PHR Student Blog

The statistics are shocking.

Malawi has only 260 doctors to care for a population of 13 million. The city of Washington, DC — home to 600,000 people — has about twice as many physicians as the entire country of Ethiopia, home to 80 million.

Today, as we celebrate World Health Day, the health workforce crisis remains one of the greatest hurdles to realizing the right to health for all in developing countries. Now, the US Government has an amazing new opportunity to support health workers in Africa, Asia and other regions to fight AIDS, malaria, maternal mortality and other medical conditions that kill millions every year.

The Global HEALTH Act, introduced in Congress by Representative Barbara Lee on March 24, would provide $2 billion over 5 years to increase the number of doctors, nurses, pharmacists and other health workers in developing countries, and to improve primary care for all. The bill not only authorizes new resources. It also develops a comprehensive vision for a US Global Health Strategy that will complement the goals of developing countries and ensure our aid money is effectively used to save the lives of hundreds of thousands of people.

Commemorate World Health Day by taking action. Email your Representative and encourage him/her to co-sponsor the Global HEALTH Act today.

Want to learn more about the Global HEALTH Act? Check out PHR’s blog series on the bill. Read the bill, check out our fact sheet, watch videos on the health workforce crisis, and hear from African doctors and nurses as they describe what it is to work in broken health systems.

This bill would revolutionize America’s response to the health workforce crisis, and could help save hundreds of thousands of lives: Tell your Representative to co-sponsor the Global HEALTH Act today.

Cross-posted from Health Rights Advocate

This month, PHR is examining the health workers shortage in Africa ahead of the introduction of the Global HEALTH Act, which would provide $2 billion over five years to strengthen the health workforce in developing countries. Today, we want to highlight an organization that is working right now to fill health worker vacancies in rural areas in Southern Africa. If you are a doctor or nurse, Africa Health Placements (AHP) needs your skills to support rural health in South Africa, Lesotho, and Swaziland—contact them today for more information. Africa Health Placements originated in South Africa and now works in several other countries in the region to increase the public sector health workforce through recruitment from the private sector and through recruiting foreign health workers who are looking for the excellent work experience and unrivalled lifestyle that is offered through such an opportunity. AHP’s support is aimed specifically at those provinces and areas where there are major shortages of doctors, nurses, and other health professionals. AHP’s focus is on patients and equity in healthcare for rural and disadvantaged communities—communities that are suffering high burdens of AIDS and other diseases, including malaria and TB. These efforts are having far-reaching results. In 2009, their foreign recruitment efforts placed approximately seven times more doctors in rural South Africa than the long-term rural placements of all 8 South African medical schools combined. Learn more about their work by watching the film Bush Doctors. AHP delivers support to health workers by offering a way of smoothing the application and registration process, matching interested health workers with available opportunities, and by providing clinical, cultural and logistical orientation and ongoing support throughout a recruit’s placement. AHP also supports the strengthening of human resources in health in the region through consulting, advocacy and knowledge-sharing with relevant partners and government bodies. AHP recruits into rural areas, where health workers are asked to commit to at least 12 months of services. Many renew their term of service—for one year, two years, even longer. Since its founding in 2005, AHP has placed more than 1,500 health professionals in Southern Africa, half of whom are from abroad. Check out AHP’s website, and consider working with them to deliver health care to the rural poor in Africa. If you have friends or colleagues who might be interested in this critically important opportunity, please spread the word!

Yesterday, Representative Barbara Lee (D-CA) introduced the Global HEALTH Act (House Resolution 4933) in Congress. We are thrilled at this opportunity to transform America’s global health policy and provide billions more in aid to develop health systems in poor countries.

Take 10 minutes to read the bill (pdf)—there is a lot to learn:

• What the HEALTH in Global HEALTH Act really stands for (This one I’ll give you: Global Health Expansion, Access to Labor, Transparency, and Harmonization Act of 2010).
• The overall goal of the bill (This one you get too—the rest you have to look up: To establish a strategy to coordinate all health-related United States foreign assistance, to assist developing countries in improving delivery of health services, and to establish an initiative to assist developing countries in strengthening their indigenous health workforces).
• The GHA’s vision for a new United States Global Health Strategy (page 2).
• Which Millennium Development Goals the new Strategy would target (page 4).
• The ration of health workers to population the Strategy will aim for (page 12).
• How the Global Health Strategy will really work—what it will support, what it can do (page 8).
• How the US Global Health Strategy will support National Health Strategies in developing countries (page 30).
• How the new Global Health Workforce Initiative  fits in to the Global Health Strategy (page 39).
• How many countries the GHWI will target (page 40).
• The criteria for selecting these countries (page 40).
• What the GHWI will do to support health workers in developing countries (page 43).
• How much money the Global HEALTH Act will provide for all these critical global health capacity building programs (this one I have to tell you—$2 Billion over 5 years. Amazing. See the yearly breakdown on pages 64-65).

