"Doing more with less," in theory at least, should mean there is more for those who rely on subsidized or free services.  In addition, efficiency does stress preventative care, as vaccinations and prevention are much more efficient options than treatment of disease.  This falls in line with equality issues, as long as who to vaccinate does not become an issue, but is viewed as an allocative efficiency issue (IE coverage for all) rather than a technical efficiency issue, which may value vaccinating those close to a clinic, but devalue the cost of reaching those in hard-to-reach communities. Equity should be one of the most fundamental considerations in all health systems strengthening efforts, and should be the aim of any system.