Averages over the periods 2006-10 and 2001-05 were used for expenditure to capture its effects on performance and smooth its developments. Potential gains are measured if efficiency in a country were to be raised to the level implied by the estimated efficiency frontier while holding inputs constant and under the assumption of non-increasing returns to scale. Healthy competition should be encouraged, financing systems need to offer the right incentives, and better monitoring of the efficiency and quality of frontline services is required.