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On May 10th, The New York Times published a heartrending story on the faltering fight against AIDS in Uganda — a story that has sparked a firestorm of controversy and criticism of the Obama Administration’s global AIDS strategy.

The Times identified a deep funding gap for combating AIDS in Uganda, including a freeze on new funds from the United States and a lack of commitment to AIDS spending by the Ugandan government (which evidently has no problem finding $300 million to spend on Russian fighter jets). The Times also outlined the devastating human toll this funding gap is taking on people living with — and dying of — AIDS.

Sadly, this news is not new. In March 2009, PHR invited Dr. Peter Myugenyi, Founder and Director of the PEPFAR-supported Joint Clinical Research Centre in Uganda, to Washington, DC to talk about the emerging funding gap for AIDS in Uganda. Said Dr. Mugyenyi:

After urging people to get tested and enter care, we now have to tell them there is no treatment available when they need it. We created hope and now we are returning to the days when one member of a family can get treatment and the others cannot.

It is a recipe for chaos as patients start to share doses or skip treatment altogether. I fear that we will soon start to see more drug-resistant strains of HIV and rising death rates.

As The Times notes, one year later, Dr. Myugenyi remains fearful:

Dr. Peter Mugyenyi, the hospital’s founder, helped the Bush administration form its AIDS plan and sat beside Laura Bush during the State of the Union address as it was announced.

The loss of donor interest “makes me frantic with worry,” Dr. Mugyenyi said.

He offers copies of e-mail messages he exchanged with American aid officials. One reminds him that he has been instructed to stop enrolling new patients and asks for an explanation of reports that he is treating 37,000 when only 32,000 are authorized. Another asks him not to announce publicly that his funds have been frozen.

He admits slipping pregnant women and young mothers like Ms. Kamukama into treatment slots “contrary to instructions.”

“Morally, I can’t turn them away,” he said.

This story gained traction worldwide, and was followed by a New York Times editorial, The Wavering War on AIDS, which outlined a $13 billion deficit in AIDS spending, and a series of letters to the editor, including one by PHR Global Health Action Campaign advisor Pat Daoust.

Dr. Mugyenyi won’t turn away patients. And we won’t turn away from this issue.

PHR, in conjuction with other global health groups, sent a letter to Secretary of State Clinton last week, urging her to end the AIDS funding freeze and ensure Ugandans have access to life-saving AIDS treatment.

PHR members have spent years advocating for more global AIDS funding and health programming based on science and human rights. We will continue to fight for greater global health funding, a strong US global health strategy, and to ensure people living with AIDS worldwide have access to drugs and quality care.

Want to help? Encourage your Representative to co-sponsor the Global HEALTH Act, which will provide $2 billion for health system strengthening and support a comprehensive US global health strategy, both of which will help in the fight against AIDS.

This month, PHR is examining the health workers shortage in Africa ahead of the introduction of the Global HEALTH Act, which would provide $2 billion over five years to strengthen the health workforce in developing countries.

Today, we want to highlight an organization that is working right now to fill health worker vacancies in rural areas in Southern Africa. If you are a doctor or nurse, Africa Health Placements (AHP) needs your skills to support rural health in South Africa, Lesotho, and Swaziland—contact them today for more information.

Africa Health Placements originated in South Africa and now works in several other countries in the region to increase the public sector health workforce through recruitment from the private sector and through recruiting foreign health workers who are looking for the excellent work experience and unrivalled lifestyle that is offered through such an opportunity. AHP’s support is aimed specifically at those provinces and areas where there are major shortages of doctors, nurses, and other health professionals.

AHP’s focus is on patients and equity in healthcare for rural and disadvantaged communities—communities that are suffering high burdens of AIDS and other diseases, including malaria and TB.

These efforts are having far-reaching results. In 2009, their foreign recruitment efforts placed approximately seven times more doctors in rural South Africa than the long-term rural placements of all 8 South African medical schools combined. Learn more about their work by watching the film Bush Doctors.

AHP delivers support to health workers by offering a way of smoothing the application and registration process, matching interested health workers with available opportunities, and by providing clinical, cultural and logistical orientation and ongoing support throughout a recruit’s placement. AHP also supports the strengthening of human resources in health in the region through consulting, advocacy and knowledge-sharing with relevant partners and government bodies.

AHP recruits into rural areas, where health workers are asked to commit to at least 12 months of services. Many renew their term of service—for one year, two years, even longer. Since its founding in 2005, AHP has placed more than 1,500 health professionals in Southern Africa, half of whom are from abroad.

Check out AHP’s website, and consider working with them to deliver health care to the rural poor in Africa. If you have friends or colleagues who might be interested in this critically important opportunity, please spread the word!

Over the past month, PHR’s Health Rights Advocate blog has highlighted the health workforce crisis in Africa, and how the about-to-be-released Global HEALTH Act can help.

Now, we want to hear from you.

What is your experience with the health workforce crisis in Africa? If you are from Africa or another developing country with a health workforce shortage, tell us about your experience in giving or receiving health care in your country. If you are a health professional who has left your country to practice in the US or elsewhere, we’d love to hear your story: your experience in the health system at home, why you left, and what it is like where you are now.

For those of you not from a developing country, have you visited or worked in Africa and seen the impacts of the health workforce crisis first hand? Have you met doctors and nurses from developing countries who are working in the US or going to school and plan to stay here? What have you learned from their experience?

Some African health workers have already offered their own insights into the health workforce crisis, its impact on themselves and on their patients, and their advice to policymakers.

