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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.

Urgent Call for US 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.

The undersigned organizations and experts urge the President of the United States and Congress to adopt and implement this platform.

Distinguished experts in the field of human resources for health
Lincoln C. Chen, MD, WHO Special Envoy on Human Resources for Health,
Director of the Global Equity Center at Harvard Kennedy School of Government

Peter Mugyenyi, MD, Director, Joint Clinical Research Centre, Uganda

Fitzhugh Mullan, MD, Murdock Head Professor of Medicine and Health Policy
Department of Health Policy, George Washington University, School of Public Health and Health Services

James Orbinski (Former International President of MSF-Médecins Sans Frontières)
Research Scientist, Associate Professor, University of Toronto

Josh Ruxin, Assistant Clinical Professor of Public Health, Center for Global Health and Economic Development,
Mailman School of Public Health and The Earth Institute at Columbia University

Gilbert Kombe, MD, MPH, Partnership for Health Reformplus Project,
Abt Associates Inc.

Robert S. Lawrence, MD, Edyth H. Schoenrich Professor of Preventive Medicine, Associate Dean for Professional Practice and Programs, Director, Center for a Livable Future, Johns Hopkins Bloomberg School of Public Health

Dr. Nelson Sewankambo, Dean, Faculty of Medicine, Makerere University, Uganda

Bhawani Shanker Kusum, NGO Delegate, PCB UNAIDS for Asia/Pacific

Ezinna Enwereji, President Health and Environmental Research Society
College of Medicine, Abia State University, Nigeria

Donald Cephas Epaalat, Commonwealth Nurses Federation Board
Member for East, Central and Southern Africa (Kenya)

Deborah A. McFarland, PhD, MPH, Professor, Department of Global Health,
Rollins School of Public Health of Emory University

Christine C. Quinn, Speaker of New York City Council

Organizations:

