In his article "How The Brain Drain To The West Worsens Africa's Public Health Crisis" Rotimi Sankore documents very well the devastating effect of the "brain drain" on Africa's health services, and the appalling cost to the continent of subsidising health services in rich countries. However, there is one measure which would address this problem very effectively, but which is rarely proposed, even though it is the key to Cuba's success in maintaining its high standards of health and doctor-population ratio of 1 to 165. This is for African countries to stop aiming for "equivalence" with the West in the training of health professionals.

At the moment most countries strive hard to maintain professional qualifications that are recognised in rich countries or provide a relatively easy stepping-stone to achieving registration there. Though there is much waffle about "maintaining standards", the real reason is so that the professionals who determine these qualifications (or their children) can readily leave Africa to work in rich countries. The training of doctors, nurses, dentists, pharmacists and other health workers should instead be focusing on African health needs, which differ greatly from those of rich countries. If African health qualifications didn't make it easy to get registered in the UK, Canada or the US, then much of the brain drain would stop.

I would like to thank you for a fine job - in difficult times. As all of us grow increasingly concerned about the more and more desperate situation that so many fellow Africans are facing, it is immensely helpful to have such a valuable source of information, and it keeps up our spirits to see and be linked with so many people who are struggling fiercely to turn things around. Thanks to the Pambazuka team.