“During the 1990s it had taken a while for the rest of the world to wake up to the tragedy of AIDS in Africa, but belatedly the alarm call had come,” John Wright, a consultant in clinical epidemiology at Bradford Royal Infirmary in England, writes in a BMJ opinion piece. “Global funding and international action achieved something quite miraculous, bringing the most expensive and innovative drugs in the world to the poorest people on the planet; a triumph of science and health policy that made the discovery of penicillin look quaint,” he says. “The new health colonialists have come from across the globe with admirable intentions and boundless energy in a new scramble for Africa. Dozens of well meaning health providers are falling over each other to help — but crucially also to justify their efforts to their sponsors back home,” he writes.

Wright describes a recent visit to a southern African hospital, where he worked 20 years prior, and says “donors will not fund capital development, so while the main hospital crumbles, the grounds fill up like a ghoulish holiday park” with “static caravans or motor homes,” each meant for a different task, from preventing mother-to-child HIV infection to nursing training. He continues, “The golden rule of development is sustainability, yet what I was witnessing was an industry building dependency, with a myriad [of] foreign donors creating careers and competing to provide parallel independent health services. Everyone complains about the limitations of African governance, but the truly sustainable solution would be to have a little more trust (backed up with a little more auditing perhaps) and just give all the aid funding to the ministries of health. It’s their country: let them get on with it” (4/17).