innovative governmental and private-sector mechanisms should be designed and expanded to bring qualified volunteer medical professionals into both urban and rural areas to support prevention, care, and training programs relevant to ART scale-up. The required expertise and skills and the areas for placement in country should be determined by local programs.

Recommendation 5-2. Donors and organizations with relevant expertise (e.g., academia, industry, public health agencies, nongovernmental organizations) should support active partnerships among all institutions possessing such expertise and those seeking to acquire the benefits of training; mentoring; and the transfer of antiretroviral therapy– related medical, technical, and managerial knowledge and skills. Partnerships among medical institutions within and across national borders should be encouraged by donors and governmental authorities. These twinning relationships should support the transfer of appropriate technology; expertise in medicine, monitoring and evaluation, and applied and operations research; and lessons learned. Physical and electronic means should be used to provide ongoing support for these partnerships.

Recommendation 5-3. Expertise within the AIDS Education and Training Center networks sponsored by the U.S. government and similar initiatives by other countries should be utilized to support the development of effective training programs in HIV care in order to prepare local physicians, nurses, community health workers, laboratory professionals, pharmacists, and logisticians in heavily HIV-afflicted countries facing severe human resource shortages.

DEVELOPING A SUSTAINABLE WORKFORCE

The Brain Drain

The brain drain (i.e., the departure of trained and educated individuals from one place to another) has had severe impacts on the health care sector of developing countries. Higher wages, better living conditions, and increased chances for career advancement are a few of the main reasons that health care workers are leaving their native countries (Dovlo, 2003; Padarath et al., 2003). The brain drain can occur domestically or internationally, with effects being felt at either the regional or national level. Not only are there not enough trained health care workers in most resourceconstrained settings, but the numbers are rapidly declining. As noted above, well-trained workers are leaving in search of better-paying jobs, both locally and abroad and in both the private and nongovernmental organiza-



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