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Africa: Health Resources Shortfall
AfricaFocus Bulletin
Jun 24, 2005 (050624)
(Reposted from sources cited below)
Editor's Note
"When the G8 industrialized nations gather in Scotland next month,
they should commit to subsidizing the salaries of African health
workers to keep them from leaving their home countries in search of
higher pay and better conditions in wealthier countries. ... All
the well-intentioned efforts [to address AIDS and other health
needs] are limited by the lack of personnel on the ground for both
prevention and treatment programs." - Boston Globe, June 24, 2004
Despite their commitment early this month to write off debts to
multilateral institutions by 18 developing countries (see
http://www.africafocus.org/docs05/debt0506.php), rich countries
have barely made a start in meeting the demands to address Africa's
needs. While debate tends to focus under the standard themes of
debt, aid, and trade, activists in the health field are taking the
lead to stress that the framework needs to be changed to a common
obligation to invest in universal rights rather than a narrow
conception of charitable "aid" from donors to recipients. It is in
this context that both NGOs and multilateral organizations are
seeking common estimates for defining the resources needed.
This AfricaFocus Bulletin contains excerpts from a press release
from Physicians from Human Rights and a statement by health workers
calling on the G8 to commit the funds necessary to double the
number of health workers in Africa. It also contains the latest
estimate from UNAIDS of the need and shortfall in funding for AIDS.
This places the total unfunded gap for 2006-2008 as at least $18
billion, of the $55 billion estimated at needed for that three-year
period.
For previous AfricaFocus Bulletins on health issues, including
additional documents and links, visit
http://www.africafocus.org/healthexp.php
++++++++++++++++++++++end editor's note+++++++++++++++++++++++
Africa Cannot Stop Poverty Without More Health Workers
PHR Releases New Figures: G8 Must Commit $2B in 2006 to Double
Doctors, Nurses and Other Health Workers in Africa
Physicians for Human Rights
http://www.phrusa.org
June 21, 2005
[excerpt from press release]
Contact:
Kate Krauss kkrauss@phrusa.org Tel 617 301-4240 Fax 617-301-4250
Cell: 215-939-7852
Barbara Ayotte 617-301 4210 617-549-0152 cell bayotte@phrusa.org
Available for comment:
Hetherwick Ntaba, OBE Minister of Health, Malawi
Eric A. Friedman, J.D. HIV/AIDS Policy Analyst, Physicians for
Human Rights
Citing a devastating shortage of health care workers in
AIDS-burdened countries, Physicians for Human Rights (PHR) today
released new cost estimates that would double the number of health
workers in sub-Saharan Africa in order to confront the AIDS
pandemic and reduce maternal and child mortality over the next five
years. PHR is calling for a global investment of US $2 billion in
2006, rising to $7.7 billion in 2010 by all donors, and has
calculated the U.S. share as being one-third of the sum needed, or
$650 million for 2006, rising to $2.5 billion in 2010. ...
Commented Hetherwick Ntaba, OBE, the Health Minister of the African
nation of Malawi and a surgeon: "Some countries' health delivery
systems are in danger of collapsing because of this human resource
crisis. The AIDS pandemic itself impacts negatively on our ability
to deal with AIDS because of the toll it takes on our work force.
In the middle of all this, the migration of health workers from
poor to the rich countries is very unfortunate. It is like the
biblical saying, 'For those who have more, more is being given; for
those with less, even that is being taken away.' We ask the G8 to
really look at this issue very seriously and offer their support."
Right now in Africa, a mere 1.3% of the world's health workers
struggle to care for people suffering 25% of the global disease
burden. In Malawi, only 10% of the physician slots are filled,
while 10 people die every hour of AIDS. Across Africa AIDS has
killed thousands of health care workers, and large numbers of
doctors and nurses are migrating to the West, driven out by
impoverished health care systems and lured by elaborate recruiting
packages by hospitals in G8 countries. For example, while 1200
physicians were trained in Zimbabwe during the 1990s, by 2001 only
360 remained. More than 3,000 nurses from African nations migrated
to the United Kingdom in 2002-2003.
The March 11, 2005 report of the UK Commission for Africa,
commissioned by Prime Minister Tony Blair, called for a tripling of
the healthcare workforce in Africa:
Training and retaining doctors, nurses and other health service
personnel has been neglected. ...Africa's health workforce should
be tripled through the training of an additional one million
workers over a decade. Salaries should be increased to ensure staff
are not wooed from their jobs. ,,,
Modeling on a continent-wide scale suggests that $7.7 billion
annually by 2010 could support a doubling of the health workforce.
