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Mbarara is a small town in the rural southwest of Uganda, one of the poorest countries in the world. The per capita income in this equatorial East African nation is less than $4 a day, and one third of the population lives below the poverty line. 1 When the Ugandan government and foreign donors recently committed to upgrading Mbarara Hospital’s aging infrastructure, the hospital steering committee identified the expansion of the intensive care unit (ICU) as a critical objective.

At first glance, the provision of critical care may not appear to be a rational or cost-effective priority in a country where the annual health care expenditure is just over $100 per person. 1 However, the inadequate basic medical infrastructure, the spectrum of diseases, and the demographic characteristics of Uganda, combined with the broader, less tangible benefits of an ICU, make critical care an essential component of