Urgent Call for U.S. Initiative on Health Workforce in AIDS-Impacted Countries

 (January 1 2006) The critical shortage of health care workers and weak health systems is the key bottleneck to scaling up access to AIDS treatment. While the needs of individual countries must be determined locally, experts estimate that sub-Saharan Africa needs at least 1 million new health workers to meet essential health needs. Sustained commitment and creative action are necessary to develop and support the health workforce needed to secure the right to health and achieve universal access to AIDS treatment by 2010, as well as other international health goals.

We urge the President of the United States and Members of Congress to lead a global health workforce initiative in AIDS ravaged countries. The U.S. should:

 1. Invest significant new resources in a number of impoverished countries to recruit, train, support, and effectively utilize the number of health workers needed to achieve universal access to AIDS treatment for all in need by 2010 and universal access to primary health care by 2015, while supporting a new G8 initiative to assist additional countries. The U.S. should contribute 1/3 of the funds needed, approximately $650 million in 2007 and scaling up over ensuing years. The U.S. contributions should support national human resource plans within the context of comprehensive country health plans that improve health systems performance to achieve sustainable results. Funding should be predictable and long-term, flowing directly to the public sector and local NGO and faith-based care providers as appropriate. The U.S. should also support effective regional and global initiatives.

 The U.S. should invest in (a) long-term strategic planning; (b) strengthening and expanding capacity of health training institutions; (c) retaining health workers through adequate compensation, safe and improved work conditions, stronger supervision, continuing education, and care including AIDS treatment; (d) human resource and fiscal management; (e) equitable distribution including incentives to work in underserved areas; (f) re-deploying unemployed health workers.

 2. Cover costs to public health systems of implementing PEPFAR and other U.S. initiatives. U.S. agencies should support training and retention for at least the number of indigenous health workers necessary to meet program goals. Aggressive proactive measures must be adopted to avoid drawing from other local health priorities or programs.

 3. Launch a substantial community health worker initiative to train, compensate, and deploy community members, especially women and PLWHA, to provide basic care, treatment, prevention services, and referrals. Community health workers should have access to care, including AIDS treatment, and be offered a career pathway. The program should be integrated into primary health systems, and ensure adequate supervision, support, and ongoing training.

 4. Reduce brain drain by increasing the number of U.S. health professional graduates and improving U.S. health worker distribution. The U.S. government and professional health communities should expand training opportunities in the U.S., discourage active recruitment from poor nations, and work with developing and developed countries and international organizations to develop migration and recruitment policies that mutually benefit source and destination countries. Some experts estimate that the U.S. will need to increase the annual number of medical school graduates by at least 5,000 and of nursing graduates by at least 25,000 over the next 10-15 years.

 5. Create new possibilities for U.S. and diaspora health workers to serve abroad to help meet immediate care and treatment needs while providing training and support to strengthen health systems. The U.S. should develop programs in cooperation with local governments, prioritize strengthening local institutions, and support South-South exchanges.

 6. Convene and support country-level teams of all stakeholders to devise and implement coordinated plans to achieve universal access to health services. The U.S. should provide technical assistance and facilitate the country team's access to all necessary sources of external funding. Cross-sectoral country-level planning is necessary to promote national ownership, donor coordination, and cross-sectoral planning and harmonization.

 7. Contribute 1/3 of the predicted need of the Global Fund to fight AIDS, Tuberculosis and Malaria, for both the coming year and, gradually, a sum equivalent to an additional year to alleviate donor shortfalls and enable more ambitious applications. Health systems strengthening must be sustained as a category of GFATM financing.

 8. Reform IMF-supported spending and wage policies that limit national and donor investments in health and education. Barriers to access such as user-fees for health and education should be eliminated. The U.S. should provide funds to compensate for lost revenue and support increased utilization of services.

 9. Remove Congressional and agency limits to funding recurrent expenses, salaries, and sectorwide approaches, and allow flexibility to agencies seeking to strengthen health systems and scale-up access to care and prevention.

US and US-Based International Organizations:

International and multicountry organizations based overseas: