Recent economic crises have severely affected national and international efforts to reduce the high morbidity and mortality in developing countries. The repercussions of these crises are manifest in declining living standards, increasing poverty, malnutrition, ill health and death. Depressed commodity prices, the oil crisis of the late 1970s, and the ensuing balance of payment problems have weakened most governments' efforts to halt and eventually reverse the economic decline. In sub-Saharan Africa the effects of these crises have combined with an ever-increasing population to render ineffective the limited investments in health care.