Quality has not been sidelined, as evidenced by a recently introduced performance management framework for primary care doctors. A similar system for hospitals will soon follow. Patient groups report being well involved in policy making and several intersectoral memoranda of co-operation have been agreed - including w'ith industry - on key public health issues. Medical education is also excellent, w'ith Latvian medical schools having maintained their reputation as among the best in the ex-Soviet world.