Read the bill, and get ready to take action. On April 7th, World Health Day, we’ll ask you to email your Congressperson and urge them to co-sponsor the Global HEALTH Act. And spread the word—this is a transformative bill, and you can make a difference.

Note: There is a file embedded within this post, please visit this post to download the file.

Over the past month, PHR’s Health Rights Advocate blog has highlighted the health workforce crisis in Africa, and how the about-to-be-released Global HEALTH Act can help.

Now, we want to hear from you.

What is your experience with the health workforce crisis in Africa? If you are from Africa or another developing country with a health workforce shortage, tell us about your experience in giving or receiving health care in your country. If you are a health professional who has left your country to practice in the US or elsewhere, we’d love to hear your story: your experience in the health system at home, why you left, and what it is like where you are now.

For those of you not from a developing country, have you visited or worked in Africa and seen the impacts of the health workforce crisis first hand? Have you met doctors and nurses from developing countries who are working in the US or going to school and plan to stay here? What have you learned from their experience?

Some African health workers have already offered their own insights into the health workforce crisis, its impact on themselves and on their patients, and their advice to policymakers.

The hospital where I work, which serves 100,000 people in the district, averages 2-3 maternal deaths per week due to delayed operations. The two medical officers cannot adequately cope since they have to attend to other emergencies and referrals from the neighbouring districts.” – Nurse, Homa Bay, Kenya

The shortage of doctors and nurses in our hospital has led to one nurse attending to 40 patients at time, a nightmare for those suffering acute conditions. This had led to the loss of patients who would otherwise be stabilised. The quality of service is highly compromised and bordering on unethical practice. This is inhuman treatment of fellow human beings.” – Medical Laboratory Technologist, Nairobi, Kenya

I have a situation at the moment where about 200 patients have to travel for up to six hours to get their ARVs [antiretrovirals] and access related services. Most antiretroviral treatment (ART) centres are in the cities and there are no qualified healthcare professionals in the towns and villages. ARVs are even expiring in some centres because the inconvenience involved is just too much for patients.”– Pharmacist, Abuja, Nigeria

PEPFAR is focused on urban areas. The rural areas are left behind. Patients can’t afford transit. I’ve had five patients die quietly in the last six months because they didn’t have access to AIDS treatment…There’s no electricity where I work, the roads are bad, there’s no equipment. If I get a needle puncture, there’s no prophylaxis. I’m on my own. I’m on call 24 hours; this leads to fatal errors. This is a classic case of marginalization.” – Physician, Niger State, Nigeria

Communities in rural Uganda have a difficult time accessing a health care worker. For example, at outpatient facilities upcountry, there may be 200 people per day who show up seeking care, but only one health worker and one clinic for 25 km. You may see a doctor or a nurse, but quality of care is unsure. It’s different seeing a patient first thing in the morning versus after many, many patients – my judgment may be impaired after so many consultations.” – Medical Student, Makerere University, Kampala, Uganda

There is nothing more demotivating to a worker than being in an office without any resources to do the work. Many of us have worked in hospitals where we were recycling gloves in this era of HIV. We have worked in labour wards and operating theatres where autoclaves could be broken for days, yet we are expected to provide safe motherhood services.” – Physician, Kenya

African Health Workers’ Prescriptions for Policymakers:

Policymakers at country and global levels have to make a deliberate move to recruit and retain health workers in the right numbers based on needs assessments.

Our capacity to deliver health services would be improved by a conducive working environment with adequate basic infrastructure, proper medical supply management, better and regular remuneration and opportunities for continuing education and training.

Donors need to scale up investments in human resources for health, especially in health care workers. Most donors do not fund salaries, which I find self-defeating. For example, a donor will choose to fund only medical supplies without considering how the supplies will be dispensed and by whom.

