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Africa: Health Resources Shortfall

AfricaFocus Bulletin
Jun 24, 2005 (050624)
(Reposted from sources cited below)

Editor's Note

"When the G8 industrialized nations gather in Scotland next month, they should commit to subsidizing the salaries of African health workers to keep them from leaving their home countries in search of higher pay and better conditions in wealthier countries. ... All the well-intentioned efforts [to address AIDS and other health needs] are limited by the lack of personnel on the ground for both prevention and treatment programs." - Boston Globe, June 24, 2004

Despite their commitment early this month to write off debts to multilateral institutions by 18 developing countries (see, rich countries have barely made a start in meeting the demands to address Africa's needs. While debate tends to focus under the standard themes of debt, aid, and trade, activists in the health field are taking the lead to stress that the framework needs to be changed to a common obligation to invest in universal rights rather than a narrow conception of charitable "aid" from donors to recipients. It is in this context that both NGOs and multilateral organizations are seeking common estimates for defining the resources needed.

This AfricaFocus Bulletin contains excerpts from a press release from Physicians from Human Rights and a statement by health workers calling on the G8 to commit the funds necessary to double the number of health workers in Africa. It also contains the latest estimate from UNAIDS of the need and shortfall in funding for AIDS. This places the total unfunded gap for 2006-2008 as at least $18 billion, of the $55 billion estimated at needed for that three-year period.

For previous AfricaFocus Bulletins on health issues, including additional documents and links, visit

++++++++++++++++++++++end editor's note+++++++++++++++++++++++

Africa Cannot Stop Poverty Without More Health Workers

PHR Releases New Figures: G8 Must Commit $2B in 2006 to Double Doctors, Nurses and Other Health Workers in Africa

Physicians for Human Rights

June 21, 2005

[excerpt from press release]


Kate Krauss Tel 617 301-4240 Fax 617-301-4250 Cell: 215-939-7852
Barbara Ayotte 617-301 4210 617-549-0152 cell

Available for comment:

Hetherwick Ntaba, OBE Minister of Health, Malawi Eric A. Friedman, J.D. HIV/AIDS Policy Analyst, Physicians for Human Rights

Citing a devastating shortage of health care workers in AIDS-burdened countries, Physicians for Human Rights (PHR) today released new cost estimates that would double the number of health workers in sub-Saharan Africa in order to confront the AIDS pandemic and reduce maternal and child mortality over the next five years. PHR is calling for a global investment of US $2 billion in 2006, rising to $7.7 billion in 2010 by all donors, and has calculated the U.S. share as being one-third of the sum needed, or $650 million for 2006, rising to $2.5 billion in 2010. ...

Commented Hetherwick Ntaba, OBE, the Health Minister of the African nation of Malawi and a surgeon: "Some countries' health delivery systems are in danger of collapsing because of this human resource crisis. The AIDS pandemic itself impacts negatively on our ability to deal with AIDS because of the toll it takes on our work force. In the middle of all this, the migration of health workers from poor to the rich countries is very unfortunate. It is like the biblical saying, 'For those who have more, more is being given; for those with less, even that is being taken away.' We ask the G8 to really look at this issue very seriously and offer their support."

Right now in Africa, a mere 1.3% of the world's health workers struggle to care for people suffering 25% of the global disease burden. In Malawi, only 10% of the physician slots are filled, while 10 people die every hour of AIDS. Across Africa AIDS has killed thousands of health care workers, and large numbers of doctors and nurses are migrating to the West, driven out by impoverished health care systems and lured by elaborate recruiting packages by hospitals in G8 countries. For example, while 1200 physicians were trained in Zimbabwe during the 1990s, by 2001 only 360 remained. More than 3,000 nurses from African nations migrated to the United Kingdom in 2002-2003.

The March 11, 2005 report of the UK Commission for Africa, commissioned by Prime Minister Tony Blair, called for a tripling of the healthcare workforce in Africa:

Training and retaining doctors, nurses and other health service personnel has been neglected. ...Africa's health workforce should be tripled through the training of an additional one million workers over a decade. Salaries should be increased to ensure staff are not wooed from their jobs. ,,,

Modeling on a continent-wide scale suggests that $7.7 billion annually by 2010 could support a doubling of the health workforce. A discussion of the methodology used to calculate these figures is [available on the PHR website]. ...

