During the campaign to bring affordable HIV treatment to people all over the world, South Africa’s Treatment Access Campaign volunteers spontaneously adapted the songs that united people during the fall of apartheid to the struggle that was keeping people in Africa from accessing HIV treatment. On July 10, in the halls of Mexico City’s Centro Banamex, the PHR Health Action AIDS team was part of yet another spontaneous rewriting of these songs. This time, instead of singing “We want AZT, we want Nevarapine,” we were singing about the global need for health workers.
We were part of a rally to raise awareness about the global health worker shortage that is curbing attempts to treat and prevent HIV across Sub-Saharan Africa. Organized by the Treatment Action Campaign, Medecins sans Frontieres, Health GAP, and PHR, this rally drew hundreds of supporters from the conference who marched through the Exhibition Hall, the conference center, and the Media Center singing, chanting, and speaking to the pain and suffering of people living with HIV in Sub-Saharan Africa who lack access to health workers. Holding signs stating “Where is my nurse?” and “Stop poaching our health care workers,” the rally brought together health workers from around the world with the organizations who support them to send a message to global development partners that the time to for action to solve the health workforce crisis is long overdue.
As Eric explains, AIDS activists and global health experts at the International AIDS Conference were unified in their recognition of the need to strengthen health systems and address the health workforce shortage. But, the resources are not yet flowing to address the gap between the health workforce needed to meet critical health goals such as Universal Access to HIV treatment or the Millenium Development Goals and the existing health workforce. We have had some successes—including the inclusion of training 140,000 new health workers as part of the United States Global Leadership against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008—but the funding available still falls well short of being adequate to address the global shortages.
And so, in partnership with health workers across the globe, we will continue to sing, to speak out, and to rally until the funding and the support follows.
What a difference four years makes. The health workforce crisis in developing countries, especially sub-Saharan Africa, has moved from marginal to mainstream at the International AIDS Conferences. In 2004, PHR released our report on the brain drain of health professionals out of Africa at the Bangkok International AIDS Conference. I remember going to one major session where one speaker spent perhaps one minute (maybe two) addressing the health workforce crisis. There were also a few posters of relevance. The health workforce was on the agenda, but barely.
The 2006 Toronto International AIDS Conference saw a big change. A packed session was devoted to the health workforce. Activists held up empty white coats while President Clinton spoke, calling for more nurses. Several closing ceremony speakers—Stephen Lewis and the then Acting Director General of WHO—highlighted the health workforce crisis as one of the issues that had to be addressed in order to achieve universal access to HIV treatment, prevention, care and support.
In Mexico City, issues of health workforce and health systems had a number of major sessions of its own. If not for all the meetings and other things that come up during the conference, I would have filled quite a portion of my schedule here with health workforce related sessions. Health workforce and health systems are big enough here that a one session, Asia Russell of Health GAP, a close ally of PHR, could fairly say—as she did—that the rallying cry of this International AIDS Conference, the mark it will make, is that we must scale up AIDS service using an approach that significantly contributes to broader health system strengthening.
These sessions have had two major themes. One is the connection between AIDS and health systems strengthening. What impact is the AIDS response having on health systems—especially the health workforce—and what can be done to ensure that AIDS funding is used to have a broader impact on funding. The second is task-shifting, delegating tasks that more intensely trained health workers (like doctors or nurses) would previously perform to less intensely trained professionals (like community health workers).
I see a common thread to these areas—lack of funding. Several AIDS and health systems sessions are partially driven by questions of whether AIDS is harming countries’ ability to address other diseases, such as by drawing health workers from maternal health programming to AIDS programming. There are real issues here about how to ensure AIDS programs do not inadvertently have such an impact. But the root of the potential conflict is adequate funding in AIDS and the health workforce. With adequate funding available for AIDS and the workforce, there would room for the needed investments in both areas. But with inadequate funding, money for one area may mean less for the other.
Similarly, the focus on task-shifting partially reflects inadequate funding. Again task-shifting is an important issue in its own right, and this is an important strategy for scaling up AIDS—and other health—programs. But why so much focus on task-shifting compared to other strategies, like health worker education and retention? Because training community health workers (and hopefully compensating them fairly) is less expensive than training and retaining doctors and nurses.
The major investments needed in the health workforce received minimal attention in Mexico City. There won’t be successful and sustained scale-up for universal access without this investment. Nor will the world ever achieve universal access without building health systems that are based in human rights—an issue that received a little attention in Mexico City (including through PHR’s new guide on the right to health and health workforce planning), but far too little.
I’m sure that the health workforce will be on the agenda again at the next International AIDS Conference in Vienna in 2010. When it is, I hope that we are able to look back of the time between Mexico City and Vienna and reflect on how the landscape has changed, with far greater funding for the health workforce—and for fighting AIDS—and with health workforces and health systems that are rooted in human rights.
Pat Daoust, Health Action AIDS Campaign Director, participated in a panel discussion titled “HIV and Human Resources: Competing Priorities or Interconnected Solutions?” The entire panel discussion is available on KaiserNetwork.org’s coverage of the conference. Below are some of Pat’s thoughts and comments on the panel.
