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The World Health Organization has published new guidelines meant to address the health worker shortage that plague rural and impoverished regions. In a July 2010 policy recommendation paper, the WHO offers recommendations to aid worker retention and attract new health workers to overlooked areas. Strategies include altering the ways in which students are selected and trained, as well as improvements in working and living conditions.

The WHO explains that “a shortage of qualified health workers in remote and rural areas impedes access to health-care services for a significant percentage of the population, slows progress towards attaining the Millennium Development Goals and challenges the aspirations of achieving health for all.” The WHO’s recommendations come at the request of global leaders, civil society groups, and Member States. WHO recommendations fall into four categories, with greater detail and context available within the body of the Report:

1. EDUCATION RECOMMENDATIONS
   Recommendations include targeted admission policies to enroll students with a rural background (who are statistically more likely to then practice in rural areas), exposing students to greater rural field work, and locating schools and residency programs outside of major cities.
2. REGULATORY RECOMMENDATIONS
   Recommendations include the creation of compulsory service requirements in rural and remote areas, educational subsidies offered with enforceable agreements of return service work in rural areas, and a focus on increasing the scope of medical practice in remote regions to increase job satisfaction.
3. FINANCIAL INCENTIVES RECOMMENDATIONS
   The WHO suggests “a combination of fiscally sustainable financial incentives, such as hardship allowances, grants for housing, free transportation, paid vacations, etc., sufficient enough to outweigh the opportunity costs associated with working in rural areas, as perceived by health workers, to improve rural retention.”
4. PERSONAL AND PROFESSIONAL SUPPORT RECOMMENDATIONS
   Recommendations include improved living conditions for health workers and their families in remote locales, career development programs to help rural workers progress in their careers, and the creation and promotion of senior posts in rural areas so that advancing workers are not forced to leave their communities.

The WHO suggests policies should be implemented in conjunction with the country’s national health plan and should be guided by the concept of health equity. The Report states that some countries, the Lao People’s Democratic Republic and Mali among them, are already considering using WHO recommendations to inform their retention policy.

As WHO guidelines have been disseminated, an August 14 article in The Lancet registered a first critique, underlining the roles of NGOs and INGOs in the internal brain drain within struggling countries. As an addendum to the WHO report, the article offers further policy recommendations, to be implemented in conjunction with WHO strategies.

Only 37% of Ugandan physicians are satisfied with their jobs and nearly half are at risk of either exiting the health sector or leaving Uganda entirely, according to a study published this year by the International Journal of Health Planning and Management. The study, “Satisfaction, Motivation, and Intent to Stay Among Ugandan Physicians,” is co-authored by Emily Bancroft, a former Leland Fellow with PHR in the US and AGHA in Uganda. Dovetailing with PHR’s previous works on health worker shortages in Africa, the study’s results come from a sample group of physicians working in 18 public and private health facilities in Uganda representing approximately 3% of Ugandan physicians. This study came about at the behest of Uganda’s Ministry of Health, which hopes to analyze how to implement effective policy reforms to strengthen and expand their health workforce. Bancroft’s team, headed by long time PHR advisor Professor Amy Hagopian of the University of Washington, urges Ugandan policy-makers to intervene to stem the “brain drain” that is heightened by factors such as low wages, poor infrastructure and materials, few opportunities to progress within the medical field, and regional isolation for doctors outside large cities.

14% of Ugandan physicians emigrate abroad, largely to four English-speaking countries—the US, Canada, the UK, and Australia. This number is significantly lower than that of some other countries in peril. For example, it is frequently said that more Malawian doctors practice in Manchester, England, than in the entire country of Malawi. Although Uganda’s health workforce shortage seems less drastic than Malawi’s, the crisis is no less dire: in 2008, the study’s authors estimated that there are only 2,500 physicians for Uganda’s 31 million inhabitants. Physicians, far more so than other Ugandan health professionals, were seen by Bancroft and colleagues as dissatisfied with their work and both ready and capable of vacating their posts if the opportunity should arise. Along with nurses, physicians are the group most heavily courted by international recruiters, which means many of the physicians Bancroft spoke with may already have found an opportunity to leave Uganda.

The World Bank and International Monetary Fund have exacerbated the “brain drain” seen in Uganda and throughout Africa with “structural adjustment” policies that cap domestic health expenditures. Wealthy countries can offer doctors higher salaries, greater career advancement opportunities, and, in many cases, a more stable political environment in which to work.

The Global HEALTH Act, introduced by Rep. Barbara Lee in March 2010, would assist Uganda’s efforts and help curtail health workforce shortages in countries facing similar crises by providing $2 billion over five years to increase the number of physicians, nurses, and other health workers in developing countries—and to help retain those health workers already there. The bill not only authorizes new resources, it also calls for the creation of a US Global Health Strategy to complement the goals of countries like Uganda and ensure US aid money goes where it can make a difference. This study will help foreign aid innovations like the Global HEALTH Act to better tackle complex problems like brain drain and to work with communities to solve these challenges—something PHR is dedicated to helping support.

