1.This Act may be cited as
the African Health Capacity Investment
Act of 2006
.
2.In this Act, the term HIV/AIDS
has the meaning given such term in section 104A(g) of the Foreign Assistance
Act of 1961 (22 U.S.C. 2151b–2(g)).
3.Congress makes the following
findings:
(1)The World Health
Report, 2003, Shaping the Future, states, The most critical issue facing
health care systems is the shortage of people who make them
work.
.
(2)The World Health
Report, 2006, Working Together for Health, states, The unmistakable
imperative is to strengthen the workforce so that health systems can tackle
crippling diseases and achieve national and global health goals. A strong human
infrastructure is fundamental to closing today's gap between health promise and
health reality and anticipating the health challenges of the 21st
century.
.
(3)The shortage of
health personnel, including doctors, nurses, pharmacists, counselors,
paraprofessionals, and trained lay workers is one of the leading obstacles to
fighting HIV/AIDS in sub-Saharan Africa.
(4)The HIV/AIDS
pandemic aggravates the shortage of health workers through loss of life and
illness among medical staff, unsafe working conditions for medical personnel,
and increased workloads for diminished staff, while the shortage of health
personnel undermines efforts to prevent and provide care and treatment for
those with HIV/AIDS.
(5)Workforce
constraints and inefficient management are limiting factors in the treatment of
tuberculosis, which infects over 1/3 of the global
population.
(6)Over 1,200,000
people die of malaria each year. More than 75 percent of these deaths occur
among African children under the age of 5 years old and the vast majority of
these deaths are preventable. The Malaria Initiative of President George W.
Bush seeks to reduce dramatically the disease burden of malaria through both
prevention and treatment. Paraprofessionals can be instrumental in reducing
mortality and economic losses associated with malaria and other health
problems.
(7)For a woman in
sub-Saharan Africa, the lifetime risk of maternal death is 1 out of 16. In
highly developed countries, that risk is 1 out of 2,800. Increasing access to
skilled birth attendants is essential to reducing maternal and newborn
mortality in sub-Saharan Africa.
(8)The Second Annual
Report to Congress on the progress of the President's Emergency Plan for AIDS
Relief identifies the strengthening of essential health care systems through
health care networks and infrastructure development as critical to the
sustainability of funded assistance by the United States Government and states
that outside resources for HIV/AIDS and other development efforts must
be focused on transformational initiatives that are owned by host
nations
. This report further states, Alongside efforts to
support community capacity-building, enhancing the capacity of health care and
other systems is also crucial for sustainability. Among the obstacles to these
efforts in many nations are inadequate human resources and capacity, limited
institutional capacity, and systemic weaknesses in areas such as: quality
assurance; financial management and accounting; health networks and
infrastructure; and commodity distribution and control.
.
(9)Vertical disease
control programs represent vital components of United States foreign assistance
policy, but human resources for health planning and management often demands a
more systematic approach.
(10)Implementation
of capacity-building initiatives to promote more effective human resources
management and development may require an extended horizon to produce
measurable results, but such efforts are critical to fulfillment of many
internationally recognized objectives in global health.
(11)The November
2005 report of the Working Group on Global Health Partnerships for the High
Level Forum on the Health Millennium Development Goals entitled Best
Practice Principles for Global Health Partnership Activities at Country
Level
, raises the concern that the collective impact of various global
health programs now risks undermining the sustainability of national
development plans, distorting national priorities, diverting scarce human
resources and/or establishing uncoordinated service delivery structures
in developing countries. This risk underscores the need to coordinate
international donor efforts for these vital programs with one another and with
recipient countries.
(12)The emigration
of significant numbers of trained health care professionals from sub-Saharan
African countries to the United States and other wealthier countries
exacerbates often severe shortages of health care workers, undermines economic
development efforts, and undercuts national and international efforts to
improve access to essential health services in the region.
(13)Addressing this
problem, commonly referred to as brain drain
, will require
increased investments in the health sector by sub-Saharan African governments
and by international partners seeking to promote economic development and
improve health care and mortality outcomes in the region.
(14)Virtually every
country in the world, including the United States, is experiencing a shortage
of health workers. The Joint Learning Initiative on Human Resources for Health
and Development estimates that the global shortage exceeds 4,000,000 workers.
Shortages in sub-Saharan Africa, however, are far more acute than in any other
region of the world. The World Health Report, 2006, states that [t]he
exodus of skilled professionals in the midst of so much unmet health need
places Africa at the epicentre of the global health workforce
crisis.
.
(15)Ambassador
Randall Tobias, now the Director of United States Foreign Assistance and
Administrator of the United States Agency for International Development, has
stated that there are more Ethiopian trained doctors practicing in Chicago than
in Ethiopia.