Western countries recruit health workers and have made it very easy to acquire entry visas and work permits, especially for nurses. This is like picking from the poor man’s pocket.

A healthy nation is a strong nation politically, economically and socially. Investing in health is not only right but a necessity!

We want to hear from you. Use the comment form below to tell your story.

We are just three weeks away from World Health Day (April 7) and the official launch of advocacy for the Global HEALTH Act of 2010. And we have now heard that Representative Barbara Lee will be introducing the bill in the coming days! Now more than ever we need you to be ready on April 7 to email or call your Congressperson urging him or her to co-sponsor this bill.

Since the beginning of March, though this blog you’ve learned about the purpose of the Global HEALTH Act , garnered some great facts about the health workforce crisis, seen one of the many ways in which health systems can be measured and watched four health workers at Mbagathi Hospital talk about the challenges they face on a daily basis.

Today’s post takes a closer look at some very important components of the Global HEALTH Act. But first, it is important to congratulate Representative Lee on the development of a bill that heralds a new way of working to strengthen and improve the health systems of developing countries, and the delivery of health services to the whole of the population in those countries. The bill calls on President Obama to develop a comprehensive US Global Health Strategy (the Strategy) that harmonizes and aligns all health-related US foreign assistance, and seeks to ensure that equity, non-discrimination, participation and accountability are embedded in the Strategy and, to the greatest extent possible, in the national health strategy of each country receiving direct assistance.

This is a comprehensive bill, and it is not possible to review it here completely. Hence we have selected a few specific examples for you of how the bill advances the right of everyone to the enjoyment of the highest attainable standard of health:

Equity and non-discrimination: An objective of the Strategy is to ensure that there is access to quality health services for poor, vulnerable or marginalized populations. Equity and non-discrimination permeate the bill. These issues are to be principal considerations in the construction or rehabilitation of health facilities, in the distribution of health services and health workers, and in the provision and distribution of medical, pharmaceutical and laboratory supplies. The ability of women and youth to use health services without fear, violence, discrimination or other mistreatment is one of the many principles that the President is called upon to encourage countries to include in their national health strategies.

Participation: There is a concern with participation throughout the bill. First, the Strategy itself is to be developed in consultation with all manner of individuals, groups and organizationsfrom executive agencies administering US foreign assistance, to US embassies and country missions, to civil society and nongovernmental organizations in developing countries, to international organizationsand other donor nations. At the developing country level, the bill calls on the President to encourage countries receiving direct assistance to ensure meaningful participation in developing their national health strategies. This participation is to include the poor, vulnerable, or marginalized populations, as well as nongovernmental organizations, in program and budget decisions as well as in the implementation, monitoring and evaluation of the country’s national health strategy. Hence, the bill makes a direct link between equity, non-discrimination, participation and accountability.

Accountability: The accountability process enables the government to identify what is working and what is not – to explain what it has been done and why – and to provide to individuals and communities the opportunity to understand how the government has discharged its obligations. Where mistakes have been made, accountability requires redress. It is a process that includes monitoring, mechanisms, remedies, and participation. The bill makes clear that the Strategy should have each of these components. The Strategy itself is to be monitored and evaluated for effectiveness. To allow this to take place, the Administration is to establish indicators to monitor the Strategy and provide annual reports to Congress. The bill authorizes the President to provide assistance to developing countries to improve the delivery of health services in those countries. The activities that have been authorized include direct support to civil society and nongovernmental organizations to monitor and evaluate their country’s health system. The President is also called upon to encourage countries to include in their national health strategies the development and implementation of sustainable legal frameworks that engage the whole of the population to monitor and enforce policies related to health. Ensuring there is a legal requirement to enable people to participate in monitoring and to enforce policies is essential for government accountability.

The bill’s consistent focus on equity, non-discrimination, participation and accountability indirectly promotes the incorporation of a human rights approach to health into the Strategy. If the Strategy is developed and implemented, it will provide – in time – the proof that adoption of this approach improves health outcomes and the processes to achieve those health outcomes. This bill is to be applauded. It is essential that it obtain a large number of co-sponsors to demonstrate significant support for this legislation, which will help move this bill towards final passage. This is not only for the benefit of the populations in the countries receiving direct assistance but also for the benefit of the US. This bill has the potential to do more for the credibility of the US in the arena of human rights and global health than anything that has gone before.

On April 7 BE READY to email your representative – PLEASE!