Two years ago, Kamiar Alaei, MD, and Arash Alaei, MD, were arrested in Iran, just as they were preparing to leave for Mexico to present on their innovative harm reduction work at the XVII International AIDS Conference.

On July 18, the world convenes again for the XVIII International AIDS Conference in Vienna, Austria — but will be short two shining stars. Arash and Kamiar remain in jail today. The Iranian government accused the brothers of using trips to AIDS and public health conferences around the world to “foment a velvet revolution” and sentenced them to years in prison. We say treating AIDS is not a crime.

Friends and colleagues of the Alaeis will be in Vienna spreading the word about their case and advocating for their release, and PHR will be supporting them all the way.

Will you be in Vienna at the AIDS conference? To volunteer with these efforts, email Clint Trout at clintworldwide [at] yahoo [dot] com.

Want to take action to support the Alaeis? Sign our new petition, calling on the government of Iran to free the Alaeis.

Throughout their careers, the Alaeis have promoted public health diplomacy and supported the quest for shared solutions to the world’s shared disease burden. It is an outrage to call this treason. Medical professionals should not be put in prison for doing their jobs. Take action today and stand in solidarity with the Alaeis.

See the Background page at IranFreeTheDocs.org for more information on their case.

Physicians for Human Rights joins numerous international NGOs, including Amnesty International, Human Rights Watch, and Reporters Without Borders, in supporting United4Iran’s Global Day of Action on June 12, 2010. June 12 events will be occurring in over 70 cities around the world. Go to 12June.org for more information.

June 12 marks the one year anniversary of Iran’s disputed election, which was followed by a government crackdown that saw an increase in arbitrary arrests, torture, and politically motivated use of the death penalty. The Global Day of Action calls attention to Prisoners of Conscience in Iran, and demands their unconditional release.

Since last year’s elections, the human rights situation in Iran has only grown worse. PHR continues to highlight the case of Drs. Kamiar and Arash Alaei, Iranian doctors who have been held by Iranian authorities since June 2008. After being imprisoned without charge for six months, the Doctors Alaei were convicted and sentenced for the charges of being in “communications with an enemy government” and “seeking to overthrow the Iranian government.” Kamiar was given a three year prison sentence, while Arash was sentenced to six years.

The Iranian government used the doctors’ travel to international AIDS conferences as a basis for the charge. Iran cannot continue to imprison medical professions for doing their job. By equating public health diplomacy with treason, the Iranian government poses a threat to all Iranians working for scientific knowledge.

Stand with PHR and the international community to tell the world that “Treating AIDS is not a crime.” Visit iranfreethedocs.org for more information on the Alaeis. And on June 12, please help us remember and defend those in Iran jailed for their humanitarian work.

The Obama Administration has initiated a comprehensive review of US landmines policy to decide whether or not the US will join the Mine Ban Treaty. President Obama needs to hear from you about how harmful landmines are to the health and human rights of people worldwide.

Email President Obama today and tell him to join the Mine Ban Treaty.

PHR shared the 1997 Nobel Peace Prize for our work to ban landmines. Since then, 156 countries have signed onto the treaty, which bans the use, trade, production and stockpiling of antipersonnel mines.

However, the US has refused to join. President Obama now has the opportunity to partner with every member of NATO—and every country in the Western Hemisphere, save Cuba—in supporting this critical treaty. Tell him to take action today.

Landmines kill thousands of people a year, with millions more affected by the agricultural, economic and psychological impact of the device. While landmines are a weapon of war, most casualties are civilians: indeed, UNICEF estimates that 30-40% of landmine victims are children. And landmines don’t just kill in conflict zones: there are millions of landmines and unexploded ordinances in more than 80 countries worldwide.

These indiscriminate weapons maim and kill, and destroy families and communities. The US has not used landmines since the 1991 Gulf War; it is time for us to promise never to use them again. Tell Obama to join the Mine Ban Treaty today.

68 Senators co-signed a letter to President Obama in May, showing their support for the Mine Ban Treaty. Now Obama needs to hear from you. Email him today, and ask 6 friends to do the same. PHR members have been advocating to ban landmines for more than 15 years. This is our best chance to join the Mine Ban Treaty in years, and we need your support.

Take action today!

Want to do more? We are asking major US health professional associations to sign a letter to the Administration against the use of landmines. If you have any contacts at health professional associations who might be able to help, please email Gina at gcoplon-newfield[at]phrusa[dot]org.

As you read in our previous landmines blog post, the Obama Administration is reviewing current US landmine policy right now, and will soon decide whether or not the US will join the Mine Ban Treaty. Why should the US join? Check out these compelling facts and see why this is a critical health and human rights issue:

Injury and Death:

• The International Campaign to Ban Landmines (ICBL) estimates that 15,000-20,000 people are maimed or killed by landmines yearly, with millions more affected by the agricultural, economic and psychological impact of the weapon.
• UNICEF estimates that 30-40% of mine victims are children under 15 years old.
• Landmines are responsible for the injury and death of thousands of US and allied troops in all US-fought conflicts since World War II, including dozens in Iraq and Afghanistan. In the 1991 Gulf War, landmines caused 34% of US casualties.
• At the beginning of the 20th century, nearly 80% of landmine victims were military personnel. Today, 90% of landmine victims are civilians.

