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Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS (2005)

Chapter: 5 Programs of the U.S. Global Health Service

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Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
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5
Programs of the U.S. Global Health Service

This chapter describes six independent programs proposed for the Global Health Service (GHS). Each program would make a unique contribution to the mission of the GHS as discussed in Chapter 4; that is, to be flexible and responsive to target countries’ needs for human resources for health to combat HIV/AIDS; to provide expertise in the form of caregivers, technical advisers, trainers, and mentors; and to sustain enduring relationships after U.S. health professionals work with colleagues on the ground. Taken together, the committee believes this set of programs can significantly augment human resource capacity in seeking to acheive the PEPFAR goals (see Chapter 1). 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. Corps members would serve for a minimum of 2 years overseas. The Fellowship and Loan Repayment Programs would provide incentives and reduce barriers to participation by qualified and motivated professionals serving for 1 and 2 years, respec-

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

tively, overseas. The Twinning Program would mobilize health professionals for short- and long-term deployments keyed to specific needs of host countries and/or organizations. In addition, the committee proposes that gaps in human resources for health be evaluated for each PEPFAR focus country through formal needs assessments that could double as a baseline for follow-up evaluation of workforce capacity and distribution. Once these needs assessments had been carried out, uniform data for all countries could be compiled in a central electronic clearinghouse to enable the recruitment of other skilled health professionals. This virtual clearinghouse would thereby utilize information posting and global networking to further support the work of many other organizations and professionals contributing to the fight against global HIV/AIDS.

The committee believes that all six programs proposed for the GHS would be helpful in meeting the prevention, treatment, and care goals of PEPFAR. At the same time, some countries might choose to avail themselves of one resource more than another based on their individual needs.

The remainder of this chapter is divided into six sections, each describing one of the six proposed GHS programs (for a summary, see Table 5-1). Each section presents in turn background information (often echoing themes and evidence presented earlier in this report), the committee’s recommendation for that program, a fuller description of the program, and the rationale and evidence behind the committee’s recommendation. In some cases, there is also a discussion of deployment, public versus private placement of the program, and program costs.

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 Assessment

A standardized health personnel needs 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

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

GLOBAL HEALTH SERVICE CORPS

If the PEPFAR goals are to be achieved, HIV/AIDS prevention and treatment programs will likely need cadres of health personnel far larger than those currently available in most PEPFAR focus countries (USAID, 2003; USAID Guyana, 2003; WHO, 2003). In addition, the rapid scale-up of antiretroviral therapy (ART) will require expertise and knowledge in a variety of medical and nonmedical areas often unavailable in resource-constrained settings. Indeed, as discussed earlier, there is broad recognition that the limited stock of health workers in many of the PEPFAR focus countries alone could spell failure for the scale-up effort (Kober and Van Damme, 2004). Factors contributing to profound shortages of health workers in these countries are limited baseline educational capacity; the active emigration of many newly trained health personnel; low pay and morale, poor working conditions, and inadequate management, encouraging the departure of health workers; movement of other workers to the private sector; and HIV/AIDS-related attrition of existing staff (WHO, 2004). Additional problems at the health services delivery level include not only shortages and poor distribution of doctors and nurses, but also weak program management, poor technical support, inadequate supplies of drugs, and lack of equipment and infrastructure (HLF, 2004; WHO, 2004). In sum, inadequacies of both health care delivery and infrastructure pose extraordinary challenges to building a sustainable workforce.

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. Its members would work in such areas as medical and nursing education, information technology for health systems, health systems design and management, and laboratory and pharmaceutical management. The common purpose of the Corps would be to enhance the effectiveness of current health personnel and support efforts to expand the health workforce of the future. Thus, the Corps would play a key role in the GHS’s overall contribution to the successful realization of PEPFAR goals.

Recommendation 3: Establish a U.S. Global Health Service Corps to send key health personnel to PEPFAR countries on a full-time/long-term basis. The committee recommends the establishment of a full-salaried/ long-term U.S. Global Health Service Corps for the recruitment, placement, and support of U.S. health, technical, and management professionals in PEPFAR countries. Because of the critical and highly visible nature of this Corps and the necessity for it to coordinate closely with PEPFAR, the committee further recommends that it be established and

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

administered as a program of the federal government. U.S. Global Health Service Corps professionals should be selected and deployed based on the prioritized needs identified by ministries of health in conjunction with in-country PEPFAR teams. Assignments will be made for a minimum of 2 years with placements in areas and programs where Corps members’ presence would have maximum impact on enhancing the human capacity to prevent and treat HIV/AIDS. The committee proposes an initial deployment of 150 U.S. Global Health Service Corps professionals in the 15 PEPFAR countries based on needs assessment, placement development, and the availability of professionals with the required skills.

Program Description

Structure

The Global Health Service Corps could be established as a program of the federal government. This strategic positioning of the program would allow coordination of the Corps’ mission with the PEPFAR program and U.S. government country teams both abroad and domestically.

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. The Corps’ specialized professionals would be deployed on a full-time basis for a minimum of 2 years to provide technical assistance for scale-up of these programs. Given the heterogeneous needs of the 15 PEPFAR focus countries, the Corps should encompass a similarly diverse range of expertise, from clinicians and clinician trainers to experts in such nonclinical areas as information technology, health systems management, and laboratory and pharmaceutical management. Deployed U.S. professionals would be expected to work side-by-side with their host country counterparts to maximize the transfer of their skills and to help to develop the next generation of local health leadership. Priority would be given to positions and roles with the greatest potential to have a multiplier effect in promoting indigenous skills and capacity.

The Global Health Service Corps would also play a meaningful role in the United States. It would become a dedicated program of the U.S. government supporting the long-term service of personnel in global health. It would provide career options for U.S. health, management, and technical professionals committed to addressing the HIV/AIDS pandemic and other

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

global scourges. As such, the Corps could become an enduring instrument of U.S. 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. government in-country teams; and current governmental efforts to scale up HIV/AIDS prevention and treatment programs abroad, including those of the U.S. Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA). The Corps could recruit commissioned officers of the U.S. Public Health Service and civil service professionals currently in government service, as well as nongovernmental professionals, into its ranks. It would call on reserved and retired commissioned officers and attract specialists from the private sector, universities, and industry. It would use the Intergovernmental Personnel Act (see Box 5-1) and the GHS Loan Repayment program (described later in this chapter) to assist in its recruitment efforts.

The development and prioritization of positions within the Corps would be the responsibility of PEPFAR country teams in conjunction with the respective ministries of health. Using the results of the workforce needs assessments discussed in the next section, these PEPFAR/ministry of health teams would identify key country-level clinical, management, and technical workforce needs associated with the PEPFAR mission. Requests to address these needs with Corps personnel would be made to the Corps, and assignments would be made based on prioritization of needs and identification and availability of appropriate professionals. Priority in making assignments would be given to those supporting the infrastructure development and sustainability of national HIV/AIDS programs. In all cases, the assignments should be relevant to long-term capacity building in the country and should, to the extent possible, involve the transfer of skills to host country professionals.

Deployment

Individual Corps members would be deployed abroad as government employees with all associated benefits. Following admission into the Corps, members would undergo a country-specific orientation in the United States, followed by a site-specific orientation in the country of assignment. Regardless of previous experience, all Corps members will need to acquire familiarity with cultural and ethical issues specific to their countries of assignment, as well as the particulars of their job. Corps members would generally be supervised by their PEPFAR country team while also being integrated to

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

BOX 5-1
The Intergovernmental Personnel Act

The Intergovernmental Personnel Act (IPA) Mobility Program provides for the temporary assignment of personnel to facilitate cooperation between the federal government and state and local governments, colleges and universities, Indian tribal governments, federally funded research and development centers, and other eligible organizations. The goal of the program is to facilitate the movement of employees for short periods of time to serve a sound public purpose.

Typically, only senior executive–level positions are filled by an IPA agreement. The assignment is for 2 years, extendable for an additional 2 years. The recipient of the appointment continues to be paid by his or her parent organization at full salary and benefits, and the parent organization receives a negotiated reimbursement from the government.

At American University for example, Interagency Personnel Agreement (IPA) assignments provide opportunities for faculty members to work for the federal government on special assignment. These assignments require a contract between the university and the employing agency, and must be processed through the Office of Sponsored Programs (OSP).

While on an IPA, the faculty member is “on detail” to the agency (or office) while still on active service at the university. Many faculty members have been able to combine an IPA with their sabbaticals and thus arrange a full-year leave at full pay.

Most IPAs are for a full-time commitment, although arrangements for a partial IPA may be approved, depending on the nature of the IPA assignment, if the time committed to university service is substantial. The university does not charge indirect costs on IPAs, however, the university does not provide cost share on such agreements either.

Sources: http://www.american.edu/academics/provost/dean/faculty/leave_policy.htm.

the extent possible into the host country organization to which they are assigned. In addition, coordination and cooperation would be encouraged among Corps personnel in a given country and between these personnel and local public health authorities. Given the complexity and importance of the anticipated assignments and the need for strong collegial relationships to develop, tours of duty should be at least 2 years in length. Assignments might be extended when there is agreement on doing so among Corps leadership, the host organization, and the Corps member. Corps members could serve sequential assignments in different countries depending on skills needed, prioritization, and availability. 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. An initial deployment

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

of 150 Corps members (prorated according to need and availability) would achieve these aims while allowing the Corps to remain manageable as a new enterprise.

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). A range of skills is needed, particularly at the level of key clinical, management, and technical leadership positions essential to building the infrastructure of HIV/AIDS treatment systems (WHO, 2002). Because of the specialized nature of these positions and the long-term requirements of the work, volunteer health professionals and those with short-term availability will be of limited utility in addressing core country-level needs. It will be the role of the Global Health Service Corps, working with public health leaders in the PEPFAR focus countries, to provide specialized health personnel for extended assignments to fill these positions and accelerate program scale-up.