A discussion of the methodology used to calculate these figures is
[available on the PHR website]. ...
The G-8 Must Commit to Addressing the Global Health Worker Crisis
Statement for Group of 8 Meeting in July 2005
Physicians for Human Rights
http://www.phrusa.org/campaigns/aids/g8message/
We are nurses and doctors, pharmacists and laboratory technicians,
medical assistants and community health workers. We are
non-governmental organizations. We are [members of] government[s].
We are people with HIV/AIDS. Some of us sit in government
ministries, some of us work in rural health facilities, and some of
us work wherever it is we find people in need. We share in common
a deep concern for the health and well-being of the members of our
communities and citizens of our own and other countries. Yet
despite our best efforts, health systems in many developing
countries are in crisis, and millions of people whose lives we
could save and whose health we could preserve are dying and
becoming seriously ill.
Health workers are at the core of these health systems. Health
systems collapse where there are too few health workers, or health
workers without proper training, supervision, and management and
support structures, or health workers who are separated from their
community structures and needs, or health workers who are
themselves ill and dying and working in unsafe conditions. Yet this
is the situation many of our countries face. Annual health budgets
that are often $10 or less per capita, the exodus of health
professionals, failure to prioritize human resources, and the
HIV/AIDS pandemic, both through the disease burden it creates and
its impact on health workers themselves, have combined to create a
crisis. Until we surmount this crisis in human resources for health
and health systems, preventable death and suffering on a massive
scale will continue.
Overcoming this crisis will require the joint efforts of your
countries and ours. We will take the lead, but require cooperation
and support in what must be a global response to a problem of
global proportions. Together, we must develop and implement
sustainable and greatly expanded responses that address underlying
causes to the health worker crisis, that improve health systems,
and that dramatically improve access to quality health services for
people in underserved areas.
Everyone has the right to the highest attainable standard of
health. Fulfilling this right requires addressing the crisis in
human resources for health and in health systems. The efforts of
our countries alone will not be enough to resolve this crisis and
secure for every person the dignity she deserves. We therefore urge
your governments to meet your obligations under the UN Charter and
other human rights law to join us in taking the actions required to
resolve this crisis.
To enable our countries to have the health workforces we require to
meet our people's health needs and achieve the Millennium
Development Goals, we urge the members of the G8 to make the
following commitments:
1. Strengthening national health systems
1.1 We urge you to support African and other developing countries
that are experiencing crises in human resources for health by
providing the necessary financial and technical support to enable
our countries to develop and fully implement national strategies on
human resources for health as a central part of any overall plan to
improve service delivery and strengthen national health systems so
as to achieve the Millennium Development Goals.
1.2 We urge you to ensure that through your efforts and those of
others, the resources required to fully fund these strategies are
available.
1.3 We urge you to coordinate your investments and those of other
donors and organizations with those of regional communities and
developing country governments, and to use local technical
resources where possible.
1.4 Strategy development should be led by national authorities with
broad stakeholder participation that engages civil society and
responds to local needs.
1.5 Assistance in the development of strategies should not delay
the provision of urgently needed financial assistance and other
technical assistance.
2. Supporting and enlarging health worker capacity
2.1 We urge you to support, with financial and technical
assistance, national efforts to create conditions that facilitate
health worker retention and deployment to underserved areas,
including adequate compensation; improved health worker management,
planning, and information systems; incentives; continuous learning
opportunities; and; safe working environments for health workers
through universal precautions and other forms of infection
prevention and control, universal access to post-exposure
prophylaxis, and workplace HIV treatment and prevention programs.
2.2 We urge you to support models of education and care that
respond to national circumstances and priorities, providing quality
health care to the maximum number of people and expanding health
services in underserved areas. The models of care will often
include the development of high quality mid-level and community
health worker cadres, effective competency-based training
strategies, and policies, training, supervision, and adequate
compensation to enable nurses to engage in advanced nursing
practices. We urge you to further support the development of career
pathways for mid-level and community health worker cadres,
permitting competence- and skills-based movement up the hierarchy
of the health system.