The Economic and Social Cost:

• The ICBL estimates that there are millions of landmines and other unexploded ordnance in the ground in over 80 countries.
• Landmines cost as little as $3 to produce and up to $1,000 per mine to clear.
• Most kinds of landmines last forever. Mines laid during WWII are still killing and maiming civilians.
• It costs $100 to $3,000 to provide an artificial limb to a landmine survivor. Adults require a prosthesis replacement every two to three years and a child must have a new one every six months to a year.
• Landmines cause environmental damage in the forms of soil degradation, deforestation, and the pollution of water resources with heavy metals. Subsistence farmers are unable to work the land in mined areas.
• Landmines affect all aspects of human life, including the ability of refugees to return home. A report from the United Nations High Commissioner for Refugees (UNHCR) published in 1997 stated that 13.2 million refugees, 4.9 million internally displaced people and 3.3 million returnees were at risk from landmines.

The US and Landmines:

• The United States is one of only 39 countries that have not yet joined the Mine Ban Treaty; in the Western Hemisphere, only the U.S and Cuba are non-signatories.
• The US has the third largest mine arsenal in the world—a stockpile of 11 million Anti-Personnel Landmines (APLs)—despite not using landmines since 1991 or producing them since 1997. Enormous amounts of taxpayer money are used to maintain these weapons.
• The United States is one of only 13 countries that refuse to halt production of APLs.
• The Bush Administration’s landmine policy, announced in February 2004, represented a major rollback of US progress on the landmine issue. The policy increased funding for mines, permitted indefinite US use of self-destructing mines, and refused to phase out long-lived mines until 2010. The Obama Administration has yet to revise the Bush policy.

These indiscriminate weapons maim and kill, and destroy families and communities. President Obama is currently reviewing US landmine policy. We need your voice to tell the President to ban mines now! The US has not used landmines since the 1991 Gulf War. It is time for us to promise never to use them again.

Take action today: email Obama and tell him to join the Mine Ban Treaty!

The Obama Administration has initiated a comprehensive review of the US landmines policy to decide whether or not the US will join the Mine Ban Treaty. PHR has re-engaged in this campaign at the request of The US Campaign to Ban Landmines (USCBL) and members of the Administration, and we are hopeful that this will be an opportunity to show the world that the US respects health and human rights.

Over the next few months, we’ll be updating you on the treaty via a new blog series (this is blog #1) and asking for your help to urge President Obama to join the Mine Ban Treaty.

One immediate action item: We are asking the presidents of major US health professional associations to sign a letter to the Administration showing the unity of the medical, public health and nursing community against the use of landmines. If you have any contacts at major health professional associations who might be able to help, please email Gina Coplon-Newfield at gcoplon-newfield[at]phrusa[dot]org as soon as possible.

As you may know, PHR is a founding member of the International Campaign to Ban Landmines (ICBL), a grassroots movement that brought the international community together to form the 1997 Mine Ban Treaty, which bans the use, trade, production, and stockpiling of antipersonnel mines. PHR and the other ICBL founding groups were awarded the Nobel Peace Prize for their work toward achieving the treaty, which 156 countries have signed.

As with many international human rights treaties, the US has refused to sign, arguing that US soldiers are exposed to risk if the country can’t use landmines as a deterrent weapon. The United States’ position sets us apart from most other countries: Indeed, all other member countries of NATO are signatories to the treaty (Poland plans to ratify the treaty in 2012). By refusing to sign, the US joins China, Russia, Cuba, India and Pakistan among the countries that have not committed to stop using landmines. The US has not used landmines since the 1991 Gulf War, yet previous administrations have chosen to keep the weapon available, just in case.

Early in his tenure, it appeared President Obama had made the same decision. In November 2009, a White House spokesman stated that after reviewing the matter, the Obama Administration had decided not to sign the Mine Ban Treaty. The announcement prompted public outcry among human rights groups, and the following day, the White House insisted the issue was still under review. The current review is headed by Samantha Power and Barry Pavel at the National Security Council.

We expect the Obama Administration to make a decision in the next few months, making it critically important that the President hear from health professionals and human rights activists about how harmful landmines are to humanity. We will soon send out an action alert, which will give you the chance to email Obama and urge him to sign onto the Mine Ban Treaty. Please take action, and urge friends and family to do the same.

Congress is joining in the advocacy too. On May 22, Senator Patrick Leahy of Vermont sent a letter co-signed by 68 senators (including 10 Republicans) to President Obama, encouraging him to develop a plan to overcome any obstacles to joining the Convention. 68 is a magic number: international treaties must be approved by a 2/3 majority in the Senate, so if Obama decides to sign onto the treaty, 68 Senators would be enough to accede to it (of course, though this letter is a good indication of potential votes, it’s not a guarantee).

PHR members have been advocating to ban landmines for more than 15 years, and we need your help again at this critical juncture. Keep an eye out for more actions alerts and blogs. And spread the word—this is our best chance to join the Mine Ban Treaty in years, and we need your voice!