UK Department for International Development | 23 May 2008

At a major meeting this week of the World Health Organisation (WHO), more countries signed up as donors to the International Health Partnership (IHP). The annual World Health Assembly session in Geneva (19-23 May) saw Finland, Sweden, Australia and Spain all commit to the partnership, which aims to improve health systems in developing countries.

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Henry Neondo | 24 May 2008

Africa Science News Service

Weak health systems in developing countries is one of the main obstacles to scaling up immunization and other life-saving interventions, and remain a key barrier to achieving the Millennium Development Goals, especially goals 4 and 5, which aim to reduce child and maternal mortality.

"Much of the world's burden of disease could be prevented or cured. There are known, afford-able technologies to achieve this. The problem is getting those drugs, vaccines, and other forms of prevention, care, or treatment to those who need them - on time, reliably, in sufficient quantity, and at reasonable cost," explained Dr Julian Lob-Levyt, Executive Secretary of the GAVI Alliance.

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Mark Dodd | 14 May 2008

The Australian

FOREIGN aid gets a $500million boost to $3.7billion in 2008-09, fast-tracking the UN's Millennium Development Goals by putting money behind the Rudd Government's symbolic embrace of the world body.

The aid budget provides $1.3billion of new initiatives over four years, with the focus on poverty alleviation and regional security building. A commitment to invest $200million over four years in partnership with UN agencies marks a departure for a relationship left in the cold by the Howard government.

The $500million aid increase compares with last year's total of $3.2billion and is a step towards Labor's election pledge to increase Overseas Development Assistance to 0.5 per cent of Gross National Income by 2015.

It is expected the ratio will reach 0.35 per cent in 2009-10, a year earlier than targeted, fast-tracking the UN's millennium goals. The 18 MDGs range from action to end poverty and hunger to plans to boost environmental sustainability and education.

Labor's decision to withdraw the 550-strong Overwatch Battle Group from southern Iraq has been softened by a $140million aid package over three years, targeting the war-torn country's immediate humanitarian needs.

Funding of $300million aims to improve water and sanitation in impoverished countries in the Asia-Pacific region, while there is $45million over two years for a pilot eye and vision care program.

The scourge of HIV/Aids in the region will be tackled by programs totalling $130million in 2008-09. These include support for a continuing $100million program in Indonesia.

As part of its new approach to dealing with Papua New Guinea -- assistance guided by the Port Moresby Declaration signed in March -- the former colony has been allocated $389million for 2008-09, out of a total $1billion earmarked for the Pacific islands.

PNG's aid will focus on the four-pillars strategy: governance, nation building, sustainable economic growth and productivity improvements. The budget aims to help rebuild Pacific island nations' dilapidated infrastructure with funding of $127million over four years, with $5.5million earmarked for 2008-09.

Performance-linked support will be provided for basic infrastructure services in combination with multinational development banks and other donors.

It should also help marginalise Taiwanese largesse in the Pacific designed at securing diplomatic recognition ahead of China. This money-fuelled diplomacy has been marked by charges of corruption, most recently in Taipei's attempts to woo Port Moresby.

``Support will be country specific, targeted to address local constraints to growth and challenges to nation building and stability,'' the budget papers say.

Troubled East Timor will get $58million in Country Program aid, bringing its ODA total to $96.3million. The priority will be on improving policing, promoting the rule of law and developing parliamentary practices.

Humanitarian aid to the people of Burma will total $16.1million, focusing on public health, water and sanitation -- an immediate priority following Cyclone Nargis.

Under the Pacific Regional Program, $219million will be spent tackling malaria, climate change and governance through a Pacific Leadership Initiative.

UN News Centre | 06 May 2008

A dozen international companies announced concrete initiatives to apply business expertise to tackle poverty at an event hosted in London today by the United Nations Development Programme (UNDP) and the British Government.

More than 80 business leaders attended the Business Call to Action event, aimed at showcasing innovative and creative initiatives from the private sector to tackle poverty in the developing world.

New business initiatives announced by Diageo, Vodaphone, Coca Cola, Sumitomo Chemical, Microsoft, SABMiller, Thomson Reuters, Citi and Cisco are expected to create thousands of jobs and potentially improve the lives of millions of poor people across Africa and Asia.

They are part of a concerted push to meet the Millennium Development Goals (MDGs), which were endorsed by 189 world leaders in 2000 and represent a global partnership to promote poverty reduction, education, maternal health and gender equality and to combat child mortality, AIDS and other diseases.

The Business Call to Action aims to enable poor people to access speedy flows of information, money and business expertise, as well as creating new employment opportunities.

“In the race to achieve the MDGs, one of the greatest untapped resources is the private sector,” UNDP Administrator Kemal Dervis said. “Innovative business leaders, both in the North and the South, are changing the way that many businesses operate. They are expanding beyond traditional business practices, to also focus on the needs of those locked out of the global market, bringing them in as partners in growth and wealth creation.

Wendy Glauser | 13 Mar 2008

KAMPALA, Uganda -- Earlier this month, 1,000 people from around the world gathered at a World Health Organization-sponsored forum http://www.who.int/mediacentre/news/releases/2008/pr06/en/index.html here to discuss what's increasingly being seen as a global crisis: the acute shortage of health care workers.

