*EPF411 07/15/2004
More Health Care Workers Needed to Combat AIDS
(U.S. works to expand treatment, care capabilities in hard-hit nations) (760)

By Charlene Porter
Washington File Staff Writer

Bangkok, Thailand -- Increasing the flow of anti-retroviral drugs to people living with AIDS in the developing world and increasing the global financial commitment to combat the disease are two of the dominant issues at the XV International AIDS Conference under way in Bangkok.

Yet there is a third issue that U.S. officials call the greatest barrier to getting treatment to people living with HIV/AIDS in the developing world -- the lack of adequately trained health care providers in those countries to administer drugs properly and to monitor patients to determine that the drugs are working effectively.

U.S. Global AIDS Coordinator Randall Tobias called the lack of human capacity the major challenge to success of programs to deliver anti-retrovirals to the developing world.

"Ignoring those limitations means wasting money and failing to solve problems," said Tobias in a keynote speech July 14. "All the AIDS drugs in the world won't do any good if they're stuck in warehouses with no place to go to actually be part of the delivery of treatment to those in need."

In developed countries, the ratio of physicians to population can be several hundred per 100,000 people. According to a report issued by Physicians for Human Rights during the Bangkok AIDS conference, 75 percent of sub-Saharan nations have fewer than 20 physicians per 100,000 people, a ratio that is a minimum standard set by the World Health Organization. Some nations have five or fewer doctors for every 100,000 people, the report says.

The U.S. Agency for International Development (USAID) is at the forefront of many of the U.S. programs to deliver AIDS treatment in the developing world. In a Washington File interview in Bangkok, Assistant Administrator for Global Health Dr. E. Anne Peterson echoed Tobias, saying, "The hardest part of moving the drugs is having the people to do it."

The United States is working to improve human capacity in the health care sectors of hard-hit nations through its five-year, $15 billion program, the President's Emergency Plan for AIDS Relief (PEPFAR). The program began receiving funding in the early months of 2003, and Tobias said the efforts in the early years of the plan will concentrate on building stronger networks of health care providers to enable the delivery of treatment and continuing care to people living with HIV/AIDS.

There are a variety of ways to set about that task. Encouraging and supporting full-scale medical education for developing world students is one way, but that effort takes years and does not put enough providers in communities rapidly enough.

Peterson said U.S. programs will pursue several other strategies, "to take existing human capacity to make it more efficient" -- by upgrading skills and tools, for example. She said another important concern is to keep existing cadres of health care providers intact by preventing their infection either through inadvertent exposure in medical settings or other means of transmission.

"We also need to look at providers who may have been underutilized," the USAID official said. In some underdeveloped countries, Peterson said, faith-based institutions currently provide as much as 50-60 percent of health care. There may be greater opportunities to involve these caregivers in treatment of people with HIV/AIDS and link them to major nongovernmental organizations and national governments that are the recipients of PEPFAR funding, Peterson said.

Another underutilized resource may be private and business organizations, Peterson said. "Businesses are just beginning to step up the plate," and they have human capacity to contribute to solving this problem, she said.

Even as USAID works to increase numbers of developing world health care providers in a variety of ways, Tobias said that some successes are already being achieved. He noted that the United States has quickly trained 14,700 health workers and built capacity at over 900 different health care sites as part of its "prevention of mother-to-child transmission" programs.

The Physicians for Human Rights report calls for African countries themselves to better protect the health of medical workers by providing proper protective equipment to avoid infection through contact with patients.

The report, entitled "An Action Plan to Prevent Brain Drain," also suggests that developed world donors should help African nations increase salaries, benefits and working conditions for health care workers to prevent them from leaving their homelands to seek better economic opportunities in developed countries.

(The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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