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Only 37% of Ugandan physicians are satisfied with their jobs and nearly half are at risk of either exiting the health sector or leaving Uganda entirely, according to a study published this year by the International Journal of Health Planning and Management. The study, “Satisfaction, Motivation, and Intent to Stay Among Ugandan Physicians,” is co-authored by Emily Bancroft, a former Leland Fellow with PHR in the US and AGHA in Uganda. Dovetailing with PHR’s previous works on health worker shortages in Africa, the study’s results come from a sample group of physicians working in 18 public and private health facilities in Uganda representing approximately 3% of Ugandan physicians. This study came about at the behest of Uganda’s Ministry of Health, which hopes to analyze how to implement effective policy reforms to strengthen and expand their health workforce. Bancroft’s team, headed by long time PHR advisor Professor Amy Hagopian of the University of Washington, urges Ugandan policy-makers to intervene to stem the “brain drain” that is heightened by factors such as low wages, poor infrastructure and materials, few opportunities to progress within the medical field, and regional isolation for doctors outside large cities.

14% of Ugandan physicians emigrate abroad, largely to four English-speaking countries—the US, Canada, the UK, and Australia. This number is significantly lower than that of some other countries in peril. For example, it is frequently said that more Malawian doctors practice in Manchester, England, than in the entire country of Malawi. Although Uganda’s health workforce shortage seems less drastic than Malawi’s, the crisis is no less dire: in 2008, the study’s authors estimated that there are only 2,500 physicians for Uganda’s 31 million inhabitants. Physicians, far more so than other Ugandan health professionals, were seen by Bancroft and colleagues as dissatisfied with their work and both ready and capable of vacating their posts if the opportunity should arise. Along with nurses, physicians are the group most heavily courted by international recruiters, which means many of the physicians Bancroft spoke with may already have found an opportunity to leave Uganda.

The World Bank and International Monetary Fund have exacerbated the “brain drain” seen in Uganda and throughout Africa with “structural adjustment” policies that cap domestic health expenditures. Wealthy countries can offer doctors higher salaries, greater career advancement opportunities, and, in many cases, a more stable political environment in which to work.

The Global HEALTH Act, introduced by Rep. Barbara Lee in March 2010, would assist Uganda’s efforts and help curtail health workforce shortages in countries facing similar crises by providing $2 billion over five years to increase the number of physicians, nurses, and other health workers in developing countries—and to help retain those health workers already there. The bill not only authorizes new resources, it also calls for the creation of a US Global Health Strategy to complement the goals of countries like Uganda and ensure US aid money goes where it can make a difference. This study will help foreign aid innovations like the Global HEALTH Act to better tackle complex problems like brain drain and to work with communities to solve these challenges—something PHR is dedicated to helping support.

Today, as we celebrate International Nurses Day, the health workforce crisis remains one of the greatest hurdles to realizing the right to health for all in developing countries.

The Global HEALTH Act can help. The GHA, introduced in Congress by Representative Barbara Lee on March 24, would provide $2 billion over five years to increase the number of doctors, nurses, pharmacists and other health workers in developing countries, and to improve primary health care for all. The bill not only authorizes new resources, it also calls for the creation of a US Global Health Strategy that will complement the goals of developing countries and ensure our aid money is effectively used to save the lives of hundreds of thousands of people.

That is why PHR is uniting with more than 15 other US organizations to hold a national Call-in Day TODAY to support the Global HEALTH Act. Be part of the movement. Tell your Representative to support Global Health by co-sponsoring this bill.

It’s easy. Call the Congressional Switchboard at (202) 224-3121 and ask to be connected to your Representative’s office (if you don’t know who your Rep. is, find out). Then, make your case. Use the script below, and/or bring your own experiences into the call:

Hi, my name is XXX and I live in Town, State. I am calling to encourage Representative XXX to co-sponsor HR 4933, The Global HEALTH Act, which will help fix broken health systems in developing countries. The Global HEALTH Act calls for the development of a US Global Health Strategy to harmonize aid, and provides $2 billion over 5 years to help countries in Africa hire, train and retain more doctors, nurses and other health workers. The Global HEALTH Act will save lives: I hope Rep. XXX will consider co-sponsoring this bill today.

As of today, the global health community has secured nine co-sponsors: Reps. John Conyers (MI), Lynn Woolsey (CA), Raul Grijalva (AZ), Keith Ellison (MN), John Garamendi (CA), Fortney Pete Stark (CA), Diane Watson (CA), Jesse Jackson, Jr. (IL) and Eleanor Holmes Norton (DC). Help us secure more. Commemorate International Nurses Day by taking action. Join thousands around the country today who are making a difference. Call your Representative and encourage them to co-sponsor the Global HEALTH Act today.

UPDATE, May 17: The Global HEALTH Act has garnered six new co-sponsors: Jesse Jackson, Jr. (IL), Eleanor Holmes Norton (DC), Sam Farr (CA), Maxine Waters (CA), Bobby Rush (IL) and James McGovern (MA).

Yesterday, Representative Barbara Lee (D-CA) introduced the Global HEALTH Act (House Resolution 4933) in Congress. We are thrilled at this opportunity to transform America’s global health policy and provide billions more in aid to develop health systems in poor countries.