The hospital where I work, which serves 100,000 people in the district, averages 2-3 maternal deaths per week due to delayed operations. The two medical officers cannot adequately cope since they have to attend to other emergencies and referrals from the neighbouring districts.” – Nurse, Homa Bay, Kenya

The shortage of doctors and nurses in our hospital has led to one nurse attending to 40 patients at time, a nightmare for those suffering acute conditions. This had led to the loss of patients who would otherwise be stabilised. The quality of service is highly compromised and bordering on unethical practice. This is inhuman treatment of fellow human beings.” – Medical Laboratory Technologist, Nairobi, Kenya

I have a situation at the moment where about 200 patients have to travel for up to six hours to get their ARVs [antiretrovirals] and access related services. Most antiretroviral treatment (ART) centres are in the cities and there are no qualified healthcare professionals in the towns and villages. ARVs are even expiring in some centres because the inconvenience involved is just too much for patients.”– Pharmacist, Abuja, Nigeria

PEPFAR is focused on urban areas. The rural areas are left behind. Patients can’t afford transit. I’ve had five patients die quietly in the last six months because they didn’t have access to AIDS treatment…There’s no electricity where I work, the roads are bad, there’s no equipment. If I get a needle puncture, there’s no prophylaxis. I’m on my own. I’m on call 24 hours; this leads to fatal errors. This is a classic case of marginalization.” – Physician, Niger State, Nigeria

Communities in rural Uganda have a difficult time accessing a health care worker. For example, at outpatient facilities upcountry, there may be 200 people per day who show up seeking care, but only one health worker and one clinic for 25 km. You may see a doctor or a nurse, but quality of care is unsure. It’s different seeing a patient first thing in the morning versus after many, many patients – my judgment may be impaired after so many consultations.” – Medical Student, Makerere University, Kampala, Uganda

There is nothing more demotivating to a worker than being in an office without any resources to do the work. Many of us have worked in hospitals where we were recycling gloves in this era of HIV. We have worked in labour wards and operating theatres where autoclaves could be broken for days, yet we are expected to provide safe motherhood services.” – Physician, Kenya

African Health Workers’ Prescriptions for Policymakers:

Policymakers at country and global levels have to make a deliberate move to recruit and retain health workers in the right numbers based on needs assessments.

Our capacity to deliver health services would be improved by a conducive working environment with adequate basic infrastructure, proper medical supply management, better and regular remuneration and opportunities for continuing education and training.

Donors need to scale up investments in human resources for health, especially in health care workers. Most donors do not fund salaries, which I find self-defeating. For example, a donor will choose to fund only medical supplies without considering how the supplies will be dispensed and by whom.

Western countries recruit health workers and have made it very easy to acquire entry visas and work permits, especially for nurses. This is like picking from the poor man’s pocket.

A healthy nation is a strong nation politically, economically and socially. Investing in health is not only right but a necessity!

We want to hear from you. Use the comment form below to tell your story.

We’re just a month away from World Health Day (April 7th) and the official launch of advocacy for the Global HEALTH Act of 2010. So far this month, through this blog you’ve learned about the Global HEALTH Act and gotten some great facts about the health workforce crisis (and how many people are waiting in line for an I-Pad — impressive!). Today’s post includes a few more resources that highlight the impact of Africa’s health workforce shortage. Check them out and share with colleagues.

PHR made the following video in collaboration with our Kenyan partner group, the Health Rights Advocacy Forum. In this 6-minute video, four health workers at Mbagathi Hospital talk about  the challenges they face every day — and why they stay and practice medicine in their home country. This moving video can be shown on campus or at your workplace to stimulate discussion and urge people to take action.

For more personal stories, check out Africa’s Health Care Worker Crisis: Views from the Ground, a PowerPoint presentation that outlines six main drivers of the health workforce crisis in Africa and explores these challenges through the eyes of four Ugandan medical student leaders. Feel free to use this to make a presentation on campus or in your community, or use facts from it to drive home the need for action.

And watch our slideshows of Dr. Fred Katumba and Clinical Officer Jane Byarugaba following them through a typical day as they provide health care to the rural poor in Southwestern Uganda. Dr. Katumba’s work has propelled Lyantonde District to #2 out of more than 90 districts in terms of health outcomes — a phenomenal accomplishment and testament to Dr. Katumba, his staff, and the millions of hard-working health professionals who help communities realize the right to health every day.

To promote and protect the Right to Health, a health system must be of good quality, equitable, integrated, responsive, effective, and accessible to all. The capacities of health systems can be measured in many ways. No matter how they are measured, the disparities between countries’ health systems are tremendous, and these differences are a matter of human rights. It’s evident that these disparities have a significant – and at times, astonishing – impact on health outcomes:

Approximate number of Washington, DC residents: 600,000

Population size of Ethiopia: 80.7 million

Ratio of doctors in Washington, DC to doctors in Ethiopia: 2:1

Number of countries the World Health Organization identified as having severe shortages of health workers: 57

Number of times quarterback Jay Cutler spoke the phrase “you know” during a televised interview within five minutes: 57

Vehicles recalled by Toyota in October 2009 for faulty floor mats: 4.3 million

Number of missing health workers in 57 severe shortage nations: 4.3 million

Of the 57 shortage nations, percentage of which are in Africa with severe health worker shortages: 69

Ratio of physicians to total Liberian population (2007): 1:21,000

Ratio of physicians to total U.S. population (2009): 1:386

Percent increase in number of health workers required to address African nation shortages: 140

Temperature in Celsius degrees for the boiling point of aspirin: 140

Additional health workers (doctors, nurses, midwives) required to alleviate severe health workers shortage in South East Asia region: 1.2 million

Minimum number of new health workers the US government has committed to train and help retain in the 2008 PEPFAR legislation: 140,000

Number of applications currently available for Apple’s new iPad: 140,000

Number of health workers in Africa the Japanese government has promised to train by 2013: 100,000

Amount of funding G8 nations have jointly agreed to commit to addressing the health worker shortage: $0