Healers Abroad Americans Responding to the Human Resource Crisis in HIV/AIDS (2005) / Chapter Skim
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5 Programs of the U.S. Global Health Service
5 Programs of the U.S. Global Health Service
Pages 96-137
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From page 96... ...
. The six programs are as follows: · Global Health Service Corps · Health Workforce Needs Assessment · Fellowship Program · Loan Repayment Program · Twinning Program · Clearinghouse In brief, the committee envisions the Global Health Service Corps as the elite, anchor resource of the GHS, playing a far-reaching role in increasing the effectiveness of current in-country health personnel and expanding the future pool of resident health care assets.
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From page 97... ...
TABLE 5-1 Six Proposed Programs of the U.S. Global Health Service Global Health Service Corps A small group of highly skilled professionals, deployed for a minimum of 2 years Health Workforce Needs A standardized health personnel needs Assessment assessment for all PEPFAR focus countries Fellowship Program A $35,000 award to enable health professionals to work overseas for a minimum of 1 year Loan Repayment Program A $25,000 loan repayment for qualified health professionals for each year of a 2-year service overseas Twinning Program A mechanism for short-, medium-, or long-term mobilization of needed skilled professionals Clearinghouse A resource using information technology for recruitment, information posting, and networking
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From page 98... ...
To address the critical need in all PEPFAR focus countries for key specialized health, management, and technical professionals, the committee proposes the establishment of a Global Health Service Corps. This cadre of specialists would be available to assist with and support the implementation of national strategic HIV/AIDS programs.
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From page 99... ...
As the committee envisions the Corps, health professionals, as well as experts in management and technical matters related to health, would be dispatched for extended periods of service to PEPFAR focus countries. The primary purpose of these placements would be to advance the PEPFAR goals by assigning highly qualified personnel to key positions in newly expanding national programs of HIV/AIDS prevention and treatment.
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From page 100... ...
foreign aid, foreign policy, and health policy. Eligibility and Selection Process The Global Health Service Corps would work in close coordination with PEPFAR; U.S.
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From page 101... ...
Evaluation of all assignments would be carried out on an annual basis. The committee believes that the Global Health Service Corps should be launched modestly, but that it should also be large enough to establish its identity, make a contribution, and garner experience.
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From page 102... ...
Rationale and Evidence Why a Global Health Service Corps? As discussed throughout this report, a lack of skilled and trained health professionals is one of the principal barriers to the rapid scale-up of HIV/ AIDS prevention and treatment programs in the PEPFAR focus countries (Adano et al., 2004; Wyss, 2004a,b)
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From page 103... ...
Costs Salaries, benefits, and travel would account for most of the costs of the Global Health Service Corps. Projecting the exact cost of the Corps is not possible without making a series of assumptions about the personnel system to be used, the disciplines and seniority of the personnel involved, and the details of the approaches to orientation and supervision to be used for the Corps.
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From page 104... ...
On balance, however, the committee concluded that the investment in a small and specialized Corps that would play a pivotal role in ART scale-up and global health development is an equally important commitment on the part of PEPFAR and the United States. The committee notes further that a $37.5 million aggregate yearly investment represents approximately 1 percent of the current annual PEPFAR budget.
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From page 105... ...
government that currently deploy health professionals should be considered in deciding about the positioning of the Global Health Service Corps. Each is briefly discussed below; a listing of these agencies' attributes that may be helpful in making this decision is provided in Appendix G
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From page 106... ...
health personnel; HRSA oversees similar deployments on a smaller scale and targeted to the PEPFAR focus countries. Likewise, the U.S.
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From page 107... ...
Access to systematic data on vacancies in the health workforce would also provide valuable information for individuals and institutions engaged in mobilizing health professionals for service in the PEPFAR focus countries. According to a critical review performed for the committee (see Appendix C)
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From page 108... ...
Program Description A standardized health workforce needs assessment is necessary for all the PEPFAR focus countries. Responsibility for leadership of this effort should lie with each country's ministry of health in conjunction with the PEPFAR in-country program.
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From page 109... ...
This variability is a major impediment to the fair and equitable distribution of workforce resources among the 15 PEPFAR focus countries. Lack of consistency among countries in how human resource development strategies are monitored and evaluated on an international basis has also been noted (Diallo et al., 2003)
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From page 110... ...
On the basis of available data, it appears that the total human resource stock delivering all health services in 2004 in the PEPFAR focus countries was 566,580 (74 percent nurses, 21 percent doctors, and 5 percent pharmacists)
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From page 111... ...
As a result, they have had little or no impact upon human resource needs in sub-Saharan Africa. The proposed GHS Fellowship Program would provide incentives and reduce barriers to mobilize a broad range of trained professionals with skills relevant to addressing the human resource crisis in the PEPFAR focus countries.
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From page 112... ...
Placement would respond to the needs of the PEPFAR focus countries as defined by each country operating plan and the Opportunity Bank of the GHS Clearinghouse (discussed later in this chapter)
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From page 113... ...
To apply, an individual would first submit a work plan, requisite credentials, references, and a statement of commitment from a host organization either working or based in a PEPFAR focus country. A selection panel comprising health professionals from the United States and focus countries would then review the application and score the applicant using a uniform measure.
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From page 114... ...
Many existing academic and government fellowship programs in the United States send professionals abroad whose main focus is HIV research. For example, the Fogarty International Center at the National Institutes of Health has forged global relationships focused on research through the AIDS International Training and Research Program.
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From page 115... ...
Just as the Fulbright awards represent opportunities for collaboration in global education, the Fogarty International Center opportunities for research, and the Peace Corps opportunities for diplomacy and cross-cultural exchange, the GHS Fellowship Program would offer opportunities for partnering in global health. Selection of Fellows.