The production of new health care workers has not kept pace with the growing demand for greater workforce capacity (RATN, 2003). There is a shortage of trained workers with specific experience in the clinical management of HIV/AIDS treatment programs; there are also severe shortages of well-trained professionals needed to handle other critical functions, such as commodity logistics, pharmaceutical regulation, information management for laboratory support, and operations research (Interim Pharmacy Council of South Africa, 1998; IOM, 2005; Katerere and Matowe, 2003; Ntuli et al., 2003). Uganda illustrates this point. One of the primary constraints on increasing Ugandan ART enrolees from 25,500 to 60,000 by the end of 2005 is the lack of qualified health staff. Most likely, the target will not be reached unless an aggressive intervention is quickly developed and implemented (Adano et al., 2004), yet the country faces an imposing challenge in producing the needed professionals (see below). Kenya also appears to be facing human resource shortage issues. In addition to dealing with the greater numbers of patients due to the upward-spiralling HIV epidemic, Kenyan health workers treating patients with AIDS and AIDS-related illnesses have found that the complexity of the disease poses new demands (Personal communication, Annalisa Trama, UNAIDS Kenya, December 1, 2004). Many such patients require full-time attention and longer hospital stays. As a result, roughly half of the patients in Kenyan medical wards have AIDS-related illnesses.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

A low stock of skilled health workers is not the only impediment to scale-up; fragmentation of the employment process also plays a role (HLF, 2004). Country-level planning and human resource management capacity are often limited in developing countries and inadequately responsive to the changing priorities likely as more people begin ART or receive prevention counselling. An important structural problem in some areas is the undue centralization of government health systems. When all budget and policy decisions are made by the central government, a sense of powerlessness and lack of accountability can result at the district and province levels where the services are delivered (Personal communication, Stephen Moore, CDC-Nairobi, October 24, 2004).

The challenge of producing skilled health care workers in the PEPFAR countries is illustrated by Uganda. Although educational institutions (medical schools, nursing schools, schools for health science) produce personnel who then serve as trained professional staff, the country is not generating enough doctors, nurses, pharmacists, or laboratory technologists to run basic health services, let alone HIV/AIDS-specific services (Adano et al., 2004). In addition, many recent graduates of health training institutions cannot find employment because of budget constraints and restrictions on personnel recruitment. Some cadres of trained health workers feel underutilized because they cannot obtain jobs in their areas of professional training that will maximize their potential and create opportunities for professional growth. This lack of career paths and motivation among young professionals has long-term consequences for human resource planning.

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. A reasonable estimate of costs for the Corps can be derived from CDC, which deploys health professionals abroad using government personnel systems; its rough estimate for sending a skilled professional overseas is $250,000 per year per person.1 Using this yardstick, the deployment of an

1  

The total can be $300,000 or more depending on certain factors, such as whether the country is more expensive; the base salary is higher (e.g., a medical epidemiologist compared with a junior administrator); how many children the person has (the government pays school fees at $10,000–15,000 per child per year); whether the total tour is shorter (because the costs of the move and set-up [e.g., housing] are amortized over fewer years); or security-related costs are increased (Personal Communication, Michael St. Louis, CDC, February 23, 2005).

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

initial Corps of 150 individuals as recommended by the committee would require a budget of $37.5 million (150 × $250,000).

The committee discussed these costs at length, appreciating that the investment required for a fully salaried, full-time/long-term professional would be substantial, and that many other health-related goods and services could be purchased for the same sum. 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.

Options for Placement

Public versus Private Sector

Several options exist for the organization and placement of the Global Health Service Corps as the anchor program of the GHS. The first decision to be made is whether to locate the Corps in the public or private sector. The committee decided that all the programs of the GHS should be managed in a unitary fashion within the federal government, while individual programs might be candidates for publicprivate collaboration or placement in the private sector through contract mechanisms (see Chapter 4).

The committee believes strongly that the specialized nature of the Corps, its requirement for long-term service, its visibility, and its potential to be the signature program of the U.S. global health effort argue for its being established as a program of the federal government. Doing so would address important and sensitive issues, including the need for close coordination with PEPFAR and other U.S. global health and foreign policy initiatives. The committee discussed at length the option of placing the Corps in the private sector, managed through a federal government contract. The committee members were aware of many not-for-profit and for-profit organizations under government contract that have been successful in deploying health professionals abroad. These contracts are usually framed in terms of the delivery of specific services and recruitment of health professionals as assets to help to achieve the goals of the contract. Private firms working in this area are generally credited with the ability to locate health professionals and move them into the field quickly. However, working at the government-to-government level is an area in which private firms are less well positioned. For this reason, the committee believes the Corps would better be established as a program of the U.S. government, and that such federal placement would best serve recruitment, placement, mission

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

coordination, skill banking, retention, and long-term program development. A federally based Corps would also greatly facilitate the program’s integration with PEPFAR and in-country strategies.

Multiple agencies and individuals—including the American Medical Student Association, United Methodist Committee on Relief, International Health Medical Education Consortium, and American Society for Tropical Medicine—testified to the committee regarding the growing interest in careers in global health. This interest is seen across the career spectrum—students, established experts, and health professionals wanting to retire early to participate in health programs abroad (Kelly, 2004; Palmer, 2004; Weaver, 2004). The committee believes strongly that this interest should be captured by the range of programs envisioned for the GHS, but that the Corps in particular should provide deployment opportunities and model careers in global health. As the signature program of the GHS initiative, the Corps should be a program of the federal government that will make a statement at home and abroad about the importance of careers in global health and the commitment of the U.S. government to the long-term mission of improving health worldwide. Moreover, a federal Corps would be in a position to recruit from the ranks of the Public Health Service and civil service while also recruiting new professionals into its ranks.

Potential Federal Agencies

A number of agencies of the U.S. 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. Moreover, the experience of these agencies should inform policy makers designing the Corps.


The Peace Corps. The Peace Corps is well established, well recognized, and well regarded with respect to the placement of U.S. citizens abroad. Over the years, public health has been among its areas of focus. The Peace Corps, however, functions with volunteers and does not provide recompense likely to appeal to many senior-level clinical, technical, or management personnel undertaking extended assignments. Rather, the Peace Corps provides volunteers with a living allowance that enables them to live in a manner similar to that of the local people in their community (United States Peace Corps, 2005a).


Centers for Disease Control and Prevention. CDC has had extensive experience with foreign assignments. Through its Global AIDS program, it has roughly 40 direct hires in the PEPFAR focus countries, with an average of

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

2 to 3 per country (CDC, 2005). CDC has a strong epidemiologic tradition (the Epidemic Intelligence Service in particular) and is very well recognized in public health circles worldwide. Its expertise, however, is largely in surveillance and prevention; it has less experience and less of a mandate regarding health systems development or the personnel needed to assist in such efforts.


National Health Service Corps. The National Health Service Corps (NHSC) has almost 35 years of experience with the placement of health professionals in underserved areas and with scholarship and loan repayment programs as recruitment strategies (NHSC, 2003). It has an identity that is mission driven and easily equates with a domestic version of the proposed Global Health Service Corps. However, NHSC has no international mandate or experience, and its program is limited to clinicians.


Indian Health Service. The Indian Health Service (IHS) is an agency within the Department of Health and Human Services. It provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 35 states. Similar to the proposed GHS, the IHS has a recruitment website, administers scholarship and loan repayment programs, employs a variety of health professionals, and encourages commissioned officers to participate (IHS, 2005). The IHS does not work internationally, however, and has a broad focus on general health care not specific to HIV/AIDS.

Other agencies of the federal government also send health professionals abroad. USAID employs multiple contract mechanisms to sponsor health programs that deploy U.S. health personnel; HRSA oversees similar deployments on a smaller scale and targeted to the PEPFAR focus countries. Likewise, the U.S. Armed Forces deploy large numbers of health personnel abroad, both in support of the military mission and in humanitarian relief efforts.

The experience of all of the above U.S. government agencies should be taken into account when considering the placement of the Global Health Service Corps. After examining the various options, the committee concluded that the effectiveness, identity, and mission of the Corps to support the PEPFAR goals would best be served by the establishment of a discrete program of the federal government managed by the GHS. Furthermore, the structure of the Corps would then be in place and prepared to mobilize health personnel proactively for emerging global health crises in the future.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

HEALTH WORKFORCE NEEDS ASSESSMENT

Timely and accurate information on workforce needs will be essential to maximize the impact of programs mobilizing health personnel to achieve the PEPFAR goals. Despite the key role of human resources in the functioning of health systems, few well-conducted qualitative or quantitative studies have assessed the adequacy of the health care workforce in the PEPFAR focus countries (SWEF Research Network, 2005). Failing to complete such an assessment before initiating a scale-up plan for health personnel could ultimately undermine the effectiveness of the initiative. 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), the PEPFAR focus countries need better data to project the quantity of health care workers needed to scale up HIV/AIDS activities. Better data are also needed to establish the existing skill mix of providers and other support staff in each country, as well as the distribution of workers in urban versus rural settings and the public versus private health sector. In estimating national stocks, worker profiles, and the distribution of personnel, moreover, certain assumptions regarding the service delivery model must be made. For example, the annual growth rate of human resource stock over the next 5 years is assumed to be equivalent to the annual growth rate of the past 5 years—4.5 percent according to the available data. Other assumptions relate to the numbers of patients and diagnosis rates of HIV infection. Despite these limitations, estimates of human resource needs have been made for the PEPFAR focus countries, some of which are presented in this chapter.

Collated data from a thorough workforce needs assessment not only would inform host and donor countries about where and how assistance would most effectively build human resource capacity to achieve the PEPFAR goals, but also could serve as a baseline for follow-up evaluation of national health capacity. Finally, although HIV/AIDS is the target of funding for the PEPFAR program, the inseparability of this infection from tuberculosis (TB) and malaria in most of the 15 focus countries should be recognized (see Chapter 2). A comprehensive needs assessment would take into account the overlap in the work of doctors combating all three diseases.