(16)According to the
United Nations Development Programme, Human Development Report 2003,
approximately 3 out of 4 countries in sub-Saharan Africa have fewer than 20
physicians per 100,000 people, the minimum ratio recommended by the World
Health Organization, and 13 countries have 5 or fewer physicians per 100,000
people.
(17)Nurses play
particularly important roles in sub-Saharan African health care systems, but
approximately ¼ of sub-Saharan African countries have fewer than 50 nurses per
100,000 people or less than ½ the staffing levels recommended by the World
Health Organization.
(18)Paraprofessionals
can be trained more quickly than nurses or doctors and are critically needed in
sub-Saharan Africa to meet immediate health care needs.
(19)Imbalances in
the distribution of countries' health workforces represents a global problem,
but the impact is particularly acute in sub-Saharan Africa.
(20)In Malawi, for
example, more than 95 percent of clinical officers are in urban health
facilities, and about 25 percent of nurses and 50 percent of physicians are in
the 4 central hospitals of Malawi. Yet the population of Malawi is estimated to
be 87 percent rural.
(21)In parts of
sub-Saharan Africa, such as Kenya, thousands of qualified health professionals
are employed outside the health care field or are unemployed despite job
openings in the health sector in rural areas because poor working and living
conditions, including poor educational opportunities for children,
transportation, and salaries, make such openings unattractive to
candidates.
(22)The 2002
National Security Strategy of the United States 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.
.
(23)Public health
deficiencies in sub-Saharan Africa and other parts of the developing world
reduce global capacities to detect and respond to potential crises, such as an
avian flu pandemic.
(24)On September 28,
2005, Secretary of State Condoleezza Rice declared that HIV/AIDS is not
only a human tragedy of enormous magnitude; it is also a threat to the
stability of entire countries and to the entire regions of the
world.
.
(25)Foreign
assistance by the United States that expands local capacities, provides
commodities or training, or builds on and enhances community-based and national
programs and leadership can increase the impact, efficiency, and sustainability
of funded efforts by the United States.
(26)African health
care professionals immigrate to the United States for the same set of reasons
that have led millions of people to come to this country, including the desire
for freedom, for economic opportunity, and for a better life for themselves and
their children, and the rights and motivations of these individuals must be
respected.
(27)Helping
countries in sub-Saharan Africa increase salaries and benefits of health care
professionals, improve working conditions, including the adoption of universal
precautions against workplace infection, improve management of health care
systems and institutions, increase the capacity of health training
institutions, and expand education opportunities will alleviate some of the
pressures driving the migration of health care personnel from sub-Saharan
Africa.
(28)While the scope
of the problem of dire shortfalls of personnel and inadequacies of
infrastructure in the sub-Saharan African health systems is immense, effective
and targeted interventions to improve working conditions, management, and
productivity would yield significant dividends in improved health care.
(29)Failure to
address the shortage of health care professionals and paraprofessionals, and
the factors pushing individuals to leave sub-Saharan Africa will undermine the
objectives of United States development policy and will subvert opportunities
to achieve internationally recognized goals for the treatment and prevention of
HIV/AIDS and other diseases, in the reduction of child and maternal mortality,
and for economic growth and development in sub-Saharan Africa.
4.It is the sense of
Congress that—
(1)the United States
should help sub-Saharan African countries that have not already done so to
develop national human resource plans within the context of comprehensive
country health plans involving a wide range of stakeholders;
(2)comprehensive,
rather than piecemeal approaches to advance multiple sustainable interventions
will better enable countries to plan for the number of health care workers they
need, determine whether they need to reorganize their health workforce,
integrate workforce planning into an overall strategy to improve health system
performance and impact, better budget for health care spending, and improve the
delivery of health services in rural and other underserved areas;
(3)in order to
promote systemic, sustainable change, the United States should seek, where
possible, to strengthen existing national systems in sub-Saharan African
countries to improve national capacities in areas including fiscal management,
training, recruiting and retention of health workers, distribution of
resources, attention to rural areas, and education;
(4)because
foreign-funded efforts to fight HIV/AIDS and other diseases may also draw
health personnel away from the public sector in sub-Saharan African countries,
the policies and programs of the United States should, where practicable, seek
to work with national and community-based health structures and seek to promote
the general welfare and enhance infrastructures beyond the scope of a single
disease or condition;
(5)paraprofessionals
and community-level health workers can play a key role in prevention, care, and
treatment services, and in the more equitable and effective distribution of
health resources, and should be integrated into national health systems;
(6)given the current
personnel shortages in sub-Saharan Africa, paraprofessionals represent a
critical potential workforce in efforts to reduce the burdens of malaria,
tuberculosis, HIV/AIDS, and other deadly and debilitating diseases;
(7)it is critically
important that the governments of sub-Saharan African countries increase their
own investments in education and health care;
(8)international
financial institutions have an important role to play in the achievement of