One of the key issues here at the 17th International AIDS Conference is the debate which focuses on AIDS exceptionalism and the potential negative effects this supposedly has had on health systems and human resources in developing countries.The debate was stimulated by an article by Roger England in the BMJ in May. England claimed that funds pouring into developing countries to address the AIDS pandemic attracted health workers and is building health infrastructure at the expense of other important health issues:
HIV is an emergency that has killed 25 million people in the last 25 years…but what about the 50 million children who have died of pneumonia…or the 25 million neo-nates that have also died within the same time frame. Why is this not an emergency?
In response to this statement, I noted in my comments on the panel that “Yes, these are emergencies and just as we have responded to the AIDS pandemic, we need to support a similar response to both of these inexcusable health issues. We believe in a rights-based health system that gives equal access to all…” AIDS has provided us with an opportunity to take lessons learned and apply them to the health system broadly. AIDS has shone a light on disparities we would otherwise not have prioritized.
AIDS, as Peter Piot, Exec Director of UNAIDS explained, is a “revealer of problems.” I would like to add, AIDS has also been a revealer of solutions. Our response to AIDS needs to be replicated throughout the health community. Addressing health worker shortages and the weak health systems that we are determined to fix so that Universal Access to HIV Care, Prevention and Treatment is feasible…will also help us address equal access to quality care for all regardless of diagnosis or health related situation.
This discussion highlighted the need for continued advocacy for a rights-based health care system for those living with HIV – and for all in need.
Using the Kaiser Network’s video of this session for discussion, students can host a hub of the conference. Pat’s comments start at one hour into the panel.
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Photo: HAA Campaign Director Pat Daoust speaking during Panel Discussion on “HIV and Human Resources: Competing Priorities or Interconnected Solutions?” To right is Dr. Tedros Adhanom Ghebeysus, Ethiopian Minister of Health. To the left is Tesfa Ghebrehiwet, Ph.D., M.P.H., B.Sc., Nursing and Health Policy Consultant, International Council of Nurses
Physicians for Human Rights held a press conference on Tuesday in Mexico City to release a new guide: “The Right to Health and Health Workforce Planning: A Guide for Government Officials, NGOs, Health Workers and Development Partners.”
The whole idea of the guide is to show how even very poor countries can build human rights into their health workforce planning—and not leave behind marginalized groups, like women, front-line health workers, or people who live in rural areas.
The guide is both a manifesto—declaring that countries have an obligation to step up and provide health care for their most vulnerable residents—and a step-by-step handbook: Who do you invite into the process? How do you find them? How do you make sure your plan is really working?
PHR staffers Maggie Cooper and Eric Friedman wrote the guide with input from numerous African NGOs, government officials, and individual health professionals.
We had some auspicious help in launching it at the press conference. Our CEO, Frank Donague, noted that the guide was a follow up to PHR’s “An Action Plan to Prevent Brain Drain,” released at the International AIDS Conference in Bangkok, Thailand—a report that explored in depth—for the first time—the idea of addressing Africa’s health worker shortage as a separate issue.
Eric Goosby, MD; head of Pangea Global AIDS Foundation, talked about the vital need for basic information for incorporating human rights into health system planning. Pat Daoust, RN MSN, head of PHR’s Health Action AIDS campaign, gave an overview of the health workforce crisis that many countries are now facing. And Dr. Carolyne Onyango, founder of the Action Group for Health, Human Rights, and HIV/AIDS (AGHA) the first Ugandan group of health worker/AIDS advocates, spoke about how the idea of human rights, once introduced among Ugandan health professionals, is catching on like wild fire.
This guide already has its fans.
I find this document impressive, accessible, and groundbreaking. When one reads the document one can’t but be amazed by the intense and intensive, broad and detailed consultations that have gone into this unique publication. It should be a pocket book to every health professional, a bible to every Minister of Health, a guiding star for every health and human rights expert and novice.
—Maxwell V. Madzikanga, Senior HIV/AIDS Researcher to the UN Special Rapporteur on the Right to Health
Voice of America television and radio is producing both radio and television pieces on the guide which will air later this week, so watch this space for details!
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Photos:
- Eric Goosby, MD, Pangea Global AIDS Foundation
- Eric Friedman, PHR; Dr. Carolyne Onyango, AGHA; Frank Donaghue, PHR; Pat Daoust, RN MSN, PHR; Eric Goosby, MD, Pangea Global AIDS Foundation
I am excited to announce that videos made for World AIDS Day 2007 by students in the US, Kenya and Uganda will be featured at the conference this week. This was one of the advocacy initiatives that PHR’s Student Program has collaborated on with our partner organizations in East Africa. American and East African students created video postcards that were delivered to the US Congress and called on them to make the right to health a reality.
Conference organizers have set up a Youth Networking Zone that will feature multimedia created by youth HIV/AIDS advocates. The videos created by these students are an amazing example of the powerful voice of health professional students in advocacy.
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