Human Resource crisis in HIV/AIDS
Apr 20, 2005, 20:08, Reviewed by: Dr.
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"In addition to this proposed corps of highly skilled health and management professionals, the Global Health Service would also have five other components. The individuals serving in all of these programs would constitute a critical driving force to carry out the president's plan -- and to build the developing world's capacity to control HIV/AIDS, tuberculosis, and malaria over time. They would multiply essential skills and services, offering both concrete assistance and hope. In our interconnected world, such work benefits us all."
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By The National Academies ,
The federal government should create and fund an umbrella organization called the United States Global Health Service (GHS) to mobilize the nation's best health care professionals and other experts to help combat HIV/AIDS in hard-hit African, Caribbean, and Southeast Asian countries, says a new report from the Institute of Medicine of the National Academies. Full-time, salaried professionals would make up the organization's pivotal "service corps," working side by side with other colleagues already on the ground to provide medical care and drug therapy to affected populations while offering local counterparts training and assistance in clinical, technical, and managerial areas. The proposal's goal is to build the capacity of targeted countries to fight the pandemic over the long run. The dearth of qualified health care workers in many low-income nations is often the biggest roadblock in mounting effective responses to public health needs.
In January 2003 President Bush announced the President's Emergency Plan for AIDS Relief (PEPFAR), which is directed at 15 countries that are home to half of the world's HIV-infected people. PEPFAR's "2-7-10" goals are to treat 2 million infected people with antiretroviral therapy, prevent 7 million new HIV infections, and care for 10 million people who are infected with HIV or affected by it. This comprehensive, five-year strategy is part of the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act, which Congress passed in 2003. Among other measures, the legislation calls for a pilot program to test how U.S. health care professionals and others with technical expertise could help meet the "2-7-10" goals through public service abroad. The federal Office of the U.S. Global AIDS Coordinator asked the Institute of Medicine to study options for placing such workers in the 15 focus countries.
"In addition to this proposed corps of highly skilled health and management professionals, the Global Health Service would also have five other components. The individuals serving in all of these programs would constitute a critical driving force to carry out the president's plan -- and to build the developing world's capacity to control HIV/AIDS, tuberculosis, and malaria over time," said study committee chair Fitzhugh Mullan, contributing editor of the journal HEALTH AFFAIRS, and clinical professor of pediatrics and public health, George Washington University, Washington, D.C. "They would multiply essential skills and services, offering both concrete assistance and hope. In our interconnected world, such work benefits us all."
CREATING THE UNITED STATES GLOBAL HEALTH SERVICE
Today HIV/AIDS is one of the world's greatest health crises, the report emphasizes. Nearly 40 million people are infected with HIV, and 95 percent of them live in resource-poor countries. About 6 million HIV-infected people in these areas need antiretroviral treatment now. PEPFAR has provided such drug therapy in the 15 focus countries: Botswana, Cote d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam, and Zambia. However, a shortage of workers to administer medication and provide essential support could ultimately thwart PEPFAR's efforts. Preventing and treating HIV/AIDS in these developing nations will require unprecedented health systems and human resource initiatives.
GHS should be based in the federal government, but private agencies should also play supporting roles, the report says. Furthermore, an international advisory committee should be established to provide input on the development, ongoing operation, and evaluation of the proposed service.
In the first year, 150 U.S. health professionals should be selected for the GHS service corps and deployed based on several criteria, including specific priorities that have been identified by each country's health ministry in conjunction with federal PEPFAR teams already on the ground; the availability of people with the required skills; and the readiness of institutions to host corps participants. They would be assigned for at least two years to programs or geographic areas where they could have the greatest impact. Participants' ability to help combat the spread of malaria and tuberculosis -- which often overlap HIV infections in the developing world -- would also be considered. On the whole, the initial cost of the GHS is estimated at about $100 million annually, or roughly 3 percent of PEPFAR's current budget. About $35 million of this would be for the service corps, the report says.
Another component of the GHS would be a fellowship program, which should offer competitive awards of $35,000 annually for skilled professionals who want to make a difference overseas but are stymied by financial and logistical barriers. Fellows would provide health care, training, or technical assistance in a PEPFAR focus country for at least one year, the report says.
GHS also would include a loan-repayment program for student debt. Any participants who serve in a focus country could erase $25,000 of higher-education debt for each year of service completed, the report says. Given the heavy student-debt load that health professionals often carry, this incentive would expand the overall pool of candidates.
BROAD COLLABORATION NEEDED
Smooth, quick transfers of talented people to the targeted nations would be vital, the committee said. To that end, adequate funding would be needed to foster innovative, long-term partnerships between relevant institutions based in the United States and in PEPFAR countries. Such bilateral arrangements, known as "twinning," can strengthen institutional work forces in host countries by providing staff to fill vacancies and to offer specialized training and development opportunities. Partners could include hospitals, universities, nongovernmental organizations, and public health agencies.
Education and training offered by all GHS participants should encompass not only clinical and technical skills, but also management of finances, social services, and human resources. Developing effective new ways to deliver health care in impoverished regions should also be a priority, the report notes.
Education systems and health care infrastructure in developing countries are often weak and understaffed. In addition, skilled health professionals frequently accept job offers from wealthy countries that are experiencing their own shortages of health care workers. But the shortfall is dramatically worse in the developing world. Few African nations, for example, have more than one doctor per 5,000 people. Without an increase in the number of physicians, nurses, technicians, pharmacists, and other health care professionals, expanding the scope of antiretroviral drug therapy for HIV/AIDS would only exacerbate these personnel challenges.
The committee also recommended that GHS create a clearinghouse for comprehensive information about various groups that mobilize health professionals to work in PEPFAR focus countries. It would include a searchable, Internet-based directory of programs; an electronic job bank related to service in targeted countries; and information about cultural and logistical issues. To ensure that GHS participants are properly assigned, country-based teams of PEPFAR workers should collaborate with national health ministries to assess each country's health personnel needs. The assessments would generate a baseline inventory for all mobilization programs and their subsequent evaluation, and could inform each nation's human-resources plan. All assessment data should be collected the same way in each country, updated regularly, and stored in the job bank of the clearinghouse. Additionally, the report outlines several promising steps to enhance and sustain the health work force worldwide. 
- HEALERS ABROAD: AMERICANS RESPONDING TO THE HUMAN RESOURCE CRISIS IN HIV/AIDS
http://www.nas.edu/
The study was sponsored by the Office of the U.S. Global AIDS Coordinator, located in the U.S. Department of State. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster follows.
Copies of HEALERS ABROAD: AMERICANS RESPONDING TO THE HUMAN RESOURCE CRISIS IN HIV/AIDS are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at HTTP://WWW.NAP.EDU. Reporters may obtain a pre-publication copy from the Office of News and Public Information (contacts listed above).
[ This news release and report are available at HTTP://NATIONAL-ACADEMIES.ORG ]
INSTITUTE OF MEDICINE
Board on Global Health
COMMITTEE ON THE OPTIONS FOR THE OVERSEAS PLACEMENT OF U.S. HEALTH PROFESSIONALS
FITZHUGH MULLAN, M.D. (CHAIR)
Contributing Editor
Health Affairs, and
Clinical Professor of Pediatrics and Public Health
George Washington University
Washington, D.C.
MICHELE BARRY, M.D.
Professor of Medicine and Global Public Health, and
Director
Office of International Health
Yale University School of Medicine
New Haven, Conn.
JANE CARTER, M.B.B.S., F.R.C.P.(C.)
Head, Laboratory Program
African Medical and Research Foundation
Nairobi, Kenya
LINCOLN CHEN, M.D., M.P.H.
Director
Global Equity Center
Asia Center
Harvard University
Cambridge, Mass.
GARY GUNDERSON, M.DIV., D.MIN.
Director of the Interfaith Health Program
Department of International Health
Rollins School of Public Health
Emory University Atlanta
MALCOLM BARRY KISTNASAMY, M.D.
Dean
Nelson R. Mandela School of Medicine
University of KwaZulu-Natal
Durban, South Africa
RONALDO LIMA, M.SC.
Director of International Technology
International AIDS Vaccine Initiative
New York City
LESLIE MANCUSO, PH.D., R.N.
CEO
Johns Hopkins Program for International Education in Gynecology and Obstetrics
Johns Hopkins University
Baltimore
WILLIAM L. MOORE JR., M.D.
Major General
Medical Department Center and School
U.S. Army (retired)
Hendersonville, Tenn.
ANDRE-JACQUES NEUSY, M.D.
Associate Professor of Medicine, and
Director, Center for Global Health
School of Medicine
New York University
New York City
JAMES B. PEAKE, M.D., M.C.
Executive Vice President and Chief Operating Officer
Project HOPE
Millwood, Va.
CHRISTINA POLYAK, M.P.H.
Student
School of Medicine
University of Maryland
College Park
MARLA SALMON, SC.D., R.N.
Professor and Dean
Nell Hodgson Woodruff School of Nursing, and
Professor
Rollins School of Public Health
Emory University
Atlanta
ROBERT SCHOOLEY, M.D.
Tim Gill Professor, and
Head, Division of Infectious Diseases
Health Sciences Center
University of California
San Diego
HARRISON SPENCER, M.D., M.P.H.
President and CEO Association of Schools of Public Health
Washington, D.C.
INSTITUTE STAFF
PATRICIA CUFF, M.S., M.P.H.
Study Director
PATRICK KELLEY, M.D., PH.D.
Board Director
Additional Contact:
Christine Stencel, Media Relations Officer
Chris Dobbins, Media Relations Assistant
Office of News and Public Information
202-334-2138; e-mail [email protected]
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