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From page 116... ...
health professionals and graduates of higher educational programs graduate with significant debt (Morrison, 2005) , the committee believes GHS fellows should be eligible for the GHS Loan Repayment Program (discussed next)
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From page 117... ...
The committee recommends the establishment of a U.S. Global Health Service Loan Repayment Program for clinical, managerial, and technical professionals prepared to serve for desig nated periods in PEPFAR focus countries.
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From page 118... ...
. Like the Felowship Program, the Loan Repayment Program, would start with 100 awards (roughly 510 per PEPFAR focus country, prorated by need)
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From page 119... ...
. Similar to the NHSC loan repayment program, the HRSA Nursing Education Loan Repayment Program offers assistance to registered nurses to repay educational loans in exchange for service in facilities with critical shortages.
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From page 120... ...
These relationships can take many forms, including publicprivate partnerships, as well as arrangements that involve governments, public health agencies, NGOs, hospitals, and universities. Moving skilled personnel from the United States to organizations in the PEPFAR focus countries offers the potential to build human resource capacity.
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From page 121... ...
health professionals to engage with maximum speed and effectiveness. Program Description Twinning partnerships should target institutions and organizations that national authorities in the PEPFAR focus countries deem to be of strategic importance in building human resources for health.
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From page 122... ...
All of the exchanges would need to be monitored and evaluated regularly to ensure that both parties are satisfied with the relationship and its results. Evaluations should be conducted by the intermediary organization and might include, for example, measuring the effectiveness of the twinning process, gauging the partnerships' ability to achieve the agreed-upon outcomes, and determining the impact of the partnership on targeted indicators of capacity development (such as the number of health personnel trained to monitor resistance to ART)
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From page 123... ...
As discussed above, bringing in-country health professionals to a U.S. organization for specific forms of training can multiply the health workforce of the host country.
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From page 124... ...
The American International Health Alliance (AIHA) , for example, has been the intermediary for partnerships between the United States and Eastern Europe since the end of the cold war in 1992.
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From page 125... ...
knowledge, tools, and lessons · Overall costs are higher learned across partnerships because of overhead · Permits distillation of charges procedural requirements · Local or U.S. groups may · Facilitates grant management be reluctant to work · Reduces donor management through an intermediary workload · Can create confusion as to · Donor retains substantive roles and functions oversight, while management · Conflict with the burden is minimized intermediary may arise · Promotes equity among partners as not one partner is receiving funds Direct Partnership · Provides an opportunity for the · Heavy management donor to shape and guide the workload emerging relationship · Staff may lack skills or · Allows substantive donor time to nurture involvement in program design partnerships and implementation · Host country partner · Permits close monitoring and becomes more dependent oversight on the U.S.
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From page 126... ...
CLEARINGHOUSE Many organizations currently send health professionals to work in the PEPFAR focus countries. Given their experience, these groups are well positioned to assist in HIV/AIDS prevention, treatment, and care, thus helping to achieve the PEPFAR goals.
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From page 127... ...
organizations that mobilize health personnel for deployment in the PEPFAR focus countries, as well as liaising with those performing the health workforce needs assessments discussed earlier. This database would be available to host country counterparts.
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From page 128... ...
Its value, however, would depend to a large extent on the quality of the in-country health workforce needs assessment activity and of the link between host country personnel and the Clearinghouse team. Cultural and Strategic Issues Reference Site The Cultural and Strategic Issues Reference Site would be a virtual warehouse of information pertinent to all health professionals planning to work in the PEPFAR focus countries, including those seeking a GHS Fellowship, loan repayment, or assignment to the Global Health Service Corps.
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From page 129... ...
Moreover, even similar organizations, such as those linked to religious bodies, rarely focus on the networking and sharing of assets in the recruitment and deployment of health professionals needed to build HIV/AIDS human resource capacity in the PEPFAR focus countries. While the multiple origins and sources of support for these critical organizations explain this relative lack of coordination, the committee believes it important to promote harmonized mobilization efforts where possible and the partnering of organizations when appropriate.
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From page 130... ...
International Medical Volunteers Lists health care opportunities and Association whom to contact for more information. http://www.imva.org/Pages/volsrchintro.asp Provides a volunteer registry that contains information about health professionals seeking volunteer medical assignments around the world.
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From page 131... ...
Peace Corps Website addresses aspects of http://www.peacecorps.gov/ volunteering. International Federation of Red Cross and Website with a code of good practice Red Crescent Societies for NGOs responding to HIV/AIDS.
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From page 132... ...
and extensive placement possibilities in the PEPFAR focus countries (the proposed Opportunities Bank)
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From page 133... ...
The Fellowship and Loan Repayment programs are also expected to increase worker capacity on the ground, as is the Twinning Program, with its unique ability to insert workers into areas or institutions where a partnership has already been developed. Although each program could be implemented independently of the others, the committee believes the greatest impact would come from implementing them collectively, to varying degrees, based on the identified needs of each of the 15 PEPFAR focus countries.
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From page 134... ...
Presentation at the Institute of Medicine Workshop on the Options for the Overseas Placement of U.S. Health Professionals, Washington, DC.
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From page 135... ...
Presentation at the Institute of Medicine Workshop on the Options for the Overseas Placement of U.S. Health Professionals, Washington, DC.
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From page 136... ...
Presentation at the Institute of Medicine Workshop on the Options for the Overseas Placement of U.S. Health Professionals, Washington, DC.
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From page 137... ...
2004b. Human Resources for Health Development for Scaling-Up Antiretroviral Treatment in Tanzania.
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