This month sees a crucial vote in international public health: the nomination of the World Health Organisation's next regional director for Africa. The appointment will affect how $850m of public money is spent and what happens to the health of 550 million of the world's poorest people.

Many people are unhappy with what has been achieved since the current regional director, Dr Lobe Monekosso, took office 10 years ago. His three phase development plan for Africa has remained on the shelf, and only just over half of the region's $136m budget for 1992-3 reached the region's 45 member states. The rest of the budget was spent at the regional office in Zaire, along with two thirds of the pounds sterling 112m donated for special programmes such as the AIDS and immunisation programmes.

Dr Monekosso has been unfortunate. Chronic difficulties caused by Africa's lack of infrastructure have been aggravated over the past year by civil unrest in Brazzaville, where the regional office is based. The office has been closed, and Dr Monekosso has had to …