internationally agreed upon health goals, and in helping countries strike the
appropriate balance in encouraging effective public investments in the health
and education sectors, particularly as foreign assistance in these areas scales
up, and promoting macroeconomic stability;
(9)public-private
partnerships are needed to promote creative contracts, investments in
sub-Saharan African educational systems, codes of conduct related to
recruiting, and other mechanisms to alleviate the adverse impacts on
sub-Saharan African countries caused by the migration of health
professionals;
(10)colleges and
universities of the United States, as well as other members of the private
sector, can play a significant role in promoting training in medicine and
public health in sub-Saharan Africa by establishing or supporting in-country
programs in sub-Saharan Africa through twinning programs with educational
institutions in sub-Saharan Africa or through other in-country
mechanisms;
(11)given the
substantial numbers of African immigrants to the United States working in the
health sector, the United States should enact and implement measures to permit
qualified aliens and their family members that are legally present in the
United States to work temporarily as health care professionals in developing
countries or in other emergency situations, as in S. 2611, of the 109th
Congress, as passed by the Senate on May 25, 2006;
(12)the President,
acting through the United States Permanent Representative to the United
Nations, should exercise the voice and vote of the United States—
(A)to ameliorate the
adverse impact on less developed countries of the migration of health
personnel;
(B)to promote
voluntary codes of conduct for recruiters of health personnel; and
(C)to promote
respect for voluntary agreements in which individuals, in exchange for
individual educational assistance, have agreed either to work in the health
field in their home countries for a given period of time or to repay such
assistance;
(13)the United
States, like countries in other parts of the world, is experiencing a shortage
of medical personnel in many occupational specialties, and the shortage is
particularly acute in rural and other underserved areas of the country;
and
(14)the United
States should expand training opportunities for health personnel, expand
incentive programs such as student loan forgiveness for Americans willing to
work in underserved areas, and take other steps to increase the number of
health personnel in the United States.
5.Assistance to
increase human capacity in the health sector in sub-Saharan
AfricaChapter 1 of part I of
the Foreign Assistance Act of 1961 (22 U.S.C.
2151 et seq.) is amended by adding at the end the following new
section:
135.Assistance to
increase human capacity in the health sector in sub-Saharan Africa
(a)
(1)The
President is authorized to provide assistance, including providing assistance
through international or nongovernmental organizations, for programs in
sub-Saharan Africa to improve human health care capacity.
(2)Such programs should include assistance—
(A)to provide
financial and technical assistance to sub-Saharan African countries in
developing and implementing new or strengthened comprehensive national health
workforce plans;
(B)to build and
improve national and local capacities and sustainable health systems management
in sub-Saharan African countries, including financial, strategic, and technical
assistance for—
(i)fiscal and health
personnel management;
(ii)health worker
recruitment systems;
(iii)the creation or
improvement of computerized health workforce databases and other human resource
information systems;
(iv)implementation
of measures to reduce corruption in the health sector; and
(v)monitoring,
evaluation, and quality assurance in the health field, including the
utilization of national and district-level mapping of health care systems to
determine capacity to deliver health services;
(C)to train and
retain sufficient numbers of health workers, including paraprofessionals, to
provide essential health services in sub-Saharan African countries, including
financing, strategic technical assistance for—
(i)health worker
safety and health care, including HIV/AIDS prevention and off-site testing and
treatment programs for health workers;
(ii)increased
capacity for training health professionals and paraprofessionals in such
subjects as human resources planning and management, health program management,
and quality improvement;
(iii)expanded access
to secondary level math and science education;
(iv)expanded
capacity for nursing and medical schools in sub-Saharan Africa, with particular
attention to incentives or mechanisms to encourage graduates to work in the
health sector in their country of residence;
(v)incentives and
policies to increase retention, including salary incentives;
(vi)modern quality
improvement processes and practices;
(vii)continuing
education, distance education, and career development opportunities for health
workers;
(viii)mechanisms to
promote productivity within existing and expanding health workforces;
and
(ix)achievement of
minimum infrastructure requirements for health facilities, such as access to
clean water;
(D)to support
sub-Saharan African countries with financing, technical support, and personnel,
including paraprofessionals and community-based caregivers, to better meet the
health needs of rural and other underserved populations by providing incentives
to serve in these areas, and to more equitably distribute health professionals
and paraprofessionals;
(E)to support
efforts to improve public health capacities in sub-Saharan Africa through
education, leadership development, and other mechanisms;
(F)to provide
technical assistance, equipment, training, and supplies to assist in the
improvement of health infrastructure in sub-Saharan Africa;
(G)to promote
efforts to improve systematically human resource management and development as
a critical health and development issue in coordination with specific disease
control programs for sub-Saharan Africa; and
(H)to establish a
global clearinghouse or similar mechanism for knowledge sharing regarding human
resources for health, in consultation, if helpful, with the Global Health
Workforce Alliance.
