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.

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.

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 Times identified a deep funding gap for combating AIDS in Uganda, including a freeze on new funds from the United States and a lack of commitment to AIDS spending by the Ugandan government (which evidently has no problem finding $300 million to spend on Russian fighter jets). The Times also outlined the devastating human toll this funding gap is taking on people living with — and dying of — AIDS.

Sadly, this news is not new. In March 2009, PHR invited Dr. Peter Myugenyi, Founder and Director of the PEPFAR-supported Joint Clinical Research Centre in Uganda, to Washington, DC to talk about the emerging funding gap for AIDS in Uganda. Said Dr. Mugyenyi:

After urging people to get tested and enter care, we now have to tell them there is no treatment available when they need it. We created hope and now we are returning to the days when one member of a family can get treatment and the others cannot.

It is a recipe for chaos as patients start to share doses or skip treatment altogether. I fear that we will soon start to see more drug-resistant strains of HIV and rising death rates.

As The Times notes, one year later, Dr. Myugenyi remains fearful:

Dr. Peter Mugyenyi, the hospital’s founder, helped the Bush administration form its AIDS plan and sat beside Laura Bush during the State of the Union address as it was announced.

The loss of donor interest “makes me frantic with worry,” Dr. Mugyenyi said.

He offers copies of e-mail messages he exchanged with American aid officials. One reminds him that he has been instructed to stop enrolling new patients and asks for an explanation of reports that he is treating 37,000 when only 32,000 are authorized. Another asks him not to announce publicly that his funds have been frozen.

He admits slipping pregnant women and young mothers like Ms. Kamukama into treatment slots “contrary to instructions.”

“Morally, I can’t turn them away,” he said.

This story gained traction worldwide, and was followed by a New York Times editorial, The Wavering War on AIDS, which outlined a $13 billion deficit in AIDS spending, and a series of letters to the editor, including one by PHR Global Health Action Campaign advisor Pat Daoust.

Dr. Mugyenyi won’t turn away patients. And we won’t turn away from this issue.

PHR, in conjuction with other global health groups, sent a letter to Secretary of State Clinton last week, urging her to end the AIDS funding freeze and ensure Ugandans have access to life-saving AIDS treatment.

PHR members have spent years advocating for more global AIDS funding and health programming based on science and human rights. We will continue to fight for greater global health funding, a strong US global health strategy, and to ensure people living with AIDS worldwide have access to drugs and quality care.

Want to help? Encourage your Representative to co-sponsor the Global HEALTH Act, which will provide $2 billion for health system strengthening and support a comprehensive US global health strategy, both of which will help in the fight against AIDS.

The Global HEALTH Act can help. The GHA, introduced in Congress by Representative Barbara Lee on March 24, would provide $2 billion over five years to increase the number of doctors, nurses, pharmacists and other health workers in developing countries, and to improve primary health care for all. The bill not only authorizes new resources, it also calls for the creation of a US Global Health Strategy that will complement the goals of developing countries and ensure our aid money is effectively used to save the lives of hundreds of thousands of people.

That is why PHR is uniting with more than 15 other US organizations to hold a national Call-in Day TODAY to support the Global HEALTH Act. Be part of the movement. Tell your Representative to support Global Health by co-sponsoring this bill.

It’s easy. Call the Congressional Switchboard at (202) 224-3121 and ask to be connected to your Representative’s office (if you don’t know who your Rep. is, find out). Then, make your case. Use the script below, and/or bring your own experiences into the call:

Hi, my name is XXX and I live in Town, State. I am calling to encourage Representative XXX to co-sponsor HR 4933, The Global HEALTH Act, which will help fix broken health systems in developing countries. The Global HEALTH Act calls for the development of a US Global Health Strategy to harmonize aid, and provides $2 billion over 5 years to help countries in Africa hire, train and retain more doctors, nurses and other health workers. The Global HEALTH Act will save lives: I hope Rep. XXX will consider co-sponsoring this bill today.

As of today, the global health community has secured nine co-sponsors: Reps. John Conyers (MI), Lynn Woolsey (CA), Raul Grijalva (AZ), Keith Ellison (MN), John Garamendi (CA), Fortney Pete Stark (CA), Diane Watson (CA), Jesse Jackson, Jr. (IL) and Eleanor Holmes Norton (DC). Help us secure more.Commemorate International Nurses Day by taking action. Join thousands around the country today who are making a difference. Call your Representative and encourage them to co-sponsor the Global HEALTH Act today.

The Global HEALTH Act can help. The GHA, introduced in Congress by Representative Barbara Lee on March 24, would provide $2 billion over five years to increase the number of doctors, nurses, pharmacists and other health workers in developing countries, and to improve primary health care for all. The bill not only authorizes new resources, it also calls for the creation of a US Global Health Strategy that will complement the goals of developing countries and ensure our aid money is effectively used to save the lives of hundreds of thousands of people.

