While much of the attention on fighting AIDS and other diseases in poor countries has

focused on access to affordable drugs, concern is now shifting to the question of who exactly, will deliver them. Unfortunately, there is a severe shortage of doctors, nurses and other health-care workers in these countries. According to a report published in this weeks Lancet by the Joint Learning Initiative (JLI), an international consortium of academic centres and development agencies, sub-Saharan Africa has only one-tenth the number of nurses and doctors per head of population that Europe does, though its health-care problems are far mom pressing. (47)The reasons for this are twofold, and well known—not enough health-care workers are trained in the fast place, and too many of those who are trained then leave for better-paid jobs in the rich world. What the report does is to put some numbers on these problems. A mere 5,000 doctors, it finds, graduate in Africa each year (a third of the number that graduate in America). Only 50 of 600 doctors mined in Zambia in recent years are still in the country. There are more Malawian doctors in Manchester than Malawi. (48)And many rich countries exacerbate the problem by recruiting from poor ones to help deal with their own shortages. To overcome all this, the JLI reckons that the world needs 4m more health-care workers, of whom lm are required in sub-Saharan Africa alone. The question is who will pay for them？ The report floats some ideas. (49)It recommends that roughly $400m, or 4% of the overseas aid currently spent on health, -be earmarked to help build up the health-care workforce in poor countries. (50)But it also suggests that better use be made of existing resources, for example by employing local volunteers rather than highly trained doctors for many routine matters. As Lincoln Chen of Harvard University, one of the reports authors, points out, a few countries, such as Brazil, Thailand and Iran, have taken steps in the right direction. Others need to follow their lead.