The G-8 Must Commit to Addressing the Global Health Worker Crisis Statement for Group of 8 Meeting in July 2005

Physicians for Human Rights

We are nurses and doctors, pharmacists and laboratory technicians, medical assistants and community health workers. We are non-governmental organizations. We are [members of] government[s]. We are people with HIV/AIDS. Some of us sit in government ministries, some of us work in rural health facilities, and some of us work wherever it is we find people in need. We share in common a deep concern for the health and well-being of the members of our communities and citizens of our own and other countries. Yet despite our best efforts, health systems in many developing countries are in crisis, and millions of people whose lives we could save and whose health we could preserve are dying and becoming seriously ill.

Health workers are at the core of these health systems. Health systems collapse where there are too few health workers, or health workers without proper training, supervision, and management and support structures, or health workers who are separated from their community structures and needs, or health workers who are themselves ill and dying and working in unsafe conditions. Yet this is the situation many of our countries face. Annual health budgets that are often $10 or less per capita, the exodus of health professionals, failure to prioritize human resources, and the HIV/AIDS pandemic, both through the disease burden it creates and its impact on health workers themselves, have combined to create a crisis. Until we surmount this crisis in human resources for health and health systems, preventable death and suffering on a massive scale will continue.

Overcoming this crisis will require the joint efforts of your countries and ours. We will take the lead, but require cooperation and support in what must be a global response to a problem of global proportions. Together, we must develop and implement sustainable and greatly expanded responses that address underlying causes to the health worker crisis, that improve health systems, and that dramatically improve access to quality health services for people in underserved areas.

Everyone has the right to the highest attainable standard of health. Fulfilling this right requires addressing the crisis in human resources for health and in health systems. The efforts of our countries alone will not be enough to resolve this crisis and secure for every person the dignity she deserves. We therefore urge your governments to meet your obligations under the UN Charter and other human rights law to join us in taking the actions required to resolve this crisis.

To enable our countries to have the health workforces we require to meet our people's health needs and achieve the Millennium Development Goals, we urge the members of the G8 to make the following commitments:

1. Strengthening national health systems

1.1 We urge you to support African and other developing countries that are experiencing crises in human resources for health by providing the necessary financial and technical support to enable our countries to develop and fully implement national strategies on human resources for health as a central part of any overall plan to improve service delivery and strengthen national health systems so as to achieve the Millennium Development Goals.

1.2 We urge you to ensure that through your efforts and those of others, the resources required to fully fund these strategies are available.

1.3 We urge you to coordinate your investments and those of other donors and organizations with those of regional communities and developing country governments, and to use local technical resources where possible.

1.4 Strategy development should be led by national authorities with broad stakeholder participation that engages civil society and responds to local needs.

1.5 Assistance in the development of strategies should not delay the provision of urgently needed financial assistance and other technical assistance.

2. Supporting and enlarging health worker capacity

2.1 We urge you to support, with financial and technical assistance, national efforts to create conditions that facilitate health worker retention and deployment to underserved areas, including adequate compensation; improved health worker management, planning, and information systems; incentives; continuous learning opportunities; and; safe working environments for health workers through universal precautions and other forms of infection prevention and control, universal access to post-exposure prophylaxis, and workplace HIV treatment and prevention programs.

2.2 We urge you to support models of education and care that respond to national circumstances and priorities, providing quality health care to the maximum number of people and expanding health services in underserved areas. The models of care will often include the development of high quality mid-level and community health worker cadres, effective competency-based training strategies, and policies, training, supervision, and adequate compensation to enable nurses to engage in advanced nursing practices. We urge you to further support the development of career pathways for mid-level and community health worker cadres, permitting competence- and skills-based movement up the hierarchy of the health system.

