1 June 2006
AIDS Meeting Examines Worker Shortages, Health System Constraints, Universal Access to Treatment, in Afternoon Panel Discussion
NEW YORK, 31 May (UN Headquarters) -- During one of its two panel discussions today, the High-Level Meeting on HIV/AIDS focused on overcoming health worker shortages and other health systems and social sector constraints to the movement towards universal access to treatment.
Introducing the subject, the Executive Director of the United Nations Children's Fund (UNICEF) and co-Chair of the discussion, Ann M. Veneman, said the shortage of skilled workers was at the root of, among other things, poor surveillance, planning and distribution of funds. The issue should be addressed through speeding up of recruitment; improvement of working conditions and pay; and increasing funding from Governments and donors for training in countries with severe human resource shortages.
She said a critical long-term solution to address worker shortages could be found in prevention activities. Prevention saved lives, reduced costs and protected the capacity of existing systems, as well as ensured that health-care workers remained free of the disease. Education had been described as a social vaccine. In Zambia, for instance, HIV spread twice as fast among uneducated girls. A review of 113 studies indicated that school-based programmes were effective in postponing the age of young people's first sexual activity.
Senegal's Minister of Health, Abdou Fall, said the issue of health worker shortages had become a major and continuous challenge in Africa, where there were often no more than one doctor for 150,000 inhabitants; 2 million new HIV cases yearly; and only 3 per cent of the world's health staff. "We have lost the battle of prevention in Africa", he said, as well as in providing care and access. Therefore, the migration of qualified staff to Western countries was of great concern, as was the training of health-care workers.
He said the deficit in human resources weakened the responses of the health system. Where there was a lack of staff, people were more exposed to AIDS. As health-care workers were vulnerable to infection, they often moved to less affected areas. The HIV pandemic was plunging the continent into a "health emergency unparalleled in history". His country tried to address the issue through outpatient treatment of AIDS patients, and had established centres to that end.
In order to address the shortage of health-care workers, another panellist, Jon Ungphakorn, Chair of the non-governmental organization Coalition in Thailand, suggested the idea of a global universal health insurance system, backed by individual country contributions based on the economic status of each country. The funds for such a system would cover the costs of infrastructure development, as well as training and support for millions of new health workers in developing countries. Just as the development of universal health-insurance systems in many developed and middle-income countries required financing through progressive income taxation, development of universal access to primary health care would require contributions from the developed world that would "affect individual taxpayers".
Jeffrey L. Sturchio, Vice-President of External Affairs, Merck and Co. Inc., underlined the importance of public-private partnerships. The private sector's practical approach to challenges could be an important element to a successful strategy. Merck's experiences had shown that programmes tended to be successful if they were country-led, and that national planning bodies should facilitate private-sector involvement, through vehicles such as the Global Business Coalition on HIV/AIDS, the Corporate Council on Africa or the Global Health Initiative of the World Economic Forum. He said business investments in the national health systems of China, India and the Russian Federation -- countries of the "next wave" -- would become increasingly important.
Like many speakers, Nicholas Adomakoh of the HIV Commission and Director of HAART Clinic (Barbados), stressed the importance of a regional approach, especially in a region that consisted of small island States, such as the Caribbean. A regional training initiative had been developed with the mandate to build capacity in the countries of the region. The initiative was carried out through five training centres, as well as through distance learning and remote supervision.
Some speakers complained that the root causes of the shortage of health-care workers were not addressed. Among the causes were decades of underinvestment in human resources in the health sector, under-recruitment, low salaries and migration. Health-care workers in HIV-affected areas were also often burned out, while getting little respect and, therefore, left the field. Health-care workers needed better working environments and salaries in their countries of origin. The time had come to recognize, to respect and to reward health workers. Developed countries, as "consumers" of health-care workers, had a role to play in that regard.
Many speakers addressed the issue of migration. "If there are no soldiers to fight, how can the war be won?" wondered France's representative, noting that countries of the North were absorbing a large portion of the human resources of the developing countries, without compensation. Other speakers said the countries in the North were often not self-sufficient in health care and should become more responsible global citizens in that regard. "Taking one health official away from Africa is an unjustifiable act," Mr. Fall of Senegal exclaimed.
Another speaker, however, pointed out that people could not be prohibited from moving around the world. It was a fact that there would be a growing need for health-care workers in the richer countries. The power of the purse could not be denied, she said.
A representative of the Global Health Work Force Alliance said his group had identified 57 countries that were in crisis, as health workers could not provide essential health services, nor access to AIDS treatment. The Alliance would raise awareness of the subject and would engage with countries, both in the developed and developing world, in order to ensure that resources were mobilized and partnerships established between developed and developing countries.
Other speakers pointed to opportunities, such as increasing the training of nurses and health-care workers, as was being done in the Caribbean region, which led to increased remittances and could become part of predictable funding. Many speakers stressed the necessity of using the skills and capacity that existed at the local level and in faith-based networks.
A lack of health-care workers also had a negative impact on adherence to treatment regimes, some participants in the discussion pointed out. In that regard, speakers said that people living with HIV were the best adherence monitors, and should, therefore, be more involved in community health care. Other speakers noted that patients from developing countries adhered better to treatment regimes that those in developed countries.
Also participating on the panel was co-Chair Anarfi Asamoa-Baah, Assistant Director General for AIDS, Tuberculosis and Malaria, World Health Organization; Sigrun Møgedal, AIDS Ambassador, Norway; and Mark Dybul, Global AIDS Coordinator ad interim, United States Department of State.
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