2.3 Community members, including people living with HIV/AIDS, have
a vital role in supplementing the care provided by health
professionals. We urge you to support local, regional, and national
efforts to empower community health workers and caregivers,
including by enabling them to have the compensation, training,
accreditation, supervision, and support structure required to
maximize their effectiveness. We urge you to support local efforts
to increase community awareness and capacity to participate in a
comprehensive scale-up of prevention, care, and treatment
programming through activities such as treatment preparedness,
treatment literacy, and treatment adherence support.
2.4 We urge you to support expanded capacity of health professional
training institutions including through incentives and other
support for faculty, expanded physical space, and creation of new
training institutions as needed, and to support these institutions
in reviewing curricula to assure that the skills are relevant to
required public health needs and competencies.
2.5 We consider it a tragic irony that many of the same countries
facing enormous human resources deficits have in our midst large
numbers of unemployed health care workers.
We urge you to take all necessary steps, working with our
governments and other parties, including international financial
institutions, to enable their rapid re-engagement.
3. Overcoming macroeconomic challenges
3.1 We urge you to seek agreement with the International Monetary
Fund and other international financial institutions, finance,
health, and other ministers, and central banks to increase fiscal
space for expanded funding from external and domestic sources,
including debt cancellation, for health and other forms of human
development. Civil society must have a voice in this process.
Macroeconomic challenges should not and need not impede the flow of
the required resources.
3.2 We urge you to ensure that new and existing developing country
agreements with the IMF and other international financial
institutions do not require or lead to freezes in health worker
recruitment, prevent payment of wage levels required to retain
health workers, or prevent the hiring of unemployed health workers.
Programs critical to public health should be exempt from budget and
wage ceilings contained in such agreements.
3.3 Long-term, sustainable economic growth requires investments to
reduce poverty and hunger, improve health and expand education at
all levels, empower women, and ensure environmental sustainability,
including through improving living conditions in rural and slum
areas and universal access to clean water and sanitation.
3.4 We urge you to commit to providing your assistance in a
long-term and predictable manner, including for both bilateral and
multilateral mechanisms, such as the Global Fund to Fight AIDS,
Tuberculosis and Malaria.
4. Addressing health worker needs in high-income countries
4.1 We urge you to meet your country's own health care needs
without reducing the capacity of developing countries to meet our
health needs.
4.2 We urge you to meet your obligations under World Health
Assembly Resolution 57/19, "International migration of health
personnel: a challenge for health systems in developing countries."
4.3 We urge you to evaluate the recruitment practices of public and
private health providers in your country, and implement strategies
that will protect the health human resource base of our countries.
The strategies may include ending active recruitment from certain
countries and working with developing country governments and
regional and international organizations to develop satisfactory
policies on recruitment, such as through managed migration with
mutual benefits to both source and destination countries.
4.4 We urge you to take the necessary measures to increase your
country's supply of domestically-trained health care workers.
5. Supporting international organizations
5.1 The technical capacity and normative role of the World Health
Organization gives it a special role in addressing the human
resources for health crisis. We urge you to provide WHO the
additional funding it requires to support expanded and accelerated
large-scale technical assistance in this area; to build its own
capacity at headquarters, regional, and country levels, including
through interdepartmental collaboration and nationally led teams,
and; to enhance national capacities to develop and implement
strategies to meet Millennium Development Goals, including
effective development and management of the health workforce. We
further urge you to ensure that WHO has the funds to develop and
sustain a human resources for health observatory in Africa. All
funding to expand WHO capacity should be in addition to the funding
WHO requires to support anti-retroviral therapy scale-up.
5.2 The Global Fund to Fight AIDS, Tuberculosis and Malaria
supports health system strengthening, including human resources. We
urge you to ensure that the Global Fund is fully funded, including
so that it can renew all deserving proposals from previous rounds,
fully fund Round 5, and launch Round 6 in a timely manner. We
further urge you to make available technical support to help
applicants develop ambitious proposals in the area of AIDS,
including treatment, tuberculosis, malaria, and health system
strengthening.
5.3 We urge you to support regional health and development
organizations in their effort to address the human resources for
health crisis through regional and sub-regional interventions.
6. Ensuring soundness of donor programs
6.1 We urge you to ensure that your own funding mechanisms and
programs strengthen, and do not weaken through resource diversion
or other means, public health systems and their human resource
capacities. Bilateral programs should help build local capacity and
utilize and catalyze local capacity wherever possible.
