How would this IHO model ensure improved chronic disease management and needed investments in community capacity? There is a risk that it could simply replicate the pivotal hospital model proposed in the 1980s and accentuate the dominance of acute care. The inclusion of primary health care is important. Also given the lack of success with mergers in the private and public sectors, a strategic alliance model is more likely to succeed and avoid years of governance squabbles, labour unrest and higher costs without improved service capacity