Introduction A century ago missionaries pioneered the training of health personnel. Are contemporary church-related health programmes still leading the way? Jumping back in time, a cameo of medical missionary work might well have shown national nurses or auxiliaries caring for the sick in a hospital environment, under the direction of a missionary doctor or senior nurse. They would have used simple but adequate equipment and drugs, often sent as gifts from overseas. The patients, many of whom may have been very poor, would probably have been treated for a nominal fee, or free of charge. The training of nurses and paid medical staff usually would have been through apprenticeship, though the leaders in some mission hospitals established government recognized training schools. The support structure was strong, albeit perhaps paternalistic, and both staff and students responded eagerly to the encouragement and teaching of their missionary colleagues. Contrasting situations may be found today. In urban settings, the church-related (or mission) hospital often attracts large numbers of patients who need specialist care. But the poor may not be among the patients, since many hospitals need to charge fees for their services, thus putting those services out of the reach of the poorest members of the community. Nurses today are often trained at schools where patient care may not be as important as technical knowledge, and consequently, bedside care and careful observation are often neglected. In rural situations, the church-related health centre is often inadequately stocked and equipped, and is staffed by nurses and auxiliaries who carry enormous responsibilities, frequently way beyond the scope of their training. They may have to take their salaries from the patients' fees, and could go months without a visit from a supervisor. Job description, staff appraisals, encouragement and support are rarities for these nurses, and so the poor standards of care at health centre level are not surprising. While it is difficult to make global generalizations about the training and support of health personnel, an alarming picture emerges from some countries and within some church networks. There are still many examples of fine Christian centres of healing, but there is a sufficient number of neglected programmes to generate concern, and to compel us to look into some of the causes. Among these we will find that both the changing approaches to Christian health care and in global health policies have implications for the training needs and development of personnel working in church-related health programmes. Such changes bring inevitable constraints, which will also be discussed. Analyzing the problems may help us to understand how human resource development could improve the quality of care in church-related health programmes. From medical missions to church-related health programmes -- changing approaches in Christian health care From the early part of the nineteenth century, missionary pioneers took medical care to the peoples of newly discovered territories, often responding with a sense of personal call and vision. Sufficient funding was contributed by the sending churches/missionary societies to enable missionaries to establish hospitals and health centres, and to have sufficient funds to sustain the work. Gifts in kind (medicines and equipment) were also important. In many situations medical auxiliaries and nurses were taught through apprenticeship, though well known nursing and medical colleges were also established by missionaries, who usually based the curriculum on their own learning experiences. The medical mission period had its zenith before the first world war, when there were over 2,000 hospitals and 4,000 clinics run by Protestant missionary agencies. In the space of the next fifty years, many of these were closed, while others were handed over to the respective governments. …