Some international bodies, research institutions, and non-governmental organisations (NGOs) engaged in aiming to promote health and relieve suffering in poor countries might unwittingly have the opposite effect. By offering better salaries and working conditions, such international organisations can readily employ locally trained health workers (often the most capable). In countries where there is a shortage of the Government’s national public health staff, the only source of health provision for poor people, this creates a situation which not only threatens health care to the majority of the population who cannot afford private care, but demoralises the remaining staff who consequently have an increased and often dangerous workload.

These opinions are expressed by Dr Mamady Cham and Mr Omar Sey from theMinistry of Health and Social Welfare, The Gambia and by the international medical charity Maternal and Childhealth Advocacy International (MCAI) in a Comment published in The Lancet today.

However, these opinions are also backed up with facts. According to the authors, almost a third (28 out of 96) of Gambian nurses and midwives based in one of the poorest regions of the country catering for 250,000 people, and whose training was paid for by the Gambian government, currently work for the UK’s Medical Research Council (MRC). The MRC has been working in the Gambia for over 60 years and is funded by the UK Government through British taxpayers to the tune of an estimated £10million annually. 

The Honorary Medical Director of MCAI said: “The maternity unit in this region’s only hospital is so short of midwives and nurses that frequently, and especially at night, there may be only one midwife caring for 4 mothers in labour and 6 critically ill pregnant mothers who are fitting, suffering major haemorrhage and life-threatening anaemia. The mortality rate in the pregnant women in this hospital is unacceptably high”. He continued: “We consider that the MRC should urgently address this critical situation by returning the midwives and nurses to the Gambian public health system and support the training of new staff to undertake the MRC’s own valuable work”.

In their Lancet Comment, the authors make some recommendations on how international organisations, including NGOs, UN organisations and faith-based hospitals can work to strengthen and sustain the public health system in countries which have limited numbers of locally trained health workers rather than weaken them. For example, such organisations can routinely make provisions for replacing the NHS staff their project requires and contribute to the training of national staff.

For further information and interviews, please contact Dr David Southall directly on +44 (0)7771 067 4003 or at director@mcai.org.uk or Dr Rhona MacDonald (Honorary Executive Director) on +44 (0) 7775880628 or at rmacdonald@mcai.org.uk

MCAI (www.mcai.org.uk) works to strengthen emergency healthcare systems, especially for pregnant women, newborn infants and children in disadvantaged countries.

EDITOR’S NOTES: Attached is the Lancet Comment