In an open letter published in this week's BMJ, Professor Chris Lavy congratulates the British Prime Minister on the Commission for Africa report, but also points out some important omissions.

For instance, he is disappointed not to see anything on the escalating road traffic injuries in Africa. The World Health Organisation estimates that around 200,000 people a year, or 500 a day, are killed on African roads, yet the report suggests that the key to development is increased, cheap transport. "Can you imagine what it would do to road deaths,” he asks?

He also highlights the lack of basic surgery for the hundreds and thousands of children with a physical disability that prevents them from walking, or walking properly.

Conditions in healthcare institutions in many African countries are getting worse not better because those who make policy and govern funding do not use the local health services; they go abroad, he says. Changing this would improve African health services dramatically overnight, he argues.

Although standards of health care are dropping, some encouraging exceptions to the general rule keep us going, he adds. Locally driven schemes that provide surgical training are helping to save lives and are far more appropriate than scholarships to the West. Projects like these bring results but need the support of G8 countries.

He agrees that overseas aid can be useful if it is well thought out, but aid gaffes help no-one. For example, two new district hospitals are being built in Malawi, but there are no surgeons or other staff to run them.

He ends with a challenge, asking the prime minister to "take a lead” and give 1% of the UK's national income to development aid. "Could we in medicine also take a lead and expand our global outlook?” he adds.; Source: British Medical Journal