Much less is known about the costs of harm in LMICs but given the evidence on occurrence and severity of harm, one can assume that the costs on health system and on society are comparable to those in developed countries. The key challenges to improving safety in both developed and LMICs relate to the fragmented nature of primary and ambulatory care, no integration of information and measurement systems, and under-resourcing. These challenges cannot be overcome without leadership, co-ordination and culture change.