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A new scramble for Africa: how rich world donors are damaging healthcare

BMJ 2012; 344 doi: (Published 17 April 2012) Cite this as: BMJ 2012;344:e2726
  1. John Wright, consultant, Clinical Epidemiology, Bradford Royal Infirmary
  1. John.Wright{at}

“What we need is a national health service,” the doctor said, bemoaning the fragmentation of healthcare in his rural African district hospital. I had left the United Kingdom for southern Africa with the debate still raging on the now passed Health and Social Care Bill, and I wondered if he could have ours: “One NHS, excellent condition, unwanted gift to nation.”

I worked there as a medical officer 20 years earlier, and the hospital showed little signs of change. Gloomy wards filled with the pungent smell of disinfectant and disease. This rural mission hospital was built for a very different age, baked for half a century under the African sun.

Although the buildings remained the same, over the past two decades the health landscape had changed completely. A plague of HIV and tuberculosis had settled on the country and showed little sign of leaving. There were more people living with HIV in the mountains surrounding the hospital than the whole of the UK.

During the 1990s it had taken a while for the rest of the world to wake …

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