Investment in global health has a big payoff

If you live in the United States, you’ve been blessed with one physician for about every 400 people, on average; if you are Canadian, that number is more like 470. At the other end of the spectrum, the numbers are quite different — in Cambodia, there is one doctor for every 6,300 people, in Malawi, 50,000. These glaring inequalities are apparent throughout the developing world. Today, on World AIDS Day, in addition to the lack of medicines and funds needed to adequately address what is quickly becoming an insurmountable epidemic, there is an increasingly severe lack of basic health-care workers the world around.

Recent U.N. analyses estimate that over 1 million new health-care workers will be required on the African continent alone to achieve the Millennium Development Goals — the ambitious set of benchmarks agreed upon in 2000 to ameliorate poverty, health inequities and other socioeconomic ills, by 2015. Across Africa, a mere 1 percent of the world’s health workforce addresses almost 25 percent of the global disease burden, largely cases of HIV/AIDS. And these numbers do not take into account the currently exploding epidemics in countries such as India, China or the former Soviet Union. Perhaps more than any other disease, HIV/AIDS requires the strong support of health-care workers to provide services ranging from counseling and testing to treatment and eventual palliative care.

But there are several major impediments to increasing the number of health-care workers globally. First, many developing countries lack the basic educational infrastructures and training facilities needed to teach their future health-care professionals. Moreover, massive underinvestment in education and health sectors create poorly equipped facilities that lack necessary medicines and technology, and as a result, offer sub-optimal care. While in the United States, per capita expenditure on health care is $5,711, and in the U.K., $2,428, in Bangladesh it is a paltry $14, and in the Democratic Republic of the Congo, a mere $4. This severe underfunding of health care is further complicated by controversial terms attached to international loan monies from institutions such as the International Monetary Fund. These terms set budget ceilings and spending caps on public sector services, which particularly limit health expenditures for medical technology and human resources.

Health-care systems in these settings fail to meet patient needs, and frustrated professionals look to richer countries for better employment opportunities, higher salaries, systemic support and better lives. The current shortage of health-care professionals even in more developed countries further encourages this “brain drain” by leaving many spots open for foreign medical graduates; this crisis is exacerbated by active recruitment internationally on the part of wealthy Western nations. Between 2002 and 2003, over 3,000 nurses who had trained in South Africa, Zimbabwe, Nigeria, Ghana, Zambia or Kenya registered as health-care workers in the U.K. alone. A study published last year in the New England Journal of Medicine found that over a quarter of health-care professionals in the U.S., U.K., Canada and Australia are non-native to their country of practice. While it is everyone’s right to live and work where they choose, brain drain creates and perpetuates a tremendous inequity in access to health care.

Despite these obstacles, in late 2005, health ministers from across Africa committed to new plans aimed at universal access to antiretroviral drugs by 2010, demonstrating the crucial necessary political will to fight this pandemic. Sadly, they have received little support from the international community. One potential glimmer of hope, however, is Bill S. 3775, The African Health Capacity Investment Act of 2006, which was introduced in the U.S. Senate this past summer. This legislation aims to support a significant scale-up of health-care providers, making provisions for their retention in-country by offering adequate salaries and sufficient and equipped care facilities. The bill will also make available funds for building educational capacity to ensure sustainable health-care systems in the future.

Nearly three million people died from HIV/AIDS in the past year; close to 40 million are currently infected. Assuming the Millennium Development Goals are achieved — a rather radical assumption — it is estimated that in the 15 years following their realization, an additional 45 million will die; that number will be significantly higher if the Millennium Development Goals fail. If global health is something the international community truly values, a drastic increase in funding for the ranks of health-care workers around the globe is crucial, and initiatives such as Bill S. 3775 must receive loud, unwavering endorsement. If we hold out any hope that this World AIDS Day will stand out in history as different from those in years past, it is our responsibility to offer this support.

Ryan Schwarz is a third-year student at the School of Medicine and a member of the Yale chapter of Physicians for Human Rights.

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