2.3 Community members, including people living with HIV/AIDS, have a vital role in supplementing the care provided by health professionals. We urge you to support local, regional, and national efforts to empower community health workers and caregivers, including by enabling them to have the compensation, training, accreditation, supervision, and support structure required to maximize their effectiveness. We urge you to support local efforts to increase community awareness and capacity to participate in a comprehensive scale-up of prevention, care, and treatment programming through activities such as treatment preparedness, treatment literacy, and treatment adherence support.

2.4 We urge you to support expanded capacity of health professional training institutions including through incentives and other support for faculty, expanded physical space, and creation of new training institutions as needed, and to support these institutions in reviewing curricula to assure that the skills are relevant to required public health needs and competencies.

2.5 We consider it a tragic irony that many of the same countries facing enormous human resources deficits have in our midst large numbers of unemployed health care workers.

We urge you to take all necessary steps, working with our governments and other parties, including international financial institutions, to enable their rapid re-engagement.

3. Overcoming macroeconomic challenges

3.1 We urge you to seek agreement with the International Monetary Fund and other international financial institutions, finance, health, and other ministers, and central banks to increase fiscal space for expanded funding from external and domestic sources, including debt cancellation, for health and other forms of human development. Civil society must have a voice in this process. Macroeconomic challenges should not and need not impede the flow of the required resources.

3.2 We urge you to ensure that new and existing developing country agreements with the IMF and other international financial institutions do not require or lead to freezes in health worker recruitment, prevent payment of wage levels required to retain health workers, or prevent the hiring of unemployed health workers. Programs critical to public health should be exempt from budget and wage ceilings contained in such agreements.

3.3 Long-term, sustainable economic growth requires investments to reduce poverty and hunger, improve health and expand education at all levels, empower women, and ensure environmental sustainability, including through improving living conditions in rural and slum areas and universal access to clean water and sanitation.

3.4 We urge you to commit to providing your assistance in a long-term and predictable manner, including for both bilateral and multilateral mechanisms, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria.

4. Addressing health worker needs in high-income countries

4.1 We urge you to meet your country's own health care needs without reducing the capacity of developing countries to meet our health needs.

4.2 We urge you to meet your obligations under World Health Assembly Resolution 57/19, "International migration of health personnel: a challenge for health systems in developing countries."

4.3 We urge you to evaluate the recruitment practices of public and private health providers in your country, and implement strategies that will protect the health human resource base of our countries. The strategies may include ending active recruitment from certain countries and working with developing country governments and regional and international organizations to develop satisfactory policies on recruitment, such as through managed migration with mutual benefits to both source and destination countries.

4.4 We urge you to take the necessary measures to increase your country's supply of domestically-trained health care workers.

5. Supporting international organizations

5.1 The technical capacity and normative role of the World Health Organization gives it a special role in addressing the human resources for health crisis. We urge you to provide WHO the additional funding it requires to support expanded and accelerated large-scale technical assistance in this area; to build its own capacity at headquarters, regional, and country levels, including through interdepartmental collaboration and nationally led teams, and; to enhance national capacities to develop and implement strategies to meet Millennium Development Goals, including effective development and management of the health workforce. We further urge you to ensure that WHO has the funds to develop and sustain a human resources for health observatory in Africa. All funding to expand WHO capacity should be in addition to the funding WHO requires to support anti-retroviral therapy scale-up.

5.2 The Global Fund to Fight AIDS, Tuberculosis and Malaria supports health system strengthening, including human resources. We urge you to ensure that the Global Fund is fully funded, including so that it can renew all deserving proposals from previous rounds, fully fund Round 5, and launch Round 6 in a timely manner. We further urge you to make available technical support to help applicants develop ambitious proposals in the area of AIDS, including treatment, tuberculosis, malaria, and health system strengthening.

5.3 We urge you to support regional health and development organizations in their effort to address the human resources for health crisis through regional and sub-regional interventions.

6. Ensuring soundness of donor programs

6.1 We urge you to ensure that your own funding mechanisms and programs strengthen, and do not weaken through resource diversion or other means, public health systems and their human resource capacities. Bilateral programs should help build local capacity and utilize and catalyze local capacity wherever possible.

