Using data from three countries and seven sites we show some striking patterns in the delivery of healthcare. Healthcare is typically provided by the market on a fee for service basis. Most practitioners have no medical qualifications and are self-proclaimed "doctors". Quality of care is low: using a generous standard of correct treatment less than 50 percent of cases are correctly managed (usually much less than 50 percent) and upto 90 percent of the spending on care is medically unnecessary. However this is not principally because of lack of medical training. The providers typically treat the patient much less than their stated knowledge would dictate. This know-do gap is greater for better trained providers. We argue that these observations are consistent with a model where patients are skeptical of the provider's capacity and motives and provider's reputation is key and needs to be built slowly.