have to develop sufficiently capable and sustainable workforces to continue HIV/AIDS prevention and treatment programs into the foreseeable future. There is a strong rationale for U.S. health professionals, as well as other foreign workers, to help through training, skill development, partnership, and other forms of human resource support.

The committee believes that national capacity development in each PEPFAR focus country should entail the following steps:

  1. Each country should undertake a health workforce needs assessment as part of or a complement to its national plan. National plans are necessary to orient human resource investments and the filling of gaps by foreign personnel. The needs assessment should encompass not only HIV/ AIDS, but also primary prevention and care, because indigenous workers need to pursue their career development within a national system and strategy.

  2. National education and training should be accelerated to develop the human resources needed to address the HIV/AIDS pandemic and meet primary health care needs. Those personnel likely to be in highest demand are paraprofessionals such as community health workers. U.S. personnel can contribute to this massive training mission through regionally based activities that maximize the use of available trainers. This contribution is particularly important in sparsely populated areas that lack broad and effective educational and training institutions.

  3. The work environment for health professionals should ensure staff retention and promote staff performance. To this end, attention must be paid to financial and nonfinancial incentives, especially social recognition for work performed (Vujicic et al., 2004). Note, however, that special payments to national staff should be viewed with caution; while motivating some, they could discourage others.

  4. The “brain drain” should be stemmed by the dampening of demand in richer countries that continue to recruit health workers. Two important measures to this end are developing codes of conduct for the recruitment of health professionals and working toward self-sufficiency in the production of health workers (Buchan et al., 2003; Stilwell et al., 2004).

  5. Where necessary, priority programs and health systems should be harmonized to avoid fragmentation, duplication, and waste. With more than half of total health expenditures in some PEPFAR focus countries coming from foreign sources, U.S. personnel can enhance harmonization of funders and funding activities through policy and management support.

Although the development of long term-health professional capacity must be a priority for host countries, the United States can take significant actions to assist in the effort. Foremost among these is investing in the



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