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.
I walked into the activist meeting space yesterday morning and a wave of excitement washed over me. We are right behind the dance 4 life exhibition in the global village and they are jamming to some afro-caribbean beats that got me boppin’ as I walked by. When I entered, the room was absolutely buzzing with activity. Groups of people huddled together over blackberries and computers. The copier was humming and rhythmically churning out materials for press conferences. Another group busily making fliers and materials for today’s human rights march.
On flip chart in front of them written in English, Spanish and French:
Idea’s for todays actions and targets. Asks?
- Group intros and overview of planned actions for the week
- Ugandan M.o.P.H (Minister of Public Health)-Ask=gay Ugandan activists that were kicked out of PEPFAR implementer meeting in Uganda
Former Brown PHR student leader Jack Rusley who attended the Clinton speech today says they made a big splash. According to him, Bill Clinton, amazing and charismatic speaker that he is, incorporated the issue the activist raised into his speech.
Here are some excerpts from actions that have been posted on the AIDS2008.com blog.
- From Cameron Lefevre:
Kaytee already posted a great blog about ACT UP Paris’ action earlier today–where they took over the beginning of Bristol-Myers Squibb Symposium entitled “Rethinking Initiation of HAART” to call attention to the fact that BMS is “rethinking” production of a key HIV medication for children–but I wanted to follow-up and share a quick video and some photos from the event….
- The blog post by Kaytee, mentioned by Cameron:
You know the AIDS Conference has started when you hear the chants of activists resonate through the halls as they exit a conference room. So I’m happy to say – the AIDS Conference has officially started!
- Suzy Subway on the 1st Intl March Against Stigma, Discrimination And Homophobia (1ra. Marcha Contra El Estigma, La Discriminación Y La Homofobia)
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