US$ 22 Billion Needed in 2008 to Reverse Spread of AIDS

New report shows resource needs far higher than funding available


Geneva, 22 June 2005 - US$22 billion will be needed in 2008 to reverse spread of AIDS in the developing world, according to latest estimates. These figures feature in a new report on estimated funding needs produced by the UNAIDS Secretariat, to be released to the UNAIDS Programme Coordinating Board at the end of June.

Building on previous estimates, these figures have been developed using the latest available information and with the invaluable input from a newly established Resource Needs Steering Committee and Technical Working Group which are made up of international economists and AIDS experts from donor and developing countries, civil society, United Nations agencies and other international organizations.

"We have come a long way in mobilizing extra funds for AIDS, moving from millions to billions, but we still fall short of the US$22 billion needed in 2008," said Dr Peter Piot, UNAIDS Executive Director. "AIDS poses an exceptional threat to humanity and the response needs to be equally exceptional, recognizing the urgency as well as the need for long term planning and financing."

The revised estimates indicate funding needs of approximately US$15 billion in 2006, US$ 18 billion in 2007 and US$ 22 billion in 2008 for prevention, treatment and care, support for orphans and vulnerable children, as well as programme costs (such as management of AIDS programmes and building of new hospitals and clinics) and human resource costs (includes training and recruitment of new doctors and nurses).

This is the first time that specific attention is given to resource needs for longer term investments to improve country capacity in the health and social sectors through training of existing staff, recruiting and paying new staff and significant investments for building the necessary infrastructure. These financial requirements for the human resources and programme costs are preliminary, and will be further refined and improved.

Meeting the 2006-2008 resource needs would result in the following achievements:

  • Prevention - A comprehensive prevention response by 2010, as is required to turn around the AIDS epidemic, based on the current coverage of services and the most recent evidence on actual rates of scaling up interventions.
  • Treatment and care - 75% of people in need globally (approximately 6.6 million people) will have access to antiretroviral treatment by 2008, based on current coverage rates and rates of growth as seen in 2004.
  • Orphans and vulnerable children - Increase of support from low levels of coverage to full coverage of all orphans in Sub-Saharan Africa, given that AIDS is responsible for more than 2/3 of children who have lost both parents, as well as AIDS orphans in other low and middle-income countries.
  • Human resources - Covering the costs of recruiting and training additional doctors, nurses and community health workers in low-income countries, and two middle-income countries (South Africa and Botswana) and incentives to retain and attract people to the health sector. Future analyses will calculate costs for other health workers, including nurse practitioners, clinical officers and laboratory technicians.
  • Programme costs - The construction of over 1000 new health centres (to be available by 2010), based on the investments made during 2006-2008. An additional 19, 000 health centres and 800 hospitals would be renovated over the next three years to handle the scaling-up of HIV treatment and care.

According to the latest UNAIDS projections, a total of US$8.3 billion is estimated to be available from all sources in 2005, rising to US$ 8.9 billion and US$10 billion in 2006 and 2007 respectively.

As the response to AIDS is scaled up, funding estimates must be constantly revised and updated. UNAIDS will work with international donors and affected countries to refine the costing estimates, focusing particularly on strengthening health infrastructures.

AIDS Resource needs (US$ billion)  2006      2007      2008 

Prevention                          8,4       10,0      11,4 
Treatment and care                  3,0        4,0       5,3 
OVC                                 1,6        2,1       2,7 
Programme costs                     1,5        1,4       1,8 
Human resources                     0,4        0,6       0,9 

Total                              14,9       18,1      22,1 

Note to Editors

[1] UNAIDS has been producing resource needs estimates since 2001. Since that time there has been increased access to relevant data, a continuous improvement in the methodologies and new thinking about what comprises a comprehensive package of interventions to turn back the epidemic. The latest estimates constitute the best available assessment of global needs for AIDS ...

[2] It appears that there is a funding gap between resources available and those needed of at least US $18 billion from 2005 to 2007. However, this is likely to be a significant underestimate. ...

For more information, please contact Dominique De Santis, UNAIDS, tel. +41 22 791 4509, email. or Beth Magne-Watts, UNAIDS, tel. +41 22 791 5074,

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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