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April 21, 2005

Posted by Suzanne Nossel

This idea sounds interesting and smart - create a kind of Peace Corps for health care workers to help with AIDS in Africa.  Apropos of the earlier discussion on what progressives could do differently in dealing with global health challenges, this may be part of the answer.   

My sense is:  1) it probably ought to be a lot bigger than they are proposing; 2) we ought to include not just doctors but nurses too (not clear if they are included, but at the specified salaries my guess is no); 3) we ought to push every European country to create something similar;4) we ought to create something similar for medical school professors - so they can get paid for a year to go teach in a country  in desperate need of health care professionals.

The full article goes into the problem of the brain drain among medical professionals trained in African countries that desperately need their expertise, but who are offered great opportunities in Europe or the US and grab them.  This is a tough but important one.

In my mind, this whole line of thinking is related to a point that both Heather and I have brought up concerning how we broaden the pool of people willing to perform government service by widening the array of service options available.   This work is not military service, but it is in furtherance of a key U.S. foreign policy objective: stemming the global AIDS epidemic.  If it proved necessary in order to recruit in the numbers needed for a stabilization corps or an international medical corps, maybe we should offer people who did this kind of work some of of benefits that accrue to veterans.

U.S. Should Create Organization To Mobilize Health Care Workers to Countries Most Affected by HIV/AIDS, IOM Panel Says

21 Apr 2005

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).

Proposal Details

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."


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I don't subscribe to the Wall St. Journal, but the article you cited also contained some pretty sharp criticisms of the AIDS Peace Corps program, according to a summary from Kaiser Network:

"UNAIDS Executive Director Peter Piot said 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."

So if this were done under a Bush administration, would these health professionals be allowed to advocate condom use?

If you're interested in plans to increase the options for service, you should check out what was, for my money, one of the most interesting yet totally neglected ideas of the 2004 campaign, Wes Clark's plan for a civilian reserve (here: .) Basically: it's voluntary, and would involve being ready to serve your country if needed, for 5 years, in which case you would be paid a small stipend plus insurance etc. Your skills (including language skills) would be noted and entered in a database, and you would be called on in emergencies, and for work at home and abroad. It was, to my mind, very much the creation of someone who watched the military being used for altogether too many tasks, and also wished there was some way other than the armed forces for people to channel patriotism, and thought: why not put these two thoughts together?

Of course we need to change the health system and aware people to any change circumstances in health care.

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