Sir

Reading your News story “The fightback starts here” (Nature 426, 754; 200310.1038/426754a), it is gratifying to see that major organizations and donors are focusing on the health problems of developing countries. Perhaps improved interventions will address diseases such as AIDS, tuberculosis and malaria, but it is not always the lack of technologies and drugs that constitute the problem. As one who has been involved in this battle for many years, I know that improvements in basic public health are also needed.

To maximize the effect of the Global Fund and resources from other donors, a matching international and African effort is needed to refurbish basic health systems. For example, some 50 years ago malaria and tuberculosis in particular were under fairly effective control, at least outside sub-Saharan Africa. Even now, with techniques already on hand, an integrated approach involving indoor application of residual insecticides and using diagnosis and effective treatment would bring malaria under control in many countries. Proper planning and better public health is also needed to improve defective services, such as water and sanitation, which contribute so greatly to developing-world problems.

I hope that international donors will encourage the governments of afflicted countries to take specific steps: to adopt public-health principles by action rather than words; to foster and sustain local expertise in research and development; to show commitment to the well-being of the public and accept that sustainable health programmes require long-term government support.

The issues are both political and financial, and they cannot be ignored indefinitely. Effective public-health infrastructures are essential to the health of the communities that the Global Fund and other agencies wish to assist. These donors could use their influence to ensure that governments develop and use effective health planning. Their objectives should be the rebuilding of local health infrastructures that are sustainably funded, functional and transparent in decision-making. With such changes in hand, these international efforts might have a real chance of succeeding.