That is why PHR is uniting with more than 15 other US organizations to hold a national Call-in Day TODAY to support the Global HEALTH Act. Be part of the movement. Tell your Representative to support Global Health by co-sponsoring this bill.

It’s easy. Call the Congressional Switchboard at (202) 224-3121 and ask to be connected to your Representative’s office (if you don’t know who your Rep. is, find out). Then, make your case. Use the script below, and/or bring your own experiences into the call:

Hi, my name is XXX and I live in Town, State. I am calling to encourage Representative XXX to co-sponsor HR 4933, The Global HEALTH Act, which will help fix broken health systems in developing countries. The Global HEALTH Act calls for the development of a US Global Health Strategy to harmonize aid, and provides $2 billion over 5 years to help countries in Africa hire, train and retain more doctors, nurses and other health workers. The Global HEALTH Act will save lives: I hope Rep. XXX will consider co-sponsoring this bill today.

As of today, the global health community has secured nine co-sponsors: Reps. John Conyers (MI), Lynn Woolsey (CA), Raul Grijalva (AZ), Keith Ellison (MN), John Garamendi (CA), Fortney Pete Stark (CA), Diane Watson (CA), Jesse Jackson, Jr. (IL) and Eleanor Holmes Norton (DC). Help us secure more. Commemorate International Nurses Day by taking action. Join thousands around the country today who are making a difference. Call your Representative and encourage them to co-sponsor the Global HEALTH Act today.

UPDATE, May 17: The Global HEALTH Act has garnered six new co-sponsors: Jesse Jackson, Jr. (IL), Eleanor Holmes Norton (DC), Sam Farr (CA), Maxine Waters (CA), Bobby Rush (IL) and James McGovern (MA).

PHR wants to double this number — and double it again. To gain more support for the GHA, PHR is organizing a Global HEALTH Act National Call-in Day on May 12th, International Nurses Day.

So far, more than 15 organizations have pledged to participate. We’d love more. If your organization/school/workplace is interested in taking part, contact us at ghacallinday[at]phrusa[dot]org.

And checkout the Call-in Day toolkit (doc), which contains all the information you’ll need to organize a great call-in day.

PHR wants to double this number — and double it again. To gain more support for the GHA, PHR is organizing a Global HEALTH Act National Call-in Day on May 12th, International Nurses Day.

So far, more than 15 organizations have pledged to participate. We’d love more. If your organization/school/workplace is interested in taking part, contact us at ghacallinday[at]phrusa[dot]org.

And checkout the Call-in Day toolkit (doc), which contains all the information you’ll need to organize a great call-in day.

GHA National Call-in Day Toolkit (122.5 KiB, 4 hits)

UPDATE, May 11: The Global HEALTH Act has garnered two new co-sponsors: Reps. Jesse Jackson, Jr. (IL) and Eleanor Holmes Norton (DC).

UPDATE, May 17: Four more co-sponsors have been added: Sam Farr (CA), Maxine Waters (CA), Bobby Rush (IL), and James McGovern (MA).

However, Malawi is making progress. In 1992, it opened the College of Medicine at the University of Malawi in Blantyre, and 168 doctors graduated in the first ten years. There was a 137% increase in doctors between 2004 and 2009. Malawi is also training more nurses than ever before.

Despite this success, Malawi still faces significant challenges. It must retain these doctors and nurses while persuading them to work in isolated, underfunded and overcrowded clinics and paying them less than they would make in other English-speaking countries. According to the WHO, 57 countries have critical shortages of doctors, nurses and midwives. How can you help? Support the Global HEALTH Act.

The Global HEALTH Act will guide and fund the development of a stronger workforce in countries like Malawi. Countries will develop plans for their health systems to build up their human resources for health. A stronger workforce means greater access to care, which is essential to realizing health as a human right. You may not have chosen the Global HEALTH Act for your Global Health Week of Action, but you can still sign the petition to ask your Representative to cosponsor the bill.

Want to take it a step further? Ask your Dean to join other prominent health professionals in signing the letter that PHR will send to your Representative — Members of Congress are busy people, but they respond to experts. Present the sign-on letter (pdf) to your Dean or interested faculty member, either directly or via email. You can use this email template (doc) and include this fact sheet (pdf) if you’d like. IMPORTANT: email me at hobrien[at]phrusa[dot]org to let me know when your Dean grants permission to use her or his name.

Your efforts on this important Act can have a big impact both in Congress and to the people of Malawi.

Her letter includes a list of organizations from across the globe that support the Global HEALTH Act — including PHR. Organizations are continually being added to this list, and we encourage you all to contact your Congressperson and urge them to co-sponsor this bill, which will revolutionize foreign health aid and save lives.