ACT UP New York, NY, USA
ACT UP Paris, France
ACT UP Philadelphia, PA, USA
Action against Aids, Germany
Action Group For Health, Human Rights and HIV/AIDS (AGHA), Uganda
action medeor, Germany
ActionAid International USA
ActionAIDS, PA, USA
Africa Action, USA
Africa Faith and Justice Network, USA
Africa Youth Leadership, Development and Health (AYLDH), Uganda/int’l
African Council for Sustainable Health Development (ACOSHED), Int’l
African Services Committee, NY, USA
Agua Buena Human Rights Association, Costa Rica
AID FOR AIDS, Int’l
AIDS Action Baltimore, MD, USA
AIDS and Rights Alliance for Southern Africa (ARASA), South Africa/Int’l
AIDS Cell, Ibn Sina Academy, India
AIDS Foundation of Chicago, IL, USA
AIDS Law Project, South Africa
AIDS Vaccine Advocacy Coalition (AVAC), USA
AIDSETI-AIDS Empowerment & Treatment Int’l
AIDS-Hilfe Baden-Württemberg e.V., Germany
Aktion Canchanabury e.V., Germany
All-Ukraine PLWH Network, Ukraine
American Academy of HIV Medicine, USA
American Jewish World Service, USA
American Medical Student Association (AMSA) USA
AMSA Univ. of Pittsburgh School of Medicine Chapter, PA, USA
Ärzte für die Dritte Welt/German Doctors for Developing Countries, Germany
Asian Americans United, PA, USA
Association of Nurses in AIDS Care, USA
Association of Protestant Churches and Missions (EMW), Germany
Atbalsta Grupa Inficétajiem HIV un AIDS Slimniekiem (AGIHAS), Latvia
Beijing AIZHIXING Institute of Health Education, China
Bienestar, CA, USA
Brot für die Welt/Bread for the World, Germany
BUKO Pharma-Kampagne, Germany
Canadian HIV/AIDS Legal Network, Canada
Canadian Treatment Action Council (CTAC), Canada
CARE USA
Center for Policy Analysis on Trade and Health (CPATH), USA
Church World Service, Int’l
Comet Ltd, Malawi
Community and Family Health Initiative, Abuja, Nigeria
Community HIV/AIDS Mobilization Project (CHAMP), USA
Deutsche Welthungerhilfe / German Agro Action, Germany
Dignitas International, Canada
East European & Central Asian Union of PLWH Organisations, Ukraine
Ecumenical Pharmaceutical Network (EPN) Int’l
END AIDS NOW! NY, USA
Equinet Network for Equity in Health in east and southern Africa, Int’l
Evangelical Lutheran Church in America, USA
Foundation for Human Rights Initiative, Uganda
Foundation for Integrative AIDS Research (FIAR), NY, USA
Freedom Foundation-India, Centers of Excellence- Substance Abuse & HIV/AIDS, India
Ghana AIDS Treatment Access Group (GATAG), Ghana
Global AIDS Alliance, USA
Global Equity Gauge Alliance (GEGA) Int’l
Global Health Council, USA
GMHC Gay Men's Health Crisis, NY, USA
Gram Bharati Samiti (GBS), India
Grupo de Trabajo sobre Tratamientos del VIH (gTt), Spain
Harambee Africa Int’l
Harm Reduction Coalition, NY, USA
Health Alliance International, Int’l
Health and Development Networks (Ireland/Thailand), Int’l
Health Equity Project, USA
Health GAP (Global Access Project), USA
Health Systems Trust, South Africa
Healthpartners, Kenya
Helpless Rehabilitation Society (HRS), Nepal
Inova Hospital Juniper Program, VA, USA
Institute for the Study of Civic Values, PA, USA
International AIDS Empowerment, TX USA
International Community for the Relief of Starvation and Suffering (ICROSS), Int’l -- Kenya, Ireland and Canada offices
International Women's Health Coalition, Int’l
Intersect Worldwide, Int'l
IP-Left, South Korea
Joint Clinical Research Centre, Uganda
KAIPPG International, USA
Katholische Arbeitnehmer-Bewegung Deutschlands (KAB), Germany
Kenya AIDS Intervention Prevention Program Group (KAIPPG), Kenya
Kenya AIDS NGOs Consortium (KANCO), Kenya
Kiota Women's Development Organization (KIWOHEDE), Tanzania
Mashiah Foundation, Nigeria
McGill Global AIDS Coalition, Canada
Medilinks, USA
MesoAmerica Health Assistance Project of California, Inc (MAHAPCA), CA, USA
Mother Africa and Child Care Organisation (MACCO), Ghana
National AIDS Fund, USA
National Association of People With AIDS (NAPWA) USA
National Minority AIDS Council (NMAC) USA
National Nurses Association of Kenya (NNAK), Kenya
National Women's Lobby and Rights Group (NWLRG), Malawi
Neusser-Eine-Welt-Initiative e.V. (NEWI), Germany
New Mexico POZ Coalition, NM, USA
Pangaea Global AIDS Foundation, Int’l
PathWaysPA, PA, USA
Philadelphia Coalition of Labor Union Women (CLUW), PA, USA
Physicians for Human Rights, USA
Positive Malaysian Treatment Access & Advocacy Group (MTAAG+), Malaysia
Positive Malaysian Treatment Access and Advocacy Group (MTAAG+), Malaysia.
Preventive Healthcare Initiative, Nigeria
Progressive Organization of Gays in the Philippines
Public Health Impact Research Centre, Nigeria
Public Services International (PSI), Int’l
Resources Aimed at the Prevention of Child Abuse and Neglect (RAPCAN), South Africa
RESULTS USA
San Francisco AIDS Foundation, CA, USA
Sisters of St. Joseph of Carondelet, St. Louis Province, USA
Sisters of the Holy Cross - Congregation Justice Committee, IN. USA
Solidarité Sida, France
St. Joseph's Matale Youth Organisation (MAYO), Uganda
Street Works, TN, USA
Student Campaign for Child Survival, USA
Student Christian Movement of Great Britain, UK
Student Global AIDS Campaign, USA
Student Stop AIDS Campaign, UK
Students Against Global AIDS (SAGA), Canada
Students For Equity In Healthcare (SEHC), Makerere Medical School, Uganda
Students for Equity in Healthcare, Makerere University Medical School, Uganda
Students Partnership Worldwide (SPW), Int’l
Thai AIDS Treatment Action Group (TTAG), Thailand
The AIDS Institute, USA
The AIDS Support Organization (TASO), Uganda
Title II Community AIDS National Network, USA
Treatment Action Campaign, South Africa
Treatment Action Group, USA
Uganda CARES
Ukimwi Orphans Assistance, USA
United Methodist Church, General Board of Church & Society, USA
University Coalitions for Global Health, USA
Vital Hope Support Group, Zimbabwe
VSO (Voluntary Service Overseas) UK
Who's Positive, PA, USA
World AIDS Campaign, Int’l
Zimbabwe Activists on HIV and AIDS (ZAHA), Zimbabwe