The WHO estimates that more than four million health care workers are needed in the 57 countries it defines as grossly understaffed (fewer than 2.3 doctors, nurses and midwives per 100,000 people). Thirty-six of the 57 worst-hit countries are in Africa (Malawi has around 265 doctors for 12 million people; Zambia has about 650 for the same population). But when it comes to actual population, Asia is the most affected by the dearth of health care personnel. According to WHO figures, Asia requires 3 of the 4 million health care workers required to bridge the human resource gap.

But with aging populations, the health care worker shortfall in industrialized countries, while much less severe than that of Southeast Asia or Africa, is also driving up the demand for trained hospital and clinic staff. According to Judith Oulton, the CEO of International Council of Nurses in Geneva, Switzerland, the United States will need 800,000 nurses by 2015.

With stark international competition for the wearers of turquoise cotton, the most contentious and talked about issue at the conference was the migration of doctors and nurses. According to the WHO, one in four doctors trained in disease-plagued Africa is currently working in an OECD country, where patients see doctors to combat the sniffles.

"It is disturbing to note that the recruitment of these prized assets continues unabated," said Manto Tshabalala Msimang, the Minister of Health of South Africa. Yaw Osafo Maafo, Ghana's former minister of finance, noted that close to 70 percent of Ghanian medical officers trained between 1999 and 2003 have emigrated out of the country. "There are more doctors in the state of New York than the total number of Ghanaian doctors in public sector," he said.

Who is to Blame?

While the scale of the migration became shockingly apparent in the week-long forum, which ran from March 2-7, the question of who to blame for the problem was less clear-cut: Is the West guilty of unethically poaching doctors from developing countries, or does the fault lie with third-world governments, who haven't done enough to keep them?

In the blame-the-West camp, advocates argued that IMF loan conditions that put limits on salary increases for public service workers have tied recipient governments' hands. "The developed countries don't train enough of their own health workers and then the IMF creates incentives for people to leave developing countries," said Rotimi Sankore, a Nigerian activist with the Africa Public Health Alliance. "It seems like a conspiracy theory but it's true."

Rick Rowden, an American policy analyst with ActionAid, added that while the IMF's spendthrift strategies made sense in the global recession and third world debt crises of the early '80s, they've become "unnecessarily restrictive."

But Agnes Soucat, a senior health economist with the World Bank, argued the IMF is no longer enforcing wage caps. And Dr. Jonathan Nshasho, the director of a medial school in Uganda said IMF wage restrictions have been "an excuse" for African governments.

African governments pay public administration staffers, also affected by the salary-tightening regulations, significantly better than they do doctors, he argued.

Doctors make more money in politics . . .

"Very many doctors in Uganda have gone into politics because that's where they can get the money that is commensurate with their training," he said, noting an MP in Uganda makes three times that of a doctor.
Others criticized African governments for failing to live up to the pledge made as part of the 2001 Abuja Declaration on HIV/AIDS, TB and Other Related Infectious Diseases to spend 15 percent of their budgets on health. Only Botswana and Seychelles have fulfilled that promise. Uganda spends twice the amount on public administration that it does on health.

As a result of low funding, government clinics and hospitals in many parts of sub-Saharan Africa are decrepit and under-equipped. According to Rowden, after remuneration concerns, the biggest reason doctors leave developing countries is related to the "psychological demoralization" of not being able to provide the care they've been trained to provide due to inadequate resources. As HIV activist Dorcas Tracy Amoding put it, "You're a surgeon but you don't have the equipment to practice so you feel redundant and irrelevant."

Migration Alone Can't Explain Shortage
While some advocates argued that countries importing health care workers should pay a "transfer fee" to governments in the workers' country of origin, other speakers recognized that migration alone doesn't explain the dire shortages of doctors and nurses in developing countries.

Oulton of the International Council of Nurses noted that while South Africa currently suffers from a nursing shortage, it also hosts 30,000 unemployed nurses. In Uganda, meanwhile, many health care workers are migrating out of the sector, rather than out of the country. "We have trained doctors who become lawyers, doctors who work for NGOs," said Stephen Malligna, the minister of health for Uganda.
On the bright side, international health funding bodies like the Global Fund for HIV/AIDS, Tuberculosis and Malaria, and the Global Alliance for Vaccines and Immunization have pledged to support basic health care systems in the countries they give aid to, according to Dr. Francis Omaswa the head of WHO's Global Health Workforce Alliance. Up until now, donor money has been focused primarily on the purchase of medicines or the implementation of isolated projects.

And successful initiatives by governments in India and Ethiopia, cited several times during the conference, prove that developing countries can go a long way toward addressing the health workforce gap without outside assistance.

Ethiopia has trained 30,000 women living in remote areas to provide basic health care in their communities. And India has enlisted private-sector health care workers to tackle the country's abysmal maternal mortality rate of 300-450 deaths per 100,000 live births. Last year, the government contracted more than 800 private obstetricians in 25 rural districts in India to deliver the babies of poor women, paying them about $45 per delivery.

The good news for governments of developing countries is that while they need to improve conditions for their health care workers in order to retain them, they don't have to compete with the salaries and amenities of the West. As Oulton points out, health care workers leave their countries not because they're "pulled" by the attraction of Western but because they're "pushed."

"Many health workers in Africa would prefer to maintain the relationships and family ties they have at home than go to a cold dark place in North America," explains Brook Baker, president of the Health Global Access Program, a U.S.-based advocacy NGO. "They just need to be given a choice."

Wendy Glauser is a Canadian journalist based in Uganda.

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