Recommendation 4: Undertake a uniform health workforce needs assessment. The committee recommends that the PEPFAR country teams, in collaboration with ministries of health, initiate assessments of in-country requirements for health personnel to achieve PEPFAR goals. These assessments should form the basis for national human resources for health plans. These assessments would also generate a valuable

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

baseline inventory for all mobilization programs and subsequent evaluation activities. The data from all countries should be collected in a standardized fashion, updated regularly, and maintained in the electronic database of the U.S. Global Health Service Clearinghouse “Opportunity Bank,” available to professionals interested in service in PEPFAR countries. Timely and accurate information on workforce needs will be essential to maximize the impact of programs designed to mobilize health personnel to achieve PEPFAR goals. Current national needs assessments are irregular, nonstandardized, and not available at any single site. Local placement strategies and global recruitment efforts would be greatly strengthened by a regularized needs assessment and dissemination initiative.

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. With adequate training and staffing, ministries could perform their own data collection and analysis using this assessment. In countries where the ministry of health is not able to perform its own assessment, employing an outside organization may be necessary; a not-for-profit organization or private company experienced in analyzing human resources for ART scale-up in developing countries could conduct the assessment and analyze the data. A likely result of these assessments will be the identification of methods—such as those described in this report—for strengthening the human resource capacity of ministries of health to monitor and evaluate their programs.

Tools are currently available to assist NGOs and countries in conducting human resource management needs assessments for HIV/AIDS environments (MSH, 2003); human resource development assessments (MSH, 1998); rapid assessments of human resources for health (WHO, 2004); and baseline assessment tools for preventing mother-to-child transmission of HIV (FHI, 2003). A compilation of the most salient measurements collected from these and other previously developed assessment instruments would be a most effective means of analyzing country needs with regard to the goals of PEPFAR. However, it is important to note that unless ministries of health see the value, have the capacity, and commit to the process, these tools may not be used and/or updated appropriately.

The instrument employed for workforce needs assessment must be uniform for all countries so the data can be logged, shared, and used for resource allocation purposes in a standardized fashion. The results would

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

assist PEPFAR in determining the numbers and types of positions needing support in various countries through the GHS programs. Personnel needs identified in this fashion would also be available for posting in the GHS Clearinghouse Opportunities Bank (see below) in a systematic manner. These openings could potentially be filled by U.S. professionals seeking jobs overseas, and continuous follow-up measurements would provide tracking of open positions. Additionally, the initial assessment could serve as a baseline for follow-up analyses of human resources in HIV/AIDS health systems.

Rationale and Evidence

The GHS would be responsible for sending U.S. health and other professionals to countries that expressed a substantiated need for a particular form of assistance. Conducting a workforce needs assessment is an essential first step in establishing and verifying such needs (MSH, 2004). Currently, there is no uniformity in the way PEPFAR countries collect and analyze data on their human resources for health. 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). Although all of the focus countries have country strategic plans through USAID, these plans were not designed to address human resource issues and are therefore not useful in this regard. Country plans drafted by U.S. government teams in each PEPFAR focus country were not available for review at the time of this writing.

A review of the few available HIV/AIDS-related workforce needs assessments (listed in Table 5-2) reveals that some countries have already taken the initiative to address their workforce requirements for ART scale-up. Each assessment provides valuable information, but none of them considers all aspects of current and future workforce needs for accomplishing the PEPFAR goals. One possible exception is The Zambia HIV/AIDS Workforce Study: Preparing for Scale-Up—a comprehensive analysis that addresses whether Zambia will have the staff to scale up prevention of mother-to-child transmission and ART to reach its targeted number of clients (Huddart et al., 2004). The Ugandan and South African reports also cover many workforce issues and project staffing needs for a wide variety of health workers in addition to doctors, nurses, and pharmacists (Adano et al., 2004; South Africa Ministry of Health, 2003).

Despite a concerted effort, the committee was unable to locate an appropriate health workforce needs assessment addressing all of PEPFAR’s activities and targets. The commissioned paper presented in Appendix C is

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
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TABLE 5-2 Workforce Needs Assessments for PEPFAR Focus Countries

Country/Region

Assessment

Uganda

Rapid Assessment of the Human Resource Implications of Scaling Up HIV/AIDS Services in Uganda (Adano et al., 2004)

Zambia

The Zambia HIV/AIDS Workforce Study: Preparing for Scale-Up (Huddart et al., 2004)

South Africa

Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa (South Africa Ministry of Health, 2003)

Nigeria

Scaling Up Antiretroviral Treatment in the Public Sector in Nigeria (Kombe et al., 2004); and Nigeria: Rapid Assessment of HIV/AIDS Care in the Public and Private Sectors (PHRplus, 2004)

Eastern and Southern Africa

Eastern and Southern Africa Regional HIV/AIDS Training Needs Assessment (RATN, 2003)

Sub-Saharan Africa

Scaling-up Antiretroviral Treatment and Human Resources for Health (Wyss, 2004a)

an attempt to estimate these needs, although several limitations of data availability hamper its precision. 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). Applying these 2004 baseline data and assuming that existing conditions will not change, the total number of health workers is projected to increase to 592,076 by 2008, an annual growth rate of approximately 4.5 percent. This increase is driven primarily by Nigeria, South Africa, and Vietnam, all countries with large populations and high personnel totals. Meanwhile, countries such as Tanzania and Uganda will see a decrease in their total human resource stock. The remaining 10 PEPFAR countries will see minimum growth in their health workforce in the next 4 years.

The number of health workers needed to achieve the PEPFAR goals—not including laboratory technicians, social workers, counselors, and community health workers—was approximately 11,200 in 2004 and will be roughly 56,000 by 2008 because of the planned scale-up of the PEPFAR program. These are broad estimates for all 15 focus countries. The actual needs vary from country to country, with greatest human resource gaps existing in those countries with the greatest HIV prevalence rates.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
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Projected gaps in trained HIV/AIDS personnel suggest a great need for master trainers to train health workers in HIV/AIDS care. The approximate number of master trainers needed so that the 15 PEPFAR focus countries can provide full HIV/AIDS services to all eligible patients is 3,000—1,100 doctors, 1,200 nurses, and 700 pharmacists. To reach the PEPFAR goals by 2008, roughly 1,600 master trainers will be needed.

Given the data limitations described above, there is a clear and compelling need for the proposed health care workforce assessment. Better data on health care workforce needs obtained through the proposed assessment would also assist countries in determining the allocation of their resources. In addition, it is important to evaluate overall health systems capacity when scaling up HIV/AIDS prevention, treatment, and care services; indeed, many countries have begun such an effort to varying degrees.

FELLOWSHIP PROGRAM

As discussed earlier, many health professionals in the United States are eager to volunteer in the developing world. In fact, the International Medical Volunteers Association (IMVA) currently has a registry of more than 5,300 health professionals, many of whom are U.S. citizens, seeking overseas medical assignments (IMVA, 2005). International volunteer activities available to health professionals have traditionally been initiated and supervised by academic centers, NGOs, faith-based organizations, hospitals, and other charitable organizations. The Journal of the American Medical Association publishes an inventory entitled “Physicians Service Opportunities Abroad” every 3 years that lists more than 60 organizations offering a variety of short-term volunteer opportunities for health professionals (Vastag, 2002). However, many interested candidates are unable to overcome the financial or logistical barriers to significant periods of overseas service. 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. GHS Fellowships would enable awardees already paired with a host organization to commit a meaningful period of service to a PEPFAR country and participate in direct patient care, systems development, training of trainers, and scaling up of resources and capacities to respond to the HIV/AIDS crisis.

Recommendation 5: Create a U.S. Global Health Service Fellowship Program. The committee recommends the creation of a U.S. Global Health Service Fellowship Program that would provide professional recognition and a $35,000 award to qualified U.S. personnel to enable

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
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commitment to programs of service in PEPFAR countries. This competitive program would fund a prestigious award to individuals willing to make medium-term commitments of 1 year or longer to provide health care, training, and technical assistance in countries in need. It would provide career-long recognition as well as immediate financial assistance.

Program Description

Structure

The GHS Fellowship Program is designed to provide qualified health personnel wishing to work abroad with incentives to serve within the framework of the PEPFAR mission. The structure of the program would engage professionals by reducing financial and logistical barriers to service, while also focusing their activities to align with the PEPFAR goals. Much like the prestigious Fulbright awards, the GHS Fellowships would confer honor and professional recognition on their recipients.

The GHS Fellowship program would be housed together with the other programs of the GHS. The implementing agency would have oversight and management responsibilities, and a national board made up of experts in the field would oversee the direction and mission of the program. An annual award in the amount of $35,000 would not be meant to cover all expenses, but to supplement the recipient’s other financial resources and assist with travel expenses and the cost of living. Participants would also be eligible to apply for the GHS Loan Repayment Program (see below).

Fellows would be required to serve for a minimum of 1 year, and their work would be focused on specific projects structured in collaboration with a host organization. This close collaboration would minimize the amount of time required for recipients to adjust to their new work environment and begin the tasks at hand. The program would start small but grow quickly. One hundred awards would be made in the first year (roughly 5–10 per country, prorated by need) increasing to 1,000 awards by the third year of the program. 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).

Eligibility and Selection Process

As is true for many prestigious awards, there would be a competitive process leading to participation in the GHS Fellowship Program. U.S. citizenship or permanent resident status would be an initial requirement; in

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
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addition, applicants would have to be trained professionals, including but not limited to nurses, doctors, midwives, laboratory workers, data managers, HIV trainers, pharmacists, social scientists, and health care professionals with experience relevant to the HIV/AIDS mission of PEPFAR. To apply for the award, applicants would have to have a preidentified health services or health systems destination in a PEPFAR focus country. This destination would have to be documented, and the applicant would have to have the full support of the host organization in writing. This process would allow the applicant to select and design a suitable position that would be aligned with the needs of the host country.

