World AIDS Day

Today is World AIDS Day. World AIDS Day, World AIDS Day Campaign, and the Condom Project (a story about their activities can be found here) are among some the groups working to raise awareness about the plague of AIDS.

There are many issues to confront in the battle against this disease. One of them is the lack of professional health care providers in Africa. This is from today’s Washington Post:

President Bush made a historic pledge in his 2003 State of the Union address: to get urgently needed AIDS treatment to 2 million people living with HIV in impoverished countries by 2008. Congress concurred and launched a major initiative to fight AIDS focusing on 15 developing nations. At a U.N. General Assembly conference on AIDS this year, the United States went further and committed, along with other countries, to come as close as possible to universal access to HIV treatment by 2010.

We have come a long way since 2000, when AIDS treatment was available to only the fortunate few. Activists campaigned successfully to drive down the cost of treatment with affordable off-patent AIDS medicines that are now available in most developing countries. After initial objections, the U.S. government became a major purchaser of generic drugs.

But now that donor governments are providing more funding and medicines are becoming available, a new bottleneck threatens the success and sustainability of the effort. People with AIDS in Africa are dying simply because there aren't enough nurses, doctors and pharmacists to administer treatment. Without a new effort to train, retain and support health workers in numbers sufficient to meet basic needs, the United States will not be able to keep the deal it made with Africa in 2003.

It takes years to graduate a new doctor or nurse, and most of them prefer to build a career in a major city with well-equipped hospitals. But with modest investments, donor governments can quickly empower and mobilize an army of health workers made up of the hundreds of thousands of unemployed or underemployed people living in the very settings where HIV's toll is heaviest. Women in particular are often already serving as caregivers at the community level, usually without training or compensation.

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Many programs have sought to rely on "volunteers" and deny these laborers pay for their services -- a model conceived in wealthy countries. But in poor countries this amounts to exploitation of the poorest to treat the sickest. It should be replaced by programs that ensure living wages, continuing training and a career path.

Community health workers cannot succeed alone; they are not an excuse to cut corners. Professional backup from doctors, nurses and medical officers is necessary to provide supervision and to treat referrals. But the pool of available health professionals in many African countries is too small to address basic primary-care needs and far from adequate to supply new donor-sponsored global health programs.

Unintentionally, the laudable U.S. efforts to fight AIDS and malaria in Africa can end up weakening primary health systems that are already crumbling by hiring doctors and nurses away from public clinics and hospitals where they are also desperately needed. When primary public health systems fail, disease-specific initiatives will also fail. The United States must get serious about increasing the overall supply and retention rates for health professionals in sub-Saharan Africa.