The Global HEALTH Act: Why Is It Important?
Background
A new bill was introduced in Congress last week that could potentially impact the way the US funds global assistance, including global health.
Countries facing a shortage of health workers experience one of the most formidable challenges to reaching health-related goals. In the US, we experience a resurgence of predictions for a looming US health workforce shortage about every 15 years. Yet developing countries face the daily challenge of combating the world's heaviest burden of disease with a completely inadequate health workforce.
The health workforce gap is clear. In Seattle (where Health Alliance International is headquartered) there are 3 physicians to serve every 1,000 people, while in Mozambique (one of our focus countries) there are only 0.03 physicians to care for every 1,000 people . The World Health Organization has set a minimum of 2.3 health workers (including doctors, nurses and midwives) as the threshold required to provide adequate care to every 1,000 population members, but every 1,000 patients in Mozambique have only 1.26 health workers to provide them care. There are 57 other countries around the world that fall below this bare minimum threshold.
Waiting room in Mozambique
The US, as the world's largest economy, has taken steps to meet its corresponding responsibility to the non-wealthy of the world last year by reauthorizing PEPFAR (the President's Emergency Plan for AIDS Relief) for another 5 years and $48 billion. The PEPFAR legislation explicitly includes language and funding to support training and retention of a revitalized health workforce around the world. The Administration's 6-year, $63 billion Global Health Initiative aims to continue that work, tying together funds for malaria, tuberculosis, maternal and child care, and other infectious diseases.
One problem with assigning funds to specific diseases, called vertical or "siloed" funding, is that they are difficult for developing countries to bring together into a coherent health system that serves the people who need it. Health workers are often pulled away from their jobs to attend multiple trainings, each time for a different disease but not showing how to combine these all into a package of care. They may have different reporting requirements for different diseases and different funders. A woman may have to go to one site for prenatal care, and another site, possibly far away, to be tested for HIV. The numerous NGOs that operate in developing countries often compound the problem by setting up their own parallel provision of testing and treatment, which adds to the confusion between who is doing what.
The Global HEALTH Act
A new bill recently introduced in Congress is aiming to solve some of these issues. A coalition of groups that focus on global health (including HAI) recently collaborated with Representative Barbara Lee (CA-9) on a piece of legislation to coordinate funding and delivery of health care, the Global HEALTH Act of 2010 (HR 4933).
The Global HEALTH Act will streamline all US government health-related assistance to foreign countries, to focus our development efforts into integrated country-driven programs that work. It will establish a global health workforce initiative to support a sustainable primary care focus on health care delivery, and will mandate a review of our own health workforce recruitment practices. This piece is key because the US doesn't train enough doctors and nurses to support our population's health care needs, so we end up recruiting heatlh workers from abroad, often from countries that don't have enough health workers as it is. The Global HEALTH Act will enable us to ensure that our efforts to train and retain health workforce in developing countries are not undermined by our own lack of strategic coordination.
The bill doesn't explicitly address the Obama Administration's Global Health Initiative and the things that many advocates have criticized about it: the relatively small amount of funds to address enormous health issues, and the conservative targets for making progress on things like HIV and tuberculosis which have seen improvement but are at risk of going in reverse if support doesn't continue. (For more discussion of the GHI, see our recent blog post.)
But the bill does propose to streamline our resources in a way that has already begun to inform the Administration's plans and should influence the planned redrafting of the US Foreign Assistance Act.
Take Action on World Health Day (April 7th)
Physicians for Human Rights and American Medical Student Association are asking people to take action on World's Health Day (April 7th) by mailing letters of support and encourging their congressperson to co-sponsor the act (for a sample text, click here). We look forward to what our country's global health grassroots networks have in store for World Health Day and this bill.
Comments
The article mentions that it will"mandate a review of our own healthcare workforce recruitment practices.” Does that indicate a restriction in hiring healthcare workers from any country that is short of medical personnel?
What percentage of our health care personnel is recruited from foreign countries, and what would be the result of cutting this off?
Karen Jennings
Dear Karen,
Thanks for your questions!
Depending on the year, the number of new physicians moving to the US from abroad to become physicians varies between one out of every three to one out of every four. These figures are taken from demographic data collected from young doctors entering their first year of physician training around the country.
But other than that information on physicians, we don’t do a very good job of monitoring which countries are making the biggest contribution to America’s skilled health workforce. There are a few voluntary codes of conduct (HAI has one; so does the United Kingdom) that hiring organizations can choose to use, but nothing binding, and certainly no limits in this bill.
To address this need, this bill would set up a system to track where our foreign-trained health professionals originate, so we have more information to guide our policy-making.
Secondly, the bill mandates a review of the current recruitment practices that we allow companies who hire highly-trained health professionals abroad to use – we haven’t had a coordinated approach to this issue in the past, and we want to make sure that our recruitment policies aren’t undermining the good work our global development programs are doing to train and retain these workers in countries with severe shortages. The bill has some general language to support the creation of positive pressures for us to train and recruit our health care workforce from Americans, replacing some existing incentives to preferentially hire from abroad, but without having any impact on the number of work visas available for health professionals to come to our country each year. And finally, it would set up voluntary processes to make our recruitment practices more ethical so poor countries don’t suffer such a loss of their human capital. The bill supports the freedom of all workers to pursue employment in any country where they want to work – there are no migration restrictions in its language.
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