The purpose of this award would be to build quality care and human capacity in resource-constrained settings; proposed positions should therefore reflect this goal. Applicants proposing basic research projects would not be accepted. The committee acknowledges that operations research may be needed in some settings and organizations to identify better or more efficient ways of administering HIV/AIDS prevention, treatment, and care; depending on local needs, such research could be considered as an aspect of a project.

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. Points would be awarded for experience and level of expertise, as well as quality of references and work plan. Points for alignment with PEPFAR and national priorities would be added to the individual scores to create composite scores that would ultimately be used to rank order candidates and make the awards.

Deployment

GHS fellows would receive country-specific cultural and ethical training both before departure and upon arrival on site. In addition to receiving a packet of written information, fellows would be referred to the GHS Clearinghouse, where they would find country-specific information. Upon arrival on site, they would undergo intensive orientation organized in cooperation with the host organization. If a common foreign language (such as French, Spanish, or Portuguese) were required, the fellow would be expected to be fluent in that language before arrival. Local language training could be provided if applicable. Predeparture orientation would also include information about health needs, such as immunizations, malaria prophylaxis, and reliable sources of evacuation and health insurance. Health insurance would be required for all fellows serving overseas. Information

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
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about medical licensure, although available through the Clearinghouse, would also be provided to the participant.

Evaluation

Evaluation of the GHS Fellowship Program would take place on many levels. A participatory evaluation of the field work and experience should include the host organization, the agency granting the award, and the fellow. This evaluation should include such information as the number of professionals trained, the number of patients treated, and the satisfaction level of the host organization with the services provided by the fellow. The infrastructure of the host organization should be assessed to ensure that it does not become overburdened with volunteers. A second evaluation would be an exit survey, completed by each fellow. The results would inform the selection committee about the usefulness of the fellow’s plan, whether the plan could be replicated in other areas, and other valuable lessons learned by the returning fellow. The data compiled from these exit surveys would be collected and made accessible to future fellows via electronic dissemination.

Rationale and Evidence

Why a Fellowship Program?

The shortage and uneven distribution of health workers has been discussed at length in previous chapters as the primary constraint on achieving the PEPFAR goals. 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. The program provides HIV/AIDS-related research training to strengthen the capacity of institutions in low- and middle-income countries (Fogarty International Center, 2002). Multidisciplinary training is offered to physicians, dentists, pharmacists, scientists, and support personnel from selected developing countries. The training emphasizes research methods relevant to epidemiologic and behavioral studies related to AIDS, HIV transmission, and treatment to prevent or delay morbidity and mortality in HIV-infected persons. However, the committee could find no fellowship program focused on training counselors, providing care, or assisting in the skilled management of ART scale-up. The many U.S. health care workers who go overseas for clinical work do so either through short-term placements under travel fellowships from medical schools, medical societies, or nongovernmental organizations (NGOs) such as Doctors without Borders, or

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
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as volunteers with charitable or faith-based organizations (Vastag, 2002). Few of these clinical programs offer any long-term legacy or sustainability within a country. A 1-year GHS Fellowship would serve as an innovative incentive to mobilize large numbers of volunteer U.S. professionals rapidly for a meaningful time period to the PEPFAR focus countries in support of the PEPFAR goals. Moreover, this program could ultimately strengthen long-term ties among professionals working to fight HIV/AIDS globally and become a model program for responding to future emerging global health crises.

Program Design

In developing the concept of the GHS Fellowship Program, the committee was guided by various models discussed in this report. 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. The GHS Fellowship Program is meant to be selective and competitive, and the point system described above would allow only the most qualified professionals to receive awards. The point system would also ensure the awarding of fellowships to applicants who most closely meet the needs of a specific country. The selection process for the GHS Fellowship Program was modeled on that of the Traditional Fulbright Scholar Program, which has eligibility criteria including U.S. citizenship, a Ph.D. or equivalent professional/terminal degree (for professionals outside of academia, recognized professional standing and substantial professional accomplishments), relevant experience that corresponds to the level of work in the field, foreign language proficiency as necessary, and sound physical and mental health (CIES, 2005). Since its inception in 1946, the Fulbright program has provided more than 255,000 participants the opportunity to study and teach in each other’s countries. The program awards about 4,500 grants a year, and its alumni include Nobel and Pulitzer Prize winners, ambassadors, governors, senators, artists, prime ministers and heads of state, professors, scientists, Supreme Court justices, and many others (CIES, 2005).


Number of Fellows. As noted above, the committee agreed that the Fellowship Program should start with 100 awards in the first year (about 6 per country, prorated by need), increasing to 1,000 awards by the third year of the program. Starting small would allow the infrastructure of the program

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

to develop and would enable feedback from the first set of fellows to be incorporated into the program. The proposal to scale up to 1,000 volunteers per year is based on the fact that the Peace Corps deploys around 4,000 volunteers per year (Rieffel, 2003). As of September 2004, the Peace Corps had 7,733 volunteers abroad, 20 percent of whom (1,546) worked in the health sector. With the advent of PEPFAR in 2003, the Peace Corps2 committed more than 1,000 new volunteers to work on HIV/AIDS education, but still has not made meaningful inroads in meeting human resource needs (IOM, 2005; United States Peace Corps, 2005a). Similarly for comparison, the IHS employs 900 doctors (out of a total workforce of 15,000), who provide health services to approximately 1.5 million American Indians and Alaska Natives in 35 states (IHS, 2005). Assuming that IHS doctors make at least the median salary for a GS-15 employee in 2005 ($103,071), this program spends more than $92,700,000 each year on doctors alone (OPM, 2005a).

The committee recommends that the GHS Fellowship Program start small with 5–10 participants in 15 countries in order to pilot the program’s infrastructure. At the level of awards envisioned, the cost of the program would start at $3.5 million ($35,000 × 100 awards) and grow to $35 million ($35,000 × 1,000 awards) by the third year of the program, representing about 0.1 percent of the current PEPFAR budget and 1 percent of the projected PEPFAR budget, respectively.


Compensation. After reviewing the literature, the committee decided that the amount of $35,000 would be reasonable to assist fellows with living expenses. According to JHPIEGO, the cost of sustaining a health professional with no salary implications for 1 year ranges from $32,994 in Zambia to $45,832 in Kenya.3 It costs $75,000 annually to deploy a Peace Corps volunteer (Campbell, 2004), while a CDC employee costs $250,000–$300,000 per year, including salary (Personal Communication, Michael St. Louis, CDC, February 23, 2005). Moreover, as a large percentage of U.S. 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).

2  

The Peace Corps builds diplomacy throughout the world in pursuing its three goals of helping people of interested countries meet their needs for trained men and women, helping to promote a better understanding of Americans on the part of the peoples served, and helping to promote a better understanding of other peoples on the part of all Americans.

3  

This information was received as sample data drawn from the budgets of JHPIEGO. JHPIEGO budgets are based on USAID and State Department rates.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
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LOAN REPAYMENT PROGRAM

Educational debts are a major problem for many U.S. health personnel, and are a substantial impediment to doctors—and others who accrue similarly large debts—in pursuing volunteer or low-remuneration opportunities such as service abroad in support of the PEPFAR goals. Loan repayment programs are often used to attract health professionals to practice in areas designated as having a shortage of such personnel. In return for service, loan repayment programs offer a percentage of repayment on qualified educational loans with outstanding balances. Federal programs follow guidelines set forth by the Office of Personnel Management, but each agency has specific requirements for service and repayment. Some of the more common loan repayment programs include the NHSC, the U.S. Army Medical Department, and HRSA’s Nursing Education Program. Many states also offer loan repayment programs in exchange for service in areas of need (OPM, 2005b). Student loan payments are usually paid directly to the lender, but the payment is included in the employee’s gross income and wages for federal employment tax purposes.

Recommendation 6: Establish a U.S. Global Health Service Loan Repayment Program. 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 designated periods in PEPFAR focus countries. This program would provide $25,000 toward scholastic debt reduction for each year of service in PEPFAR focus countries. Clinical, managerial, and technical professionals graduate from training programs today with substantial debts that limit their ability to consider voluntary or less remunerative work. A loan repayment program would expand the pool of professionals who could consider service abroad and make many more skilled individuals available to address PEPFAR goals.

Program Description

Participants in any of the other GHS programs would be eligible to apply for loan repayment of up to $25,000 per year of service in the PEPFAR focus countries. Service of less than 1 year would not qualify for loan repayment. The implementing or contracted agency of the GHS would manage the Loan Repayment Program and would select recipients on the basis of such criteria as absence of judgment liens arising from federal debt; full-time service (40 hours/week); minimum of a 1-year service period; and if applicable, valid licensure for the country of service.

As is the case under the NHSC loan repayment program, eligible loans

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

could be either federal or commercial, but would have to have been used for educational purposes leading to a relevant degree. If an applicant had a PLUS loan4 for his or her child, the applicant would be eligible for loan repayment. However, if a PLUS loan were held by an applicant’s parent, the applicant would not be eligible for repayment of that loan (OPM, 2005b). Including PLUS loans might encourage midcareer in addition to early-career professionals. A participant who failed to meet the minimum 1-year full-time service requirement would be obligated to repay an amount equal to the sum of the amounts paid by the GHS.

In addition, applicants would have to document that their host organization is a nonprofit entity and that their specific project or initiative contributes to the PEPFAR goals. As with the NHSC loan repayment program, GHS repayments would be exempt from gross income and employment taxes and would not be included as wages in determining benefits under the Social Security Act (NHSC, 2004). Like the Felowship Program, the Loan Repayment Program, would start with 100 awards (roughly 5–10 per PEPFAR focus country, prorated by need) in the first year, but scale up quickly to 1,000 awards by the third year of the program.

Rationale and Evidence

Why a Loan Repayment Program?

In the academic year 1996–1997, medical students borrowed more than $1.11 billion, and 83.2 percent of the 1997 graduating class had educational debt (Beran, 1998). In 2003–2004, tuition and fees at public medical schools averaged $16,153 and at private schools reached a staggering $32,588 (Jolly, 2004). This financial burden could potentially leave a young medical professional with a debt ranging from $140,000 to $255,000, making the concept of exchanging debt for service very appealing (Morrison, 2005).

