African Health Capacity Investment Act

AFRICAN HEALTH CAPACITY INVESTMENT ACT -- (Senate - August 03, 2006)

Mr. DURBIN. Mr. President, this week I introduced the African Health Capacity Investment Act of 2006.

This bill was inspired last December, when I visited the Democratic Republic of Congo with Senator SAM BROWNBACK of Kansas.

The Congo is one of the poorest, most violent regions on Earth. This past weekend, it held its first multiparty elections in nearly 50 years. That is a moment to celebrate.

But one of the most profound challenges that the newly elected government will face is how to even begin to meet the health needs of its people. In the DRC, there are only 7 doctors and 44 nurses per 100,000 people. In the eastern Congo, which has witnessed terrible conflict and disease, there is only 1 doctor per 160,000 people. And, I was told, in the city of Goma, surgeons are literally one in a million. To put that in perspective, imagine three surgeons in a city the size of Chicago. Imagine living like that, and then imagine your doctors and nurses leaving for countries with better working conditions, better pay, and brighter futures.

That is the situation that the Congo and almost all of Sub-Saharan Africa faces every day, as doctors and nurses leave rural areas for African cities and leave African cities for the United States, the United Kingdom, and other Western destinations. Every year, Africa loses another 20,000 trained health professionals to European and North American medical facilities. That is an enormous brain drain.

As Randall Tobias, the U.S. Director of Foreign Assistance, has noted, there are more Ethiopian-trained doctors practicing in Chicago than in Ethiopia.

In the United States, we have 549 doctors and 773 nurses for every 100,000 people. And even at those levels, we face our own personnel shortages. As the baby boomers age and our health workforce retires, our shortages will grow. It has become our habit to recruit doctors and nurses from abroad and increasingly from the developing world to staff our hospitals, doctors' offices, and other health centers.

Those individuals immigrate here for the same reasons that people have always migrated here. They come for economic opportunities, greater freedom, and a better future for their children. As the son of an immigrant, I recognize their motivations and welcome the contributions that they make. But I also have to look at the countries that they leave behind.

That is what struck me so powerfully in the Congo: that we cannot continue to depend on the poorest countries in the world to train our doctors and nurses. We have to expand our own health workforce. Our nursing schools turn away thousands of qualified applicants every year because they don't have enough faculty to teach them. We have to fix that.

And we have to help Africa heal itself because even if the brain drain stopped completely, even if every doctor and nurse on the continent of Africa stayed there, they would still have tremendous shortages of health personnel.

That is why Senators COLEMAN, DEWINE, and FEINGOLD and I introduced the African Health Capacity Act this week.

The World Health Report concluded in 2003, ``The most critical issue facing health care systems is the shortage of people who make them work.'' The 2006 report, which focused entirely on health workforces, helped provide a blueprint on how to build that critical human infrastructure.

Sub-Saharan Africa has 11 percent of the world's population. It bears 25 percent of the global disease burden. But it has only 3 percent of the world's health workers, and it suffers nearly half of the world's deaths from infectious diseases.

Personnel shortages are a global problem, but nowhere are these shortages more extreme, the infrastructure more limited, and the health challenges graver than in Sub-Saharan Africa, the epicenter of the HIV/AIDS pandemic. We will not win the war against AIDS or any other health challenge without finding solutions to this problem. It looms larger than shortages of ARVs or any other single factor. The Institute of Medicine has called the health care worker shortage the greatest obstacle to fighting HIV/AIDS.

AIDS has had a particularly insidious effect on health workforces in Africa. Beginning in the 1980s, HIV/AIDS began to take a terrible toll among health workers in Africa. In 2000, 20 percent of the student nurses in Mozambique died from AIDS. Health workers are particularly vulnerable because many lack access to gloves or training in universal precautions that would help protect them from infection. These unsafe working conditions naturally drive many people to seek either safer jobs or employment in other countries. As illness, death, and migration reduce staff, those who are left face even heavier workloads, and they too may leave. This is a deadly and vicious cycle that we have to help Africa break.

The shortage of personnel has deadly repercussions that extend far beyond HIV/AIDS.

A woman in Sub-Saharan Africa, for example, has a 1 in 13 chance of dying in pregnancy or childbirth, according to UNICEF. In resource-rich countries such as ours, that risk is 1 out of 4100. You change those terrible odds for the woman in Africa by providing greater access to skilled birth attendants. You greatly improve the newborn baby's chance at survival as well.

It is critically important that as we increase assistance for HIV/AIDS and for health and economic development more generally, that we work to strengthen health systems as a whole. The Office of the Global AIDS Coordinator is doing terrific work at boosting health capacity in the public and private sectors, and USAID has also been engaged in this effort.

This bill is intended to give these agencies the tools to do more and to better integrate and coordinate their activities.

The bill seeks to help Sub-Saharan African countries strengthen the capabilities of their health systems by helping countries improve dangerous and Sub-standard working conditions; helping them train, recruit, and retain doctors, nurses, and paraprofessionals; developing better management and public health training; and improving productivity and workforce distribution. Collecting workforce data, or strengthening the public health sector may not sound very glamorous, but steps like these are critical to creating the health infrastructure that Africa so badly needs.

That infrastructure may also be very important to us. With air travel to spread avian flu, scientists tell us that we may have only 3 weeks to contain an outbreak of the disease from the time that outbreak is detected anywhere in the world. If we miss that window, the outbreak of avian flu may become a pandemic and spread around the world.

As stated in the Harvard Public Health Review, ``Those regions of the world where human expertise and resources are in shortest supply, such as Africa, are most likely to serve as particularly fertile ground for getting a large-scale human flu epidemic off to a robust start.'' It is in our own interests, as well as Africa's, to improve its public health infrastructure.

This same point was made in the President's 2002 National Security Strategy. This document provides the administration's fundamental view of how we should confront global challenges and opportunities in the security arena. It is a measure of risks and priorities that is issued each Presidential term.

President Bush's 2002 National Security Strategy stated, ``The scale of the public health crisis in poor countries is enormous. In countries afflicted by epidemics and pandemics like HIV/AIDS, malaria, and tuberculosis, growth and development will be threatened until these scourges can be contained. Resources from the developed world are necessary but will be effective only with honest governance, which supports prevention programs and provides effective local infrastructure.''

This bill is not just about spending more money to build African health capacity. It is also about spending that money better. This bill authorizes assistance to improve management and reduce corruption within the health sector. It requires the President to establish a monitoring and evaluation system to measure the effectiveness of our assistance.

Knowledge sharing is also important: Each minister of health and each nongovernmental organization should not have to reinvent the wheel.

Two years after enactment, this bill will require the production of a document publicizing best practices. This clearinghouse of information will provide valuable help for developing countries throughout the world.

The United States provides billions of dollars to fight HIV/AIDS, malaria, TB, and other health challenges in Africa. It is critical, as we pursue these programs, that we better integrate them within a framework to strengthen health systems as a whole. We need to help countries better invest their own human and material resources as well as our assistance.

In 2005, 2 million people in Sub-Saharan Africa died of AIDS, and 2.7 million people became newly infected. Nearly a million African children under the age of 5 died of malaria. Hundreds of thousands of Africans died last year of TB, cholera, dysentery, and other infectious diseases or in childbirth. These devastating mortality rates also strangle opportunities for economic development. But we can begin to change those trajectories by investing in African health capacity. Imagine living in a country like Ethiopia, with 3 doctors for every 100,000 people. Then ask yourself what we can do about it. This bill is a start.

I thank my colleagues, Senators COLEMAN, DEWINE, and FEINGOLD, for joining me in introducing this bipartisan bill, and I hope others will join us.

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