By Peter Moszynski, London

This article appears in the 15 November 2008 Edition of BMJ. (BMJ 2008; 337:a2464)

Frédéric Courbet/Merlin/Panos Pictures

An international campaign to support rural health workers in the developing world has been launched “to give people caught up in conflict, disaster, and health system collapse the chance to lead healthy lives.”

The Hands Up for Health Workers campaign (www.handsupforhealthworkers.org), run by the UK medical charity Merlin, aims to ensure that all health workers in the developing world receive a regular wage and that workers in remote and isolated areas receive incentives to stay.

The charity also wants to secure funding to train the additional health workers who are needed to deliver essential health care, and to refresh the skills of existing ones. All health workers should also be able to practise in a safe and secure working environment, it says.

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Frederic Courbet/Merlin/Panos

Over one million people - a quarter of CAR’s population - have been affected by violence. As the country fell apart, so too did its health service. As campaigns Manager for Merlin, the medical aid agency, I recently visited CAR to find out how the country, and its health service, is recovering.

Save for “bits here and there”, Jean Preside Saya has not been paid since 1989. He runs the health clinic in Grevai, a remote village 65km from the nearest hospital.

Six months ago, the clinic had no drugs, no equipment, and often no patients. “People stopped coming,” he said. “It was frustrating - as health workers, we feel we can treat most complaints but what are we meant to do without drugs? Even a traditional healer has drugs.”

“Expect insecurity, instability, no electricity, no running water. Desperation, basically,” said my Ghanaian passenger, as our plane bounced into Bangui, the capital of CAR.
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