The NHSC offers professionals an opportunity to compete for repayment of qualified educational loans (see above). In addition to loan repayment, professionals receive a competitive salary and an opportunity to make a difference in an underserved area. Maximum loan repayment during the required 2-year contract is $25,000 per year; participants are eligible to extend loan repayment 1 year at a time based on continued service

4  

Parent Loans to Undergraduate Students (PLUS) are loans to parents in order to pay the educational expenses of their child who is a dependent, undergraduate student enrolled at least half time. SOURCE: http://studentaid.ed.gov/.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

at a maximum of $35,000 per year for their third year of service and beyond. Payments are made directly to the lender. Clinicians choose their service site before applying to the program, and employment at a site does not guarantee participation in the program. A participant who fails to meet the minimum 2-year full-time service requirement is obligated to pay an amount equal to the sum of the amounts paid by the NHSC for any period of obligated service not served, an amount equal to the number of months of obligated service not completed multiplied by $7,500, and interest on the above amounts at the maximum legal rate (NHSC, 2005).

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. The purpose of this program is to assist in recruiting and retaining professional nurses to work in underserved areas. Applicants must meet strict eligibility requirements, including but not limited to registered nurse (R.N.) status, possession of one or more outstanding loans related to a completed nursing education program, full-time employment in a critical shortage area, possession of a current and unrestricted license to practice in their state of service, U.S. citizenship, absence of any judgment liens, no default on a federal debt, no work for a nurse staffing agency or traveling nurse agency, and no work as faculty at an educational institution. All participants in the loan repayment program must agree to work full time for 2 years in an approved critical-shortage facility. For 2 years of service, 60 percent of the participant’s total qualifying loan balance is paid. If a participant completes 2 years of service and decides to work a third year at a critical-shortage facility, the program pays an additional 25 percent of the qualifying loan balance. In contrast to the NHSC approach, payments are made to the participant, who is then responsible for making payments to the lender. The loan repayment program may periodically contact the lender to ensure that payments are being made. Participants who are unable to complete a contract are required to repay all payments made by the program, plus interest at the maximum legal rate (HRSA, 2005; HRSA Bureau of Health Professions, 2005).

Loan repayment is a motivating factor for recruiting and retaining highly skilled professionals to serve in areas of need. Another option, albeit less attractive, is loan deferment or forbearance. Several federal loan programs offer deferments in exchange for Peace Corps service. In addition, volunteers with Perkins loans are eligible for a 15 percent cancellation of their loan balance for each year of Peace Corps service (United States Peace Corps, 2005b). This benefit comes from the loan programs, and the Peace Corps does not actively repay loans in exchange for service. Similarly, full-time service as an officer in the Commissioned Corps of the Public Health Service is rewarded with loan deferment benefits.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
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Costs

At the level of loan repayment awards envisioned, the costs of the program would start at $2.5 million ($25,000 × 100 awards) and grow to $25 million ($25,000 × 1,000) by the third year of the program, representing less than 0.1 percent of the current PEPFAR budget and less than 1 percent of the projected PEPFAR budget, respectively.

TWINNING PROGRAM

Twinning is a potentially useful tool for building human health care resource capacity in resource-limited settings. It can be particularly helpful when a twinning partnership has been established in a country, and the skills of health professionals can be rapidly engaged through this “instant infrastructure” (USAID, 2001). Such rapid mobilization of U.S. health professionals can fill an immediate need for workers, educators, and trainers while at the same time building a long-term relationship through multiple exchanges over the years. Partnerships whose outcomes involve prevention, treatment, and care for HIV/AIDS can be extremely useful in helping to achieve the PEPFAR goals. These relationships can take many forms, including public–private 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. Likewise, moving health professionals from a host country to a U.S. organization for specific forms of training can result in multiplying the host country’s health workforce, provided the training received abroad is appropriate and directly applicable.

Recommendation 7: Promote twinning as a mechanism to mobilize health personnel. The committee recommends long-term, targeted funding for innovative, institutional partnerships that would mobilize U.S. health personnel to work in PEPFAR countries. Often called “twinning,” these bidirectional partnerships (which encompass counterpart organizations ranging from hospitals and universities to nongovernmental organizations and public health agencies) develop institutional capacities and create a sustainable relationship between the partners that extends beyond the life of the defined project. It is a bilateral arrangement that can develop collaboration in many areas but stands to be a particularly helpful instrument to augment teaching, training, and service capacities in combating HIV/AIDS. Twinning should be supported between a variety of U.S. and PEPFAR country-based institutions that are most relevant to meeting PEPFAR targets and harmonizing with PEPFAR country operating plans, especially public-sector

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

health agencies. Twinning is a mechanism that can move skilled personnel from a sending organization to a host organization to provide support, training, and technical assistance. It provides a ready-made structure in host countries for U.S. 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. A desire to partner with U.S. organizations should be defined through a country’s needs assessment (see above). These partnerships could include relationships with ministries of health, central and district-level health agencies, medical facilities, health education and training institutions, academic centers, and faith- and community-based organizations involved in prevention, treatment, and care for HIV/AIDS.

An in-country coordinator similar to those employed by the European Union could facilitate the twinning process (European Commission Directorate General for Enlargement, 2001). The coordinator would serve as a central point for communication, and would work with PEPFAR teams and national partners to determine which key institutions would most benefit from a twinning partnership. Once the decision had been made to partner with a U.S. organization, the request would be submitted to an intermediary or umbrella organization that would handle all aspects of the subgrant process, including application, selection, orientation, and administration. It would be up to the umbrella organization to find appropriate matches for the requesting country. Matching would be accomplished through a competitive process to attract U.S. participants and to ensure that the proper skill set will be matched with the needs of the focus country. An alternative to using an intermediary would be for organizations to select and arrange their own twinning partnerships. To this end, a large database of all qualifying potential partners could be maintained in the Clearinghouse (discussed in the next section). Organizations in a PEPFAR focus country could, with the help of the in-country coordinator, select a partner from this wide range of choices.

Both partners would have to agree upon a work plan and the process for its implementation before initiating the partnership. The umbrella organization could broker this exchange and monitor its status and progression. The work plan should include agreements on the length of exchanges and the duration of the partnership; Table 5-3 lists advantages and disadvantages of short- and long-term exchanges. Exchanges designed to provide

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
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TABLE 5-3 Advantages and Disadvantages of Short- and Long-Term Exchanges

Length of Exchange

Advantages

Disadvantages

Short-term (2 weeks to 3 months)

  • Unpaid volunteers—cost-effective

  • Funding less of an issue

  • Opportunity to build institutional memory

  • Attractive to skilled professionals who cannot commit to long-term service

  • Possible problems with follow-up and sustained activities between exchanges

  • Limited impact of brief engagement

  • Costs associated with high turnover of personnel

Medium- or long-term (6 months to >12 months)

  • Adequate time to develop relationships and earn the trust of key stakeholders

  • U.S. professionals better equipped to understand and respect the local value system

  • Facilitates challenging mindsets, vested interests, and power differentials

  • Opportunity to build institutional capacity

  • Lack of funding

  • Lack of volunteers for long-term stays

  • Need for substantial compensation for long-term personnel

specific educational instruction could be relatively brief, perhaps lasting 2–3 weeks, whereas those focused on institutional capacity or systems development would likely take longer, at least a year.

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). Evaluations should also address sustainability, which will be essential to the success of any partnership. If a U.S. professional provides training on a specific topic, it is essential to provide follow-up and support to ensure that the participants in the training are able to use their newly acquired skills. This follow-up could be accomplished through either in-country or virtual, online mentoring and support.

Both new and existing partnerships aimed at achieving the PEPFAR

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

goals should be encouraged although new work plans may be needed to reflect such initiatives. Strategies that emphasize targeted and results-driven efforts and can build a foundation for a sustainable relationship should be given the highest priority.

Rationale and Evidence

As noted above, established overseas twinning partnerships offer the advantage of a preexisting infrastructure prepared to receive partners. This ready-made structure can strengthen the host country workforce by allowing the rapid deployment of foreign health professionals to fill personnel voids, to provide relevant side-by-side training with colleagues in their home environment, and to train trainers who can facilitate the dissemination of knowledge in specific areas such as HIV/AIDS prevention and care (ICAD and CI, 2002). The ability to quickly mobilize U.S. personnel can also be used to send relief staff from the United States to substitute temporarily for regular in-country staff while they travel off-site for much needed training. Moreover, twinning can facilitate the development of skills and leadership ability through in-service training and care provision, as well as through on-site or online teaching, coaching, and mentoring.

To facilitate the mobilization of shorter-term professionals, some twinning partners place a key staff member in the host country for at least 12 consecutive months (European Commission Directorate General for Enlargement, 2004). Doing so is particularly helpful in settings in which the health infrastructure is stretched very thin, and no one is available to organize the visiting partner’s experience or make logistical arrangements, such as housing. Indeed, relying on the host country partner to do this planning diverts much-needed resources from the provision of health services. Indiana University School of Medicine recognizes this risk and has maintained one full-time clinician at its partner organization, Moi University in Kenya, since 1990 (Einterz et al., 1995). This model has been found to maximum the effectivenees of the partnership by providing continuity and coordination for the large number of shorter-term exchanges that are undertaken, lasting anywhere from weeks to months.

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. For more than 2 and a half years, for example, New York University (NYU) School of Medicine has been working with organizations in Mombasa and other areas of Kenya to bring physicians to NYU/ Bellevue Hospital Center for leadership and other forms of training focused on HIV/AIDS treatment (Valentine, 2004).

Often, similarly structured groups partner because of the innate learning opportunities; however, groups with organizational differences that

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

share a common goal can also have a successful partnership. An example is the Vietnam–CDC–Harvard Medical School AIDS Partnership. U.S. partners include the CDC Global AIDS Program and the Department of Social Medicine at Harvard Medical School, while activities in Vietnam are coordinated by the AIDS Division of the Ministry of Health and managed through the National Institute for Clinical Research in Tropical Medicine. Although the partners are dissimilar, they have produced positive results and have maintained a long-term relationship (Krakauer, 2004).

