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[Dear friends, thank you for the very strong array of endorsements for the
health workforce platform - we have already had some very favorable meetings
with US officials in support of this. Please continue circulating for new
endorsements in your personal NGO networks. This signature drive will remain
open through the month of March. Best regards, Paul]
Urgent Call for U.S. 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, USA
Peter Mugyenyi, MD, Director, Joint Clinical Research Centre, Uganda
Paul Farmer, MD, and Joia Mukherjee, MD, Partners in Health, USA/Int=B9l
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, USA
Allan Rosenfield, MD, Dean, Mailman School of Public Health, Columbia
University, USA
James Orbinski (Former International President of MSF-Médecins Sans
Frontières)
Research Scientist, Associate Professor, University of Toronto, Canada
Josh Ruxin, Assistant Clinical Professor of Public Health, Center for Globa=
l
Health and Economic Development,
Mailman School of Public Health and The Earth Institute at Columbia
University, USA
Gilbert Kombe, MD, MPH, Partnership for Health Reformplus Project,
Abt Associates Inc., USA
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,
Founding Member, Academic Alliance for AIDS Care and Prevention in Africa,
Uganda
Dr. Anne Merriman, Founder and Director of Policy and International
Programmes, Hospice Africa, Kampala, 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, GA, USA
Jocelyn Tindiweegi, Head Nursing Officer for Mbarara University Teaching
Hospital, Uganda
Lark Lands, M.S., Ph.D. Medical writer, editor, and educator, USA
John S. James, Publisher, AIDS Treatment News, USA
Christine C. Quinn, Speaker of New York City Council, USA
US & US-Based International Organizations:
ACT UP Austin, TX, USA
ACT UP New York, NY, USA
ACT UP Philadelphia, PA, USA
ActionAid International USA
ActionAIDS, PA, USA
Africa Action, USA
Africa Faith and Justice Network, USA
African Immigrant and Refugee Foundation (AIRF), DC, USA
African Services Committee, NY, USA
AID FOR AIDS, Int=B9l
AIDS Action Baltimore, MD, USA
AIDS Foundation of Chicago, IL, USA
AIDS Research Alliance, CA, USA
AIDS Survival Project, GA, USA
AIDS Treatment News, USA
AIDS Vaccine Advocacy Coalition (AVAC), USA
AIDSETI-AIDS Empowerment & Treatment Int=B9l
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
Artists for a New South Africa, USA
Asian Americans United, PA, USA
Association of Nurses in AIDS Care, USA
Bienestar, CA, USA
CARE USA
Center for Policy Analysis on Trade and Health (CPATH), USA
CitiWide Harm Reduction, NY, USA
Church World Service, Int=B9l
Community HIV/AIDS Mobilization Project (CHAMP), USA
Constituency for Africa (CFA), USA
Elizabeth Glaser Pediatric AIDS Foundation, Int=B9l
END AIDS NOW! NY, USA
Evangelical Lutheran Church in America (ELCA), USA
Eritrean Community for Human Rights and Refugee Protection, USA
Foundation for Integrative AIDS Research (FIAR), NY, USA
Global AIDS Alliance, USA
Global Health Council, USA
GMHC Gay Men's Health Crisis, NY, USA
Harambee Africa Int=B9l
Harm Reduction Coalition, NY, USA
Health Alliance International, Int=B9l
Health Equity Project, USA
Health GAP (Global Access Project), USA
Housing Works, NY, USA
Inova Hospital Juniper Program, VA, USA
Institute for the Study of Civic Values, PA, USA
International AIDS Empowerment, TX USA
International Association of Physicians in AIDS Care (IAPAC), Int=B9l
Jubilee USA
KAIPPG International, USA
Kentucky Divest Campaign, KY, USA
Medilinks, USA
Mennonite Central Committee, USA
MesoAmerica Health Assistance Project of California, Inc (MAHAPCA), CA, USA
Metropolitan Community Church of New York, USA
National AIDS Fund, USA
National Association of Black Social Workers, USA
National Association of People With AIDS (NAPWA) USA
