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Views & Reviews Review of the Week

How to rebuild global health

BMJ 2010; 341 doi: (Published 27 October 2010) Cite this as: BMJ 2010;341:c5520
  1. Richard Smith, director, UnitedHealth Chronic Disease Initiative

Joseph Ana’s book describes how he turned around the failing health system in a southern Nigerian state. Richard Smith is impressed with the results

Imagine that one day you’re a general practitioner in Luton and the next you are responsible for the health of the three million people of Cross River state, one of the poorest in Nigeria, where child mortality is 20% and maternal mortality 1%, childhood immunisation rates are under 20%, and you have only 72 doctors. And you’d be facing this challenge in a country where corruption is among the worst in the world, with power cuts ubiquitous and everything a struggle. Could you cope? Where would you start?

Joseph Ana made this transition and describes in his book how he went about tackling his new job. The book falls somewhat uncomfortably between a guide on how to rebuild a shattered African health system and a story of a great endeavour. There are two better books to be written: one would give more precise guidance, and one would tell the story with the full complexities that Ana faced—and mostly overcame.

Ana did have advantages. He was born in Cross River state (his brother died in the Biafra war, fought partly in the state), did his medical training in Nigeria, and has travelled the whole …

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