US$ 22 Billion Needed in 2008 to Reverse Spread of AIDS
New report shows resource needs far higher than funding available
UNAIDS
http://www.unaids.org
Geneva, 22 June 2005 - US$22 billion will be needed in 2008 to
reverse spread of AIDS in the developing world, according to latest
estimates. These figures feature in a new report on estimated
funding needs produced by the UNAIDS Secretariat, to be released to
the UNAIDS Programme Coordinating Board at the end of June.
Building on previous estimates, these figures have been developed
using the latest available information and with the invaluable
input from a newly established Resource Needs Steering Committee
and Technical Working Group which are made up of international
economists and AIDS experts from donor and developing countries,
civil society, United Nations agencies and other international
organizations.
"We have come a long way in mobilizing extra funds for AIDS, moving
from millions to billions, but we still fall short of the US$22
billion needed in 2008," said Dr Peter Piot, UNAIDS Executive
Director. "AIDS poses an exceptional threat to humanity and the
response needs to be equally exceptional, recognizing the urgency
as well as the need for long term planning and financing."
The revised estimates indicate funding needs of approximately US$15
billion in 2006, US$ 18 billion in 2007 and US$ 22 billion in 2008
for prevention, treatment and care, support for orphans and
vulnerable children, as well as programme costs (such as management
of AIDS programmes and building of new hospitals and clinics) and
human resource costs (includes training and recruitment of new
doctors and nurses).
This is the first time that specific attention is given to resource
needs for longer term investments to improve country capacity in
the health and social sectors through training of existing staff,
recruiting and paying new staff and significant investments for
building the necessary infrastructure. These financial requirements
for the human resources and programme costs are preliminary, and
will be further refined and improved.
Meeting the 2006-2008 resource needs would result in the following
achievements:
- Prevention - A comprehensive prevention response by 2010, as is
required to turn around the AIDS epidemic, based on the current
coverage of services and the most recent evidence on actual rates
of scaling up interventions.
- Treatment and care - 75% of people in need globally
(approximately 6.6 million people) will have access to
antiretroviral treatment by 2008, based on current coverage rates
and rates of growth as seen in 2004.
- Orphans and vulnerable children - Increase of support from low
levels of coverage to full coverage of all orphans in Sub-Saharan
Africa, given that AIDS is responsible for more than 2/3 of
children who have lost both parents, as well as AIDS orphans in
other low and middle-income countries.
- Human resources - Covering the costs of recruiting and training
additional doctors, nurses and community health workers in
low-income countries, and two middle-income countries (South Africa
and Botswana) and incentives to retain and attract people to the
health sector. Future analyses will calculate costs for other
health workers, including nurse practitioners, clinical officers
and laboratory technicians.
- Programme costs - The construction of over 1000 new health
centres (to be available by 2010), based on the investments made
during 2006-2008. An additional 19, 000 health centres and 800
hospitals would be renovated over the next three years to handle
the scaling-up of HIV treatment and care.
According to the latest UNAIDS projections, a total of US$8.3
billion is estimated to be available from all sources in 2005,
rising to US$ 8.9 billion and US$10 billion in 2006 and 2007
respectively.
As the response to AIDS is scaled up, funding estimates must be
constantly revised and updated. UNAIDS will work with international
donors and affected countries to refine the costing estimates,
focusing particularly on strengthening health infrastructures.
AIDS Resource needs (US$ billion) 2006 2007 2008
Prevention 8,4 10,0 11,4
Treatment and care 3,0 4,0 5,3
OVC 1,6 2,1 2,7
Programme costs 1,5 1,4 1,8
Human resources 0,4 0,6 0,9
Total 14,9 18,1 22,1
Note to Editors
[1] UNAIDS has been producing resource needs estimates since 2001.
Since that time there has been increased access to relevant data,
a continuous improvement in the methodologies and new thinking
about what comprises a comprehensive package of interventions to
turn back the epidemic. The latest estimates constitute the best
available assessment of global needs for AIDS ...
[2] It appears that there is a funding gap between resources
available and those needed of at least US $18 billion from 2005 to
2007. However, this is likely to be a significant underestimate.
...
For more information, please contact Dominique De Santis, UNAIDS,
tel. +41 22 791 4509, email. desantisd@unaids.org or Beth
Magne-Watts, UNAIDS, tel. +41 22 791 5074, email.wattsb@unaids.org.
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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