BMJ 2005;331:243 (23 July), doi:10.1136/bmj.331.7510.243
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Projectitis? Supporting health reform
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In 1992 I visited Russia as the Royal College of General Practitioners' St Petersburg fellow. The next year I hosted two Russian doctors in England. Since this exchange I have visited St Petersburg at least once a year and been asked to work on development projects in several countries of the former Eastern bloc. A few of these projects have led to real change; others achieved their objectives but left a vacuum when they finished; and a few collapsed halfway through. Each country and project is different, and practice cannot be truly evidence based. But lessons can be learnt about how we help other countries develop their health services.
The brand of Western democracy that was on offer after the fall of Communism was strongly influenced by the prevailing economic philosophy. An important legacy of this philosophy is development through "projects"—defined programmes of work with clear objectives and of
Peter D Toon, general practitioner
Canterbury petertoon@aol.com
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