bmj;393/may28_11/s953/FAF1faThe zenith of Joseph Ana’s passion to improve healthcare in Africa, particularly in his native Nigeria, came in 2004, when he was appointed health commissioner of Cross River State in the south east of the country. Donald Duke, the state governor, was impressed when Ana, a GP in the UK at the time, made clear that “medicine was not about buildings and equipment but love and care.” Duke had “gone through two health commissioners already without the satisfaction of making progress.”When Ana took up his post, the state had to serve more than three million people with only 72 doctors, no psychiatrist, radiologist, or pathologist, and just over 1000 nurses and midwives, with most practitioners concentrated in the cities. Maternal mortality was over 1% and child mortality over 20%. Only a fifth of the population were immunised, and—although hardly acknowledged because of the stigma—12% of the population were HIV positive.Ana…