National Minority AIDS Council (NMAC) USA
New Mexico POZ Coalition, NM, USA
New York City AIDS Housing Network, NY, USA
Pangaea Global AIDS Foundation, Int=B9l
Partners in Health, Int=B9l
PathWaysPA, PA, USA
Philadelphia Coalition of Labor Union Women (CLUW), PA, USA
Physicians for Human Rights, USA
Make Art/STOP AIDS, CA, USA
Presbyterian Church, (USA), Washington Office
Priority Africa Network (PAN), CA, USA
Project Inform, USA
PROTOTYPES, Centers for Innovation in Health, Mental Health and Social
Services, CA, USA
Queers for Economic Justice, NY, USA
Quixote Center/Quest for Peace, USA
RESULTS USA
San Francisco AIDS Foundation, CA, USA
Share International, USA
Sisters of St. Joseph of Carondelet, St. Louis Province, USA
Sisters of the Holy Cross - Congregation Justice Committee, IN. USA
Sojourners, USA
Street Works, TN, USA
Student Campaign for Child Survival, USA
Student Global AIDS Campaign, USA
The AIDS Institute, USA
The River Fund, FL, USA
Title II Community AIDS National Network, USA
Treatment Action Group, USA
Ukimwi Orphans Assistance, USA
United Church of Christ Network for Environmental and Economic
Responsibility, USA
United Methodist Church, General Board of Church & Society, USA
Universities Allied for Essential Medicines, USA
University Coalitions for Global Health, USA
Who's Positive, PA, USA
Wilson Resource Center, IA, USA
Women's Equity in Access to Care and Treatment (WE-ACTx)-U.S./Rwanda
World Hunger Year, Inc. (WHY), USA
International and multicountry organizations:
(WE CARE) Development Initiative, Nigeria
ACT UP Kathmandu, Nepal
ACT UP Paris, France
Action Against Aids, Germany
Action for Community Development, Uganda
Action for Community Development, Uganda
Action Group For Health, Human Rights and HIV/AIDS (AGHA), Uganda
action medeor, Germany
Africa Youth Leadership, Development and Health (AYLDH), Uganda/int=B9l
African Council for Sustainable Health Development (ACOSHED), Int=B9l
Afrihealth Information Projects/Afrihealth Optonet Association, Nigeria
Agir ici, France
Agua Buena Human Rights Association, Costa Rica
AIDS and Rights Alliance for Southern Africa (ARASA), South Africa/Int=B9l
AIDS Cell, Ibn Sina Academy, India
AIDS Law Project, South Africa
AIDS-Hilfe Baden-W=FCrttemberg e.V., Germany
Aktion Canchanabury e.V., Germany
All-Ukraine PLWH Network, Ukraine
=C4rzte f=FCr die Dritte Welt/German Doctors for Developing Countries, Germ=
any
Association of Kenya Medical Laboratory Science Officers, Kenya
Association of Positive Youth in Nigeria (APYIN)
Association of Protestant Churches and Missions (EMW), Germany
Atbalsta Grupa Infic=E9tajiem HIV un AIDS Slimniekiem (AGIHAS), Latvia
Beijing AIZHIXING Institute of Health Education, China
British Columbia Persons With AIDS Society (BCPWA), Canada
Brot f=FCr die Welt/Bread for the World, Germany
BUKO Pharma-Kampagne, Germany
Canadian HIV/AIDS Legal Network, Canada
Canadian Treatment Action Council (CTAC), Canada
Centre for Development Research, Uganda
Children for Children Organisation, Gambia
China Orchid AIDS Project, China
Christian Health Association Of Kenya (Chak)
Comet Ltd, Malawi
Community Aid Uganda
Community and Family Health Initiative, Abuja, Nigeria
CRIAA SA-DC (Centre for Research, Information and Action in Africa-Southern
Africa Development and Consulting), Namibia
Deutsche Welthungerhilfe / German Agro Action, Germany
Development Initiatives International, Uganda
Dignitas International, Canada
East European and Central Asian Union of PLWH Organisations, Ukraine
Ecumenical Pharmaceutical Network (EPN) Int=B9l
Equinet Network for Equity in Health in east and southern Africa, Int=B9l
European AIDS Treatment Group (EATG), Int=B9l
Foundation for Human Rights Initiative, Uganda
Freedom Foundation-India, Centers of Excellence- Substance Abuse & HIV/AIDS=