The support of public-sector health agencies contributes to the success of HIV/AIDS programs, whether they are orientated toward prevention, treatment, or care. Partnerships may include government entities such as state or local health authorities and public health departments, or organizations of government officials, such as state, district, or provincial AIDS officials, health policy makers, and public managers (World Bank, 2003). Such involvement not only increases the capacity of the local government infrastructure to respond to and manage HIV/AIDS-related activities and the mainstreaming of HIV/AIDS into all aspects of services, but also have the potential to increase the workforce by strengthening leadership and commitment. The Global AIDS Technical Assistance Program of the National Alliance of State and Territorial AIDS Directors, for example, partners its experienced members with country ministries of health and national AIDS control programs, and has thereby gained valuable experience in deploying volunteers and partnering at the governmental level. Since 2000, nearly 50 individuals from 29 U.S. states have provided technical assistance abroad under this program, and nearly one-third of the 50 states have hosted international delegations (NASTAD, 2005).

As noted, twinning relationships such as those described above can be arranged by the organizations themselves or through an intermediary, umbrella organization. Although more expensive, an umbrella organization can have certain advantages over direct funding of partners (see Table 5-4), including having more experience on which to draw. 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. Through the accumulated experience from its 105 partnerships, AIHA has enlisted more than 5,000 U.S. volunteers to provide 180,000 days of volunteering (Smith, 2005).

Costs

A typical partnership managed through an umbrella organization costs from $200,000 to $350,000 per year, with 65–70 percent of this amount being spent on travel-related expenses (Personal communication, James Smith, AIHA, December 16, 2004). Most of the administrative responsibili-

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

TABLE 5-4 Advantages and Disadvantages of Partnership Management Models

Model

Advantages

Disadvantages

Umbrella Organization

  • Provides a larger pool of special expertise and experience

  • Has the ability to share knowledge, tools, and lessons learned across partnerships

  • Permits distillation of procedural requirements

  • Facilitates grant management

  • Reduces donor management workload

  • Donor retains substantive oversight, while management burden is minimized

  • Promotes equity among partners as not one partner is receiving funds

  • Policy priorities may differ (intermediary may press for its own agenda)

  • Overall costs are higher because of overhead charges

  • Local or U.S. groups may be reluctant to work through an intermediary

  • Can create confusion as to roles and functions

  • Conflict with the intermediary may arise

Direct Partnership

  • Provides an opportunity for the donor to shape and guide the emerging relationship

  • Allows substantive donor involvement in program design and implementation

  • Permits close monitoring and oversight

  • More likely to reflect an emphasis consistent with the host country’s action plan

  • Reduces administrative overhead costs

  • Heavy management workload

  • Staff may lack skills or time to nurture partnerships

  • Host country partner becomes more dependent on the U.S. partner

SOURCE: USAID (2001:13).

ties are on the U.S. side, and as a result, 15–20 percent of the budget often covers the cost of a coordinator who is responsible for reports, work plans, and the like. Host countries do not receive funds for project-related administrative charges they may incur. However, they are often offered learning resource centers that may include information technologies (e.g., computers, Internet connectivity), virtual libraries (e.g., journal subscriptions), and computer and related skills training. For independent partnerships not overseen by an intermediary organization, the required start-up funding is about $350,000. This core funding allows the U.S. partner to pursue the addi-

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

tional funding needed to conduct the twinning project (Einterz, 2004). HRSA has contracted with AIHA to establish twinning partnerships in the PEPFAR focus countries. AIHA plans to develop up to 100 partnerships between the United States and focus countries and up to 50 south-to-south partnerships within the next 5 years (Personal communication, Eun-Joo Chang, AIHA, March 1, 2005).

Benefits

The benefits of twinning extend well beyond the assistance provided to the receiving organization. For the United States, participation in balanced relationships with developing countries serves as a form of public health diplomacy and promotes a positive image of American citizens around the world. Twinning also promotes organizational understanding and cooperation that might otherwise not occur (ICAD and Health Canada, 1999; NASTAD, 2004). On an individual level, participating U.S. health professionals benefit from the opportunity to use their skills in challenging and innovative ways; they also develop skills needed to work in different cultures, as well as in resource-constrained settings (NASTAD, 2004). Moreover, they often gain greater sensitivity to and understanding of immigration and refugee issues in the United States and among their patients. Health professionals participating in twinning programs are in a position to share their experiences with various audiences, raising awareness of HIV/AIDS around the world and at home. Finally, returning health professionals bring with them new perspectives and guidance for their own HIV/AIDS programs, which could translate into improved HIV/AIDS care in the United States (NASTAD, 2004).

Effective relationships established under twinning partnerships can persist over time and remain active despite the coming and going of donors. Such a relationship can grow as it adapts to changes in the environment of both partners. Trust and friendship are underlying factors that make projects successful regardless of the area being addressed.

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. The Global Health Service Clearinghouse is designed to assist this community of organizations in mobilizing health personnel to go abroad for HIV/AIDS work. The nature of the HIV/ AIDS pandemic has led many organizations that have not previously viewed themselves as “health organizations” to assume a strategic and essential

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

role in testing, counseling, access to treatment, care giving, and the nurture of orphans. The devastation brought about by HIV/AIDS to date and the growing social crisis in many of the PEPFAR focus countries calls for a heightened level of cooperation among individuals and organizations battling the pandemic. Marshaling information technology is crucial to these efforts. The Clearinghouse would help meet this need.

A virtual network of international sending organizations could offer and receive information and regularly reach thousands of volunteers. It woud be an efficient way to use emerging technology to network people and organizations for the benefit of both. For programs located in various and sometimes remote areas, the Clearinghouse would provide a mechanism for recruitment, information posting, and establishment of a global presence. Networking would also enable organizations to share experiences and to work together on common initiatives while minimizing duplication of services.

Recommendation 8: Develop a U.S. Global Health Service Clearinghouse. There are many organizations currently mobilizing health personnel to work in PEPFAR countries. These organizations could be powerful allies in meeting PEPFAR goals. Therefore the committee recommends a multifaceted Clearinghouse for the U.S. Global Health Service that would facilitate information exchange, enhance access to program data, and provide opportunity information for interested health professionals.

Program Description

The Global Health Service Clearinghouse would be managed by a small professional staff working closely with all of the other programs of the GHS. This team would be responsible for developing the virtual and actual networks that would make up the Clearinghouse. Important aspects of the work would include developing and maintaining an inventory of U.S. 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. A more detailed explanation of the four components of the Clearinghouse is presented below.

Program Resource Directory and Networks

As part of an overall website, the Program Resource Directory would be a searchable, web-based directory providing volunteers with screened, reliable links to sending organizations’ websites so as to facilitate organiza-

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

tional contacts for recruitment. This function would be especially useful to those applying for a GHS Fellowship or for the Loan Repayment Program, since their applications would be judged in part on their involvement in the program of an established mobilizing organization. Organizations posting links in the Program Resource Directory would be invited to join the network of sending organizations. Being a member would entitle them to participate in a variety of virtual and actual programs, including an annual meeting, an e-newsletter, a Listserv, and other electronic community activities. Organizations involved in twinning partnerships could potentially utilize the networking capabilities established through the Clearinghouse to keep in touch with their sister organization. Groups wishing to be included in this voluntary coordination and communication system of organizations engaged in mobilizing health personnel for the PEPFAR focus counties could self-nominate for inclusion, provided they met basic requirements pertinent to the PEPFAR goals. Criteria for being listed in the directory would be made clear to all organizations.

Opportunity Bank

A job bank of available host country positions would be a vital tool for identifying vacancies that could be filled by U.S. professionals wishing to work in the PEPFAR focus countries. The data in the Opportunity Bank would come from the health workforce needs assessment performed for each focus country (see above). Uniformity of the assessment data will ensure that information sent from the various focus countries will be compatible and comparable for receiving and posting vacancies. Continuous updating of the information posted will be crucial for tracking open positions. The Opportunity Bank offers the potential to serve as a major facilitator of mobilization by both governmental and nongovernmental programs. 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. The site would provide primary information on cultural, political, economic, and social issues for all 15 countries. It would offer a range of relevant documents, including the country strategic plans, country profiles from the Office of the U.S. Global AIDS Coordinator, and related epide-

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

miologic and regional documents for the orientation and edification of potential volunteers.

Crucial information on ethical considerations related to practice abroad would also be provided. A Code for Volunteer Behavior and Conduct could be developed and posted for GHS members to read and sign prior to leaving the United States for work abroad. Statements of policy regarding involvement in local politics and social advocacy activities for GHS-supported personnel might be provided as well.

Country Credentials and Travel Guidelines Repository

Providing potential recruits with credentialing and travel information for work overseas would simplify an often laborious process. The Country Credentials and Travel Guidelines Repository would assist prospective volunteers for work in the global arena by making this information readily available in one virtual location. This regularly updated compendium of information might include country-specific documents regarding licensure, accreditation, and work permits, as well as other helpful information, such as passport, visa, and driver’s license requirements; travel information and alerts; and details on travel medical insurance policies.

Rationale and Evidence

The principal rationale for the GHS Clearinghouse is to increase the actual and virtual connectivity of organizations engaged in mobilizing health personnel for service in the PEPFAR focus countries. Many groups in this field have organizational missions and Internet presences that involve promulgating information on volunteer opportunities or country conditions along the lines envisioned for the Clearinghouse. Their activites include the programs of governmental organizations, NGOs, and religious and sectarian organizations listed in Table 5-5.

