Intended for healthcare professionals


Poor countries make the best teachers: discuss

BMJ 2004; 329 doi: (Published 11 November 2004) Cite this as: BMJ 2004;329:1113
  1. Tessa Richards, assistant editor BMJ (,
  2. James Tumwine, associate professor of paediatrics
  1. Makere University, Kampala, Uganda

    It is not only what you spend on health but how you spend it

    We will meet in the developing world a level of will, skill, and constancy that may put ours to shame. We may find ourselves not the teachers we thought we were, but students of those who work under circumstances that would have stopped us long ago.1

    The idea of a BMJ issue focusing on what rich countries can learn from poorer ones came from our editorial board. Western medical journals' coverage of health issues in low income countries is “limited and negative,” they said. As a result they don't capture the learning potential of successful health initiatives developed in countries long honed to making the best of meagre resources.

    Challenged to do better, the BMJ set up a team of advisers, put out a call for examples, and solicited ideas via global research networks and email discussion lists including AFRO-NETS and HIF-net at the World Health Organization. This issue reflects a variety of views of what high income countries whose increasing investment in health pays uncertain dividends (figure) can learn from poorer ones—and what poorer ones can learn from each other.

    The relation between expenditure on health and outcome, here in relation to longevity, is tenuous (adapted from the UC Atlas of Global Inequality)

    Cynics may argue that …

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