As the group of eight leading industrialised nations (G8) meets for its summit at Gleneagles, Scotland, next week Africa is at a crossroads. It faces a double edged crisis: its healthcare workforce is rapidly depleting, and its health systems are weak, fragile, and hanging on a precipice. A direct consequence of this is that the indicators for health development in the continent are dismal. About one in six African children die before their fifth birthday, with half of these dying from diseases preventable by vaccines; and one woman dies every two minutes from complications of pregnancy and delivery.1 From all such indications and current evidence, it would appear that very few countries in the continent will achieve the millennium development goals.2 The goal to reduce deaths among children aged under 5 (figure) is just one example.

Chronic underinvestment, interventions by global partnerships that focus only on single diseases, and sporadic financing by both national governments and their partners have left African health systems prostrate. They are unable to deliver drugs, tools, and …