In analyzing the organizations currently engaging in networking with regard to opportunities for health professionals abroad, it became evident to the committee that no single organization or network addresses all aspects of a comprehensive clearinghouse as described above. 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. The committee believes that the sharing of information envi-

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

TABLE 5-5 A Sampling of Organizations Providing Information about HIV/AIDS Work Abroad

Organization

Activity

Virtual Matchmaking

Volunteers for Prosperity

http://www.volunteersforprosperity.gov/

Potential volunteers can obtain links to organizations that work in the areas of HIV/AIDS, capacity building, and education.

International Healthcare Opportunities Clearinghouse

http://library.umassmed.edu/ihoc/

Provides a web-based database of available positions for health care professionals that is searchable by region, time commitment, language requirement, and professional skills.

International Medical Volunteers Association

http://www.imva.org/Pages/volsrchintro.asp

Lists health care opportunities and whom to contact for more information. Provides a volunteer registry that contains information about health professionals seeking volunteer medical assignments around the world.

Networking

InterAction

http://www.interaction.org

A network of more than 160 nongovernmental organizations (NGOs) that convenes and coordinates to affect public policy and improve the outcomes of their work worldwide. They maintain close ties with NGOs and NGO networks in Europe, Asia, Africa, and Latin America.

Uganda Network of AIDS Service Organizations

http://www.unaso.or.ug/about.php

A nationwide network of NGOs, community-based organizations, faith-based organizations, groups of people living with HIV/AIDS, and local communities involved in the response to HIV/AIDS in Uganda.

Kenya AIDS NGOs Consortium

http://www.kanco.org/framebody.htm

A national membership network of NGOs/community-based organizations and religious organizations involved or with interest in activities related HIV/ AIDS and other sexually transmitted infections in Kenya.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

Organization

Activity

Africa Religious Health Assets Program

A collaboration among the University of Cape Town, University of Kwazulu Natal, and Emory University to fill the gap in strategic mapping of religious structures and networks relevant to HIV/AIDS and other underlying health issues.

African Regional Capacity Building Network for HIV/AIDS Prevention, Care, and Treatment

(World Bank Group, 2004)

A network of subregional “learning sites” designed to expand training of health care practitioners in HIV/AIDS, and to enable harmonization of approaches and facilitate greater knowledge sharing across Ethiopia, Kenya, and Tanzania.

Virtual Warehousing

InterAction

http://www.interaction.org

Publishes a newsletter; maintains a website with a virtual library, an events calendar listing meetings and locations, and Private Voluntary Organization Standards.

Health Volunteers Overseas

http://www.hvousa.org/

Website addresses aspects of volunteering.

Peace Corps

http://www.peacecorps.gov/

Website addresses aspects of volunteering.

International Federation of Red Cross and Red Crescent Societies

http://www.ifrc.org/what/health/hivaids/code/

Website with a code of good practice for NGOs responding to HIV/AIDS.

U.S. Department of State

http://www.state.gov/travel/

Provides extensive information on traveling and living aboard, along with country background notes and key contacts at U.S. embassies and consulates.

Fogarty International

http://www.fic.nih.gov/services.html

Provides links to passport and visa information, foreign travel information, and personal security training, as well as available grants.

Development Experience Clearinghouse

http://www.dec.org/about.cfm#1

An interactive website of thousands of publications funded by the U.S. Agency for International Development.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

Organization

Activity

International Healthcare Opportunities Clearinghouse

http://library.umassmed.edu/ihoc/

Provides links that offer would-be volunteers travel information, as well as information on health and safety risks and history, culture, and customs.

International Clearinghouse on Curriculum for HIV/AIDS Preventive Education

http://databases.unesco.org/IBE/AIDBIB/

A bibliographic database of nternational curriculum materials and irelated documentation for HIV/AIDS education at primary and secondary levels of schooling.

sioned for the Clearinghouse would help in maintaining a focus on mobilization goals, preventing duplication of services, and placing volunteers in areas where they would have maximal impact.

As noted, many organizations use websites to provide information about volunteering and working overseas; these sites also allow e-mail communication with the organization and with others in the field. Some sites include databases for use by potential volunteers in matching their skills with the needs of organizations recruiting in various countries. Others display links to websites that offer positions for professional and nonprofessional volunteers (e.g., Volunteers for Prosperity). Some allow volunteers to search based on their specific skill set (e.g., International Healthcare Opportunities Clearinghouse), while others supply the name of a person in the organization for the individual to contact (e.g., International Medical Volunteers Association). Many include opportunities in some PEPFAR focus countries, while Volunteers for Prosperity provides a searchable database of all the PEPFAR focus countries. The website of the International Federation of Red Cross and Red Crescent Societies posts a code of ethics. The website of Fogarty International Center of the National Institutes of Health provides links to passport and visa information, foreign travel information, and personal security information, as does the website of the U.S. Department of State. However, none of these organizations lists both comprehensive information on mobilizing organizations (the proposed Resource Directory) and extensive placement possibilities in the PEPFAR focus countries (the proposed Opportunities Bank). These two features, as well as the ethical, cultural, credentialing, and travel information that would be offered at the GHS Clearinghouse, would bring a coherence not currently available to the complex issues that surround the mobilization of health professionals.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

For ease of searching, all four elements of the Clearinghouse should be housed at one website, where those interested could go to be introduced to the various programs of the GHS. The Program Resource Directory and Networks is a likely starting point for sending organizations to become involved with the GHS, and would benefit from a well-designed format such as that of Volunteers for Prosperity or the International Healthcare Opportunities Clearinghouse.

CONCLUDING REMARKS

There have been few well-conducted studies addressing gaps in human resources for health that could guide the U.S. Department of State in determining how many specialized health, management, and technical professionals will be needed to meet the PEPFAR goals. Collecting this information systematically and storing it in a well-maintained database would provide not only a source of information for job vacancies, but also baseline and follow-up data for tracking how well countries are meeting their human resource requirements and thus how well the PEPFAR initiative is meeting its goals. Opportunities for serving in any of the programs of the GHS could also be stored in the virtual database and made available to interested and qualified professionals.

The Global Health Service Corps is likely to be the most expensive of the proposed GHS programs, but is also, the committee believes, the one most likely to have the greatest impact on human resources. 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.

REFERENCES

Adano U, O’Neil M, Decima E, Kiarie W. 2004. Rapid Assessment of the Human Resource Implications of Scaling up HIV/AIDS Services in Uganda Progress Report 1 & 2. Management and Leadership Development Project/USAID. Boston, MA: Management Sciences for Health.


Beran RL, Lawson GE. 1998. Medical student financial assistance, 1996–1997. Journal of the American Medical Association 280: 819–820.


Campbell R. 2004 (December 2). Peace Corps. Presentation at the Institute of Medicine Workshop on Options for Overseas Placement of U.S. Health Professionals, Washington, DC. Institute of Medicine Committee on the Options for Overseas Placement of U.S. Health Professionals.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

CDC (Centers for Disease Control and Prevention). 2005. Global AIDS Program Country and Regional Programs. [Online]. Available: http://www.cdc.gov/nchstp/od/gap/countries/ [accessed March 10, 2005].

CIES (Council for International Exchange of Scholars). 2005. The Fulbright Program. [Online]. Available: http://www.cies.org/about_fulb.htm [accessed February 22, 2005].


Diallo K, Zurn P, Gupta N, Dal Poz M. 2003. Monitoring and evaluation of human resources for health: An international perspective. Human Resources for Health 1(3).


Einterz R. 2004 (December 2). Partnering: University to University Training. Presentation at the Institute of Medicine Workshop on the Options for the Overseas Placement of U.S. Health Professionals, Washington, DC. Institute of Medicine Committee on the Overseas Placement of U.S. Health Professionals.

Einterz RM, Kelley CR, Mamlin JJ, Van Reken DE. 1995. Partnerships in international health: The Indiana University–Moi University experience. Infectious Disease Clinics of North America 9(2):453–455.

European Commission Directorate General for Enlargement. 2001. Twinning in Action. Brussels, Belgium: European Commission Directorate General for Enlargement.

European Commission Directorate General for Enlargement. 2004. Institution Building in the Framework of European Union Policies: A Reference Manual on ‘Twinning’ Projects. European Union: European Commission Directorate General for Enlargement.


FHI (Family Health International). 2003. Baseline Assessment Tools for Preventing Mother-to-Child Transmission of HIV. Research Triangle Park, NC: FHI.

Fogarty International Center. 2002 (October 31). AIDS International Training and Research Program Announcement PA-03-018. [Online]. Available: http://grants2.nih.gov/grants/guide/pa-files/PA-03-018.html [accessed February 22, 2005].


HLF (High Level Forum on the Health Millennium Development Goals). 2004. Health Workforce Challenges: Lessons from Country Experiences. Abuja, Nigeria: World Bank and WHO.

HRSA (Health Resources and Administration). 2005. Nursing Education Loan Repayment Program Fiscal Year 2005 Application Kit. [Online]. Available: ftp://ftp.hrsa.gov/bhpr/nelrp/nelrpapplication05.pdf [accessed February 17, 2005].

HRSA Bureau of Health Professions. 2005. Nursing Education Loan Repayment Program. [Online]. Available: http://bhpr.hrsa.gov/nursing/loanrepay.htm [accessed February 17, 2005].

Huddart J, Furth R, Lyons JV. 2004. The Zambia HIV/AIDS Workforce Study: Preparing for Scale-Up. Operations Research Results. Bethesda, MD: Quality Assurance Project, University Research Co., LLC.


ICAD and CI (Inter-agency Coalition on AIDS and Development and Communication Initiative). 2002. Twinning Against AIDS. Quebec, Canada: Canadian International Development Agency. [Online]. Available: http://www.comminit.com/pdf/twinning_against_AIDS_Final_Report.pdf [accessed March 11, 2005].

ICAD and Health Canada. 1999. Beyond Our Borders: A Guide to Twinning for HIV/AIDS Organizations. Ottowa, Ontario: Interagency Coalition on AIDS and Development. [Online]. Available: http://www.icad-cisd.com/pdf/twinning.pdf [accessed March 11, 2005].

IHS (Indian Health Service). 2005. Indian Health Service. [Online]. Available: http://www.ihs.gov/ [accessed March 17, 2005].

