar across the country. The key difference is that Tamil Nadu “(a) separates the medical officers into the public health and medical tracks, (b) requires those in the public health track to obtain a public health qualification in addition to their medical degree, and (c) orients their work towards managing population-wide health services and primary heath care…”. The additional investment required to train a cadre of public health managers is modest: in Tamil Nadu this cadre amounted to hardly 1 per cent of more than 10,000 government doctors. Of course, reverting to a separate directorate of public health and having a good public health act may also be necessary and quite feasible. And the data suggest that the costs are affordable. The central issue is not resources, but how they are organised, mandated and managed.