Intended for healthcare professionals

Rapid response to:


A theme issue “by, for, and about” Africa

BMJ 2005; 330 doi: (Published 24 March 2005) Cite this as: BMJ 2005;330:684

Rapid Response:

The Challenges of Health Care Delivery in Developing Countries

The challenges of healthcare delivery in a developing country such as Nigeria with its diverse ethnic and cultural groups pose is huge. Poverty, ignorance, lack of resources and health facilities and bad leadership acting in concert produce a wide spectrum of disease on one hand. On the other hand, are the sheer determinations and will of the people to survive in the face of man-made problems, strong family and community support. Furthermore, support by religious groups plays their part in giving the people hope. Overworked and overwhelmed medical personnel depend on their ingenuity and acumen to improvise in other to save lives. In the developed world, such improvisation would probably end in litigation.

Apart from infectious diseases which are largely preventable, injuries from ethnic and religious strife in some areas have direct impact on the most productive age groups which further stretches the limited resources available. Road traffic injuries are a major but neglected public health challenge and requires concerted efforts for effective and sustainable prevention(1)

There is the issue of emigration of highly trained personnel (the so- called brain drain) that further compounds the problem of healthcare delivery in Africa.

In order to tackle healthcare delivery head-on, governments must demonstrate the will to carry the people with them.

Legislation and persuasion are useful tools that can be utilised while being sensitive at every point to the culture and religious beliefs of those involved. Religious and traditional rulers in Nigeria wield a great deal of influence in their domain. It is, therefore, imperative to solicit their support in programmes aimed at improving the lot of the people. The recent recommendations of the global polio eradication initiative for example is a step in the right direction.(2) Improving the level of literacy is also vital in the fight against diseases.

The services of organisations like the British Council are immensely useful in the area of education and research. We were beneficiaries of the library outreach programme of British Council early on in our careers, which allowed us access to books and journals.

Collaboration with health institutions in other continents can facilitate training and research. The provision of grants to enable willing highly trained emigrants to go back to their ‘root’ for brief periods may help to improve things. Such programs can be in partnership with local and regional postgraduate medical colleges..

Good governance, accountability and transparency on the part of governments and their officials will encourage not only development aid but also create conducive atmosphere for investment and job creation. This should in turn translate to availability of resources for the provision of basic amenities. A wholesome and proactive approach is required to help turn things around.


1. WHO world report in injury prevention. Peden, M.,Scurfield R.,Sleet, D,. Mohan D., Hyder A. A.,Jarawan, E.,Mathers, C. 2004

2. Global polio Eradication Initiative. Polio News, Issue 22, Autumn 2004

Competing interests: The authors have previously worked at the Jos University Teaching Hospital,Nigeria

Competing interests: No competing interests

08 April 2005
Victor Y Ameh
SpR in Emergency Medicine
Abdu Opaluwa, Staff Grade, General Surgery, Queen Elizabeth Hospital, Kings Lynn. PE30 4EJ
Wythenshawe Hospital,Manchester M23 9LT