IMVA (International Medical Volunteers Association). 2005. The IMVA Volunteer Registry. [Online]. Available: http://imva.org/pages/volsrchintro.asp [accessed March 10, 2005].

Interim Pharmacy Council of South Africa. 1998. The Production and Distribution of Human Resources in Pharmacy. Durban, South Africa: Health Systems Trust.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

IOM (Institute of Medicine). 2005. Scaling Up Treatment for the Global AIDS Pandemic. Washington, DC: The National Academies Press.


Jolly P. 2004. Medical School Tuition and Young Physician Indebtedness. Washington, DC: AAMC.


Katerere D, Matowe L. 2003. Effect of pharmacist emigration on pharmaceutical services in southern Africa. American Journal of Health-System Pharmacy 60:1169–1170.

Kelly N. 2004 (December 2). Health Volunteers Overseas. Presentation at the Institute of Medicine Workshop on the Options for the Overseas Placement of U.S. Health Professionals, Washington, DC. Institute of Medicine Committee on the Overseas Placement of U.S. Health Professionals.

Kober K, Van Damme W. 2004. Scaling up access to antiretroviral treatment in southern Africa: Who will do the job? Lancet 364:103–107.

Kombe G, Galaty D, Nwagbara C. 2004. Scaling Up Antiretroviral Treatment in the Public Sector in Nigeria: A Comprehensive Analysis of Resource Requirements. Bethesda, MD: The Partners for Health Reform Plus Project, Abt. Associates, Inc.

Krakauer E. 2004 (December 2). Human Resource Needs for HIV Treatment in Vietnam. Presentation at the Institute of Medicine Workshop on the Options for the Overseas Placement of U.S. Health Professionals, Washington, DC. Institute of Medicine Committee on the Overseas Placement of U.S. Health Professionals.


Morrison G. 2005. Mortgaging our future: The cost of medical education. New England Journal of Medicine 352(2):117–119.

MSH (Management Sciences for Health). 1998. Human Resource Development (HRD) Assessment Instrument for Non-Governmental Organizations (NGOs) and Public Sector Health Organizations. Boston, MA: Management Sciences for Health.

MSH. 2003. Human Resource Management Rapid Assessment Tool for HIV/AIDS Environments: A Guide for Strengthening HRM Systems. Boston, MA: Management Sciences for Health.

MSH. 2004. Tackling the crisis in human capacity development for health services. Manager 13(2):1–20.


NASTAD (National Alliance of State and Territorial AIDS Directors). 2004. International Twinning and Technical Assistance Projects: How Do U.S. State HIV/AIDS Programs Benefit? [Online]. Available: http://www.nastad.org/documents/public/HIVInternationalPrograms/200497nternationalTwinningandTechnicalAssistanceProjects.pdf [accessed February 28, 2005].

NASTAD. 2005. NASTAD Global AIDS TA Program: Frequently Asked Questions. [Online]. Available: http://www.nastad.org/documents/public/HIVInternationalPrograms/2005126GlobalTAFactSheet.pdf [accessed February 28, 2005].

NHSC (National Health Service Corps). 2003. About NHSC. [Online]. Available: http://nhsc.bhpr.hrsa.gov/about/ [accessed March 10, 2005].

NHSC. 2004. NHSC Loan Repayment Program Frequently Asked Questions FY 2005. [Online]. Available: ftp://ftp.hrsa.gov/nhsc/faq/FAQ-LRP-05-ver01.pdf#page=1 [accessed February 17, 2005].

NHSC. 2005. NHSC Loan Repayment Program Fiscal Year 2005 Applicant Information Bulletin. [Online]. Available: ftp://ftp.hrsa.gov/nhsc/applications/lrp_05/2005LRPBulletin.pdf [accessed February 17, 2005].

Ntuli A, Ijumba P, McCoy D, Padarath A, Berthiaume L. 2003. HIV/AIDS and Health Sector Responses in South Africa—Treatment Access and Equity: Balancing the Act. Durban, South Africa: Health Systems Trust.


OPM (Office of Personnel Management). 2005a. Salary Table 2005-GS. [Online]. Available: http://www.opm.gov/oca/05tables/pdf/gs.pdf [accessed March 17, 2005].

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

OPM. 2005b. Federal Student Loan Repayment Program. [Online]. Available: http://www.opm.gov/oca/PAY/StudentLoan [accessed February 17, 2005].


Palmer B. 2004 (December 2). Potential Future Volunteers: Issues and Obstacles to Service. Presentation at the Institute of Medicine Workshop on the Options for the Overseas Placement of U.S. Health Professionals, Washington, DC. Institute of Medicine Committee on the Overseas Placement of U.S. Health Professionals.

PHRplus (Partners for Health Reform Plus). 2004. Nigeria: Rapid Assessment of HIV/AIDS Care in the Public and Private Sectors. Bethesda, MD: The Partners for Health Reform Plus Project, Abt. Associates, Inc.


RATN. 2003. Eastern and Southern Africa Regional HIV/AIDS Training Needs Assessment Regional Report. [Online]. Available: http://www.ratn.org/reports/Regional%20Report.pdf [accessed March 1, 2005].

Rieffel L. 2003. The Peace Corps in a Turbulent World: A Working Paper. Washington, DC: Brookings Institution.


Smith J. 2005 (February 14). Working in a PEPFAR Context. Presentation at the Institute of Medicine Workshop on the Options for the Overseas Placement of U.S. Health Professionals, Washington, DC. Institute of Medicine Committee on the Overseas Placement of U.S. Health Professionals.

South Africa Ministry of Health. 2003. Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment for South Africa. Pretoria, South Africa: South Africa Department of Health.

SWEF (Systemwide Effects of the Fund) Research Network. 2005. Measuring the Effects of the Global Fund on Broader Health Systems. Bethesda, MD: PHRplus. [Online]. Available: http://www.phrplus.org/Pubs/SWEF2_fin.pdf [accessed March 18, 2005].


United States Peace Corps. 2005a. About the Peace Corps. [Online]. Available: http://www.peacecorps.gov/index.cfm?shell=learn.whatispc.fastfacts [accessed February 22, 2005].

United States Peace Corps. 2005b. Financial Benefits and Loan Deferment. [Online]. Available: http://www.peacecorps.gov/index.cfm?shell=learn.whyvol.finben [accessed February 17, 2005].

USAID (United States Agency for International Development). 2001. Designing and Managing Partnerships between U.S. and Host-Country Entities. Arlington, VA: USAID Development Experience Clearinghouse.

USAID. 2003. The Health Sector Human Resource Crisis in Africa: An Issues Paper. Washington, DC: Academy for Educational Development SARA Project.

USAID Guyana. 2003. Country Strategic Plan 2004–2008. Guyana, South Africa: USAID. [Online]. Available: http://www.dec.org/pdf_docs/PDACA685.pdf [accessed March 10, 2005].


Valentine F. 2004 (December 2). Training Kenyan Healthcare Workers: An Academic Perspective. Presentation at the Institute of Medicine Workshop on the Options for the Overseas Placement of U.S. Health Professionals, Washington, DC. Institute of Medicine Committee on the Overseas Placement of U.S. Health Professionals.

Vastag B. 2002. Volunteers see the world and help its people. Journal of the American Medical Association 288(5):559–565.


Weaver DR. 2004 (December 2). National Health Service Corps. Presentation at the Institute of Medicine Workshop on the Options for the Overseas Placement of U.S. Health Professionals, Washington, DC. Institute of Medicine Committee on the Overseas Placement of U.S. Health Professionals.

World Bank. 2003. Local Government Responses to HIV/AIDS: A Handbook. Washington, DC: World Bank.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
×

World Bank Group. 2004. Africa: World Bank Supports Capacity-Building for HIV/AIDS Prevention, Treatment and Care in Ethiopia, Kenya, and Tanzania. [Online]. Available: http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/AFRICAEXT/KENYAEXTN/0,,contentMDK:20266665~menuPK:356530~pagePK:141137~piPK:141127~theSitePK:356509,00.html [accessed April 30, 2005].

WHO (World Health Organization). 2002. World Health Organization ARV Toolkit. [Online]. Available: http://www.who.int/hiv/toolkit/arv/en/content.jsp?ID=193&d=arv.06.01 [accessed March 10, 2005].

WHO. 2003. World Health Report 2003. Geneva, Switzerland: WHO. [Online]. Available: http://www.who.int/whr/2003/en/whr03_en.pdf [accessed March 10, 2005].

WHO. 2004. Scaling Up HIV/AIDS Care: Service Delivery and Human Resources Perspectives. Geneva, Switzerland: WHO.

Wyss K. 2004a. Scaling Up Antiretroviral Treatment and Human Resources for Health: What Are the Challenges in sub-Saharan Africa? Berne, Switzerland: Swiss Agency for Development and Cooperation.

Wyss K. 2004b. Human Resources for Health Development for Scaling-Up Antiretroviral Treatment in Tanzania. Basel, Switzerland: Swiss Tropical Institute.

Suggested Citation:"5 Programs of the U.S. Global Health Service." Institute of Medicine. 2005. Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS. Washington, DC: The National Academies Press. doi: 10.17226/11270.
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Healers Abroad:Americans Responding to the Human Resource Crisis in HIV/AIDS calls for the federal government to create and fund the United States Global Health Service (GHS) to mobilize the nation�s best health care professionals and other highly skilled experts to help combat HIV/AIDS in hard-hit African, Caribbean, and Southeast Asian countries. The dearth of qualified health care workers in many lowincome nations is often the biggest roadblock to mounting effective responses to public health needs. The proposal�s goal is to build the capacity of targeted countries to fight the HIV/AIDS pandemic over the long run. The GHS would be comprised of six multifaceted components. Full-time, salaried professionals would make up the organization�s pivotal �service corps,� working side-by-side with other colleagues already on the ground to provide medical care and drug therapy to affected populations while offering local counterparts training and assistance in clinical, technical, and managerial areas.

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