U.S. Should Create Organization To Mobilize Health Care Workers to Countries Most Affected by HIV/AIDS, IOM Panel Says
The United States should create an HIV/AIDS "Peace Corps" to send health care workers to "fill the yawning doctor gap" in countries most affected by the pandemic, according to an Institute of Medicine report released on Tuesday, the Wall Street Journal reports (Chase, Wall Street Journal, 4/20). The report, titled "Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS," was requested by the State Department's Office of the Global AIDS Coordinator to suggest ways to create one of the "key manpower components" of the President's Emergency Plan for AIDS Relief, according to the Washington Post (Brown, Washington Post, 4/20). PEPFAR is a five-year, $15 billion program that directs funding for HIV/AIDS, tuberculosis and malaria to 15 focus countries, including Botswana, Ethiopia, Cote d'Ivoire, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Zambia, Haiti, Guyana and Vietnam (Kaiser Daily HIV/AIDS Report, 4/6). The law (HR 1298) authorizing PEPFAR calls for the creation of a "pilot program for the placement of health care professionals in overseas areas severely affected by HIV/AIDS, tuberculosis and malaria" (Washington Post, 4/20).
The report recommends creating what it calls the U.S. Global Health Service -- a "select corps" of 150 HIV/AIDS physicians and other specialists who would commit to two years of service as federal employees and receive $225,000 in salary and benefits, the Journal reports. An initial 100 fellowships providing $35,000 for a year of service also would be made available to early and mid-career professionals, and a third component would offer 100 recent medical school graduates as much as $25,000 annually in loan repayments for two years of service. A partnership program also would send U.S. health care workers to fill in for local health professionals who are trained outside their native countries (Wall Street Journal, 4/20). The program would not find a job or provide a salary for people seeking to work abroad but instead would match health care workers with organizations or academic institutions that operate oversees. Although the stipends offered under the proposed program would be less than an average U.S. salary for the positions, the initiative would be created to "make motivated people believe they can afford to interrupt their career for such work," while increasing their skills and marketability, according to the Post (Washington Post, 4/20). Implementing the program would cost approximately $100 million in the first year -- about 3% of PEPFAR's total budget. If the number of fellowships and tuition-repayment recipients in subsequent years increased to about 1,000 from the initial 100, the cost could rise to $140 million annually, according to the report's authors. "The Global Health Service is a vehicle of American compassion that's long overdue," Fitzhugh Mullen, professor of pediatrics and public health at George Washington University and lead author of the report, said, adding that the program also would be a "strategically important way to use our health care sector."
An unnamed spokesperson for Global AIDS Coordinator Ambassador Randall Tobias said that officials are reviewing the report and that it is too early to provide a "timetable for action," the Journal reports. "Since we requested this report and on a short time frame, we certainly will waste no time reviewing its findings," she said. Some international health workers have called the proposal a "positive step," but they also "expressed concern" that it would be available only to PEPFAR focus countries, according to the Journal. UNAIDS Executive Director Peter Piot said the program should be linked to broader policy objectives, such as ensuring decent wages for health care workers in developing countries. He added that the partnership component of the program could exacerbate the brain drain of doctors in the developing world by recruiting health care professionals to better-paying jobs. "Isn't it a bit absurd that we then send nurses and doctors to fill slots in Africa that have been emptied by our recruitment policies?" Piot asked. Nancy Padian, associate director of the UCSF Global Health Sciences program, said that PEPFAR itself could contribute to the drain on health care professionals from countries highly affected by HIV/AIDS. Padian said that new PEPFAR-funded programs in Zambia and Botswana are attracting nurses and physicians who are being trained in Zimbabwe, according to the Journal.
Frist Proposes Legislation
In related news, Senate Majority Leader Bill Frist (R-Tenn.) on Tuesday introduced a bill (S 850) that would mobilize U.S. health care workers abroad. The Global Health Corps Act of 2005 would send doctors as federal employees and private-sector professionals as volunteers to developing countries. However, the program, which would fall under the auspices of HHS, would not be limited to HIV/AIDS treatment (Wall Street Journal, 4/20). "This legislation harnesses the power generated by America's most precious resource: its generous and compassionate citizens," Frist said, adding, "Within our borders there exists a vast reservoir of talent, knowledge and compassion that can help heal our global neighbors. And by sharing these talents with regions in need, we can spread health and healing while bolstering our nation's image throughout the world" (Frist release, 4/19).
NPR's "All Things Considered" on Tuesday reported on the IOM report. The segment includes comments from Mullan and Dr. Ken Mayer, director of the Brown University AIDS Program (Wilson, "All Things Considered," NPR, 4/19). The complete segment is available online in RealPlayer.