ducted by the Institute of Medicine’s Committee on the Options for Overseas Placement of U.S. Health Professionals.

STUDY CONTEXT

In his State of the Union address of January 28, 2003, President George W. Bush announced PEPFAR with three extraordinary goals: (1) providing antiretroviral therapy (ART) for 2 million people; (2) preventing 7 million new HIV infections; and (3) providing care to 10 million people infected with or affected by HIV/AIDS, including orphans and vulnerable children. On May 27, 2003, the U.S. Congress passed the United States Leadership against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (Public Law 108-25) to realize the President’s vision. The act supports a phased expansion of critical programs, improved agency coordination, increased resources for multilateral and bilateral efforts, expansion of private-sector efforts, and intensified efforts to develop relevant HIV/AIDS therapies. Recognizing the contributions that U.S. health professionals can make in fighting HIV/AIDS, malaria, and tuberculosis in heavily affected, often resource-poor areas, the act also calls for a pilot program to demonstrate the feasibility of deploying U.S. personnel to such areas for periods of up to 3 years to provide basic health care services, deliver on-the-job training, and augment the health education of local populations. The legislation calls for a broad recruitment effort nationwide, including incentives such as loan repayment to encourage participation.

Without such reinforcement of human resources for health, PEPFAR’s ambitious targets will be difficult if not impossible to achieve. Few African countries, for example, have more than one doctor per 5,000 persons; the number of physicians currently practicing is already insufficient to meet other needs without the additional burden of providing ART for the millions of medically eligible Africans now and over the next decade. The need for nurses and other health workers for ART scale-up is even more acute. In Uganda in 2005, for example, the projected ratio of diagnostic laboratory staff supporting ART scale-up to the annual output from in-country training institutions is roughly 10 to 1 (Adano et al., 2004). Pharmacists are similarly scarce. And assuming that all Ugandan nursing graduates worked on ART scale-up, there would still be a projected national shortfall of almost 2,000 nurses—roughly the same shortfall projected in South Africa, where major deficits of medical officers, pharmacists, dietitians, social workers, and counselors are also anticipated (South Africa Ministry of Health, 2003). In fact, comparable human resource needs—which do not even begin to address the larger agenda of HIV/AIDS counselling and testing, prevention of maternal-to-child transmission, and social and palliative care



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