Take 10 minutes to read the bill (pdf)—there is a lot to learn:

• What the HEALTH in Global HEALTH Act really stands for (This one I’ll give you: Global Health Expansion, Access to Labor, Transparency, and Harmonization Act of 2010).
• The overall goal of the bill (This one you get too—the rest you have to look up: To establish a strategy to coordinate all health-related United States foreign assistance, to assist developing countries in improving delivery of health services, and to establish an initiative to assist developing countries in strengthening their indigenous health workforces).
• The GHA’s vision for a new United States Global Health Strategy (page 2).
• Which Millennium Development Goals the new Strategy would target (page 4).
• The ration of health workers to population the Strategy will aim for (page 12).
• How the Global Health Strategy will really work—what it will support, what it can do (page 8).
• How the US Global Health Strategy will support National Health Strategies in developing countries (page 30).
• How the new Global Health Workforce Initiative  fits in to the Global Health Strategy (page 39).
• How many countries the GHWI will target (page 40).
• The criteria for selecting these countries (page 40).
• What the GHWI will do to support health workers in developing countries (page 43).
• How much money the Global HEALTH Act will provide for all these critical global health capacity building programs (this one I have to tell you—$2 Billion over 5 years. Amazing. See the yearly breakdown on pages 64-65).

Read the bill, and get ready to take action. On April 7th, World Health Day, we’ll ask you to email your Congressperson and urge them to co-sponsor the Global HEALTH Act. And spread the word—this is a transformative bill, and you can make a difference.

Note: There is a file embedded within this post, please visit this post to download the file.

We are just three weeks away from World Health Day (April 7) and the official launch of advocacy for the Global HEALTH Act of 2010. And we have now heard that Representative Barbara Lee will be introducing the bill in the coming days! Now more than ever we need you to be ready on April 7 to email or call your Congressperson urging him or her to co-sponsor this bill.

Since the beginning of March, though this blog you’ve learned about the purpose of the Global HEALTH Act , garnered some great facts about the health workforce crisis, seen one of the many ways in which health systems can be measured and watched four health workers at Mbagathi Hospital talk about the challenges they face on a daily basis.

Today’s post takes a closer look at some very important components of the Global HEALTH Act. But first, it is important to congratulate Representative Lee on the development of a bill that heralds a new way of working to strengthen and improve the health systems of developing countries, and the delivery of health services to the whole of the population in those countries. The bill calls on President Obama to develop a comprehensive US Global Health Strategy (the Strategy) that harmonizes and aligns all health-related US foreign assistance, and seeks to ensure that equity, non-discrimination, participation and accountability are embedded in the Strategy and, to the greatest extent possible, in the national health strategy of each country receiving direct assistance.

This is a comprehensive bill, and it is not possible to review it here completely. Hence we have selected a few specific examples for you of how the bill advances the right of everyone to the enjoyment of the highest attainable standard of health:

Equity and non-discrimination: An objective of the Strategy is to ensure that there is access to quality health services for poor, vulnerable or marginalized populations. Equity and non-discrimination permeate the bill. These issues are to be principal considerations in the construction or rehabilitation of health facilities, in the distribution of health services and health workers, and in the provision and distribution of medical, pharmaceutical and laboratory supplies. The ability of women and youth to use health services without fear, violence, discrimination or other mistreatment is one of the many principles that the President is called upon to encourage countries to include in their national health strategies.

Participation: There is a concern with participation throughout the bill. First, the Strategy itself is to be developed in consultation with all manner of individuals, groups and organizationsfrom executive agencies administering US foreign assistance, to US embassies and country missions, to civil society and nongovernmental organizations in developing countries, to international organizationsand other donor nations. At the developing country level, the bill calls on the President to encourage countries receiving direct assistance to ensure meaningful participation in developing their national health strategies. This participation is to include the poor, vulnerable, or marginalized populations, as well as nongovernmental organizations, in program and budget decisions as well as in the implementation, monitoring and evaluation of the country’s national health strategy. Hence, the bill makes a direct link between equity, non-discrimination, participation and accountability.

Accountability: The accountability process enables the government to identify what is working and what is not – to explain what it has been done and why – and to provide to individuals and communities the opportunity to understand how the government has discharged its obligations. Where mistakes have been made, accountability requires redress. It is a process that includes monitoring, mechanisms, remedies, and participation. The bill makes clear that the Strategy should have each of these components. The Strategy itself is to be monitored and evaluated for effectiveness. To allow this to take place, the Administration is to establish indicators to monitor the Strategy and provide annual reports to Congress. The bill authorizes the President to provide assistance to developing countries to improve the delivery of health services in those countries. The activities that have been authorized include direct support to civil society and nongovernmental organizations to monitor and evaluate their country’s health system. The President is also called upon to encourage countries to include in their national health strategies the development and implementation of sustainable legal frameworks that engage the whole of the population to monitor and enforce policies related to health. Ensuring there is a legal requirement to enable people to participate in monitoring and to enforce policies is essential for government accountability.

The bill’s consistent focus on equity, non-discrimination, participation and accountability indirectly promotes the incorporation of a human rights approach to health into the Strategy. If the Strategy is developed and implemented, it will provide – in time – the proof that adoption of this approach improves health outcomes and the processes to achieve those health outcomes. This bill is to be applauded. It is essential that it obtain a large number of co-sponsors to demonstrate significant support for this legislation, which will help move this bill towards final passage. This is not only for the benefit of the populations in the countries receiving direct assistance but also for the benefit of the US. This bill has the potential to do more for the credibility of the US in the arena of human rights and global health than anything that has gone before.

On April 7 BE READY to email your representative – PLEASE!