(3)Monitoring and
Evaluation
(A)The President shall establish a monitoring and evaluation
system to measure the effectiveness of assistance by the United States to
improve human health care capacity in sub-Saharan Africa in order to maximize
the sustainable development impact of assistance authorized under this section
and pursuant to the strategy required under
subsection
(b).
(B)The
monitoring and evaluation system shall—
(i)establish
performance goals for assistance provided under this section;
(ii)establish
performance indicators to be used in measuring or assessing the achievement of
performance goals;
(iii)provide a basis
for recommendations for adjustments to the assistance to enhance the impact of
the assistance; and
(iv)to the extent
feasible, utilize and support national monitoring and evaluation systems, with
the objective of improved data collection without the imposition of unnecessary
new burdens.
(b)Strategy of the
United States
(1)Not later than 180 days after the date of enactment of
this Act, the President shall develop and transmit to the appropriate
congressional committees a strategy for coordinating, implementing, and
monitoring assistance programs for human health care capacity in sub-Saharan
Africa.
(2)The
strategy required by
paragraph (1) shall include—
(A)a description of
a coordinated strategy, including coordination among agencies and departments
of the Federal Government with other bilateral and multilateral donors, to
provide the assistance authorized in subsection
(a);
(B)a description of
a coordinated strategy to consult with sub-Saharan African countries and the
African Union on how best to advance the goals of this Act; and
(C)an analysis of
how international financial institutions can most effectively assist countries
in their efforts to expand and better direct public spending in the health and
education sectors in tandem with the anticipated scale up of international
assistance to combat HIV/AIDS and other health challenges, while simultaneously
helping these countries maintain prudent fiscal balance.
(3)It is suggested that the analysis described
in paragraph
(2)(C) focus on 2 or 3 selected countries in sub-Saharan
Africa, including, if practical, 1 focus country as designated under the
President's Emergency Plan for AIDS Relief (authorized by the United States
Leadership Against Global HIV/AIDS, Tuberculosis, and Malaria Act of 2003
(Public Law 108–25)) and 1 country without such a designation.
(4)The
President is encouraged to develop the strategy required under paragraph (1) in
consultation with the Secretary of State, the Administrator for the United
States Agency for International Development, including employees of its field
missions, the Global HIV/AIDS Coordinator, the Chief Executive Officer of the
Millennium Challenge Corporation, the Secretary of the Treasury, the Director
of the Bureau of Citizenship and Immigration Services, the Director of the
Centers for Disease Control and Prevention, and other relevant agencies to
ensure coordination within the Federal Government.
(5)
(A)To ensure coordination with national strategies and
objectives and other international efforts, the President should develop the
strategy described in
paragraph (1) by consulting appropriate officials of the United
States Government and by coordinating with the following:
(i)Other
donors.
(ii)Implementers.
(iii)International
agencies.
(iv)Nongovernmental
organizations working to increase human health capacity in sub-Saharan
Africa.
(v)The World
Bank.
(vi)The
International Monetary Fund.
(vii)The Global Fund
to Fight AIDS, Tuberculosis, and Malaria.
(viii)The World
Health Organization.
(ix)The
International Labour Organization.
(x)The United
Nations Development Programme.
(xi)The United
Nations Programme on HIV/AIDS.
(xii)The European
Union.
(xiii)The African
Union.
(B)Assessment and
compilationThe President should make the assessments and
compilations required by subsection (a)(3)(B)(v), in coordination with the
entities listed in subparagraph (A).
(c)
(1)Not later than 1 year
after the date on which the President submits the strategy required in
subsection
(b), the President shall submit to the appropriate
congressional committees a report on the implementation of this section.
(2)Assessment of
mechanisms for knowledge sharingThe report described in
paragraph
(1) shall be accompanied by a document assessing best practices
and other mechanisms for knowledge sharing about human resources for health and
capacity building efforts to be shared with governments of developing countries
and others seeking to promote improvements in human resources for health and
capacity building.
(d)In
this section:
(1)Appropriate
congressional committeesThe
term appropriate congressional committees means the Committee on
Foreign Relations and the Committee on Appropriations of the Senate and the
Committee on International Relations and the Committee on Appropriations of the
House of Representatives.
(2)The term brain drain means the emigration of a
significant proportion of a country’s professionals working in the health field
to wealthier countries, with a resulting loss of personnel and often a loss in
investment in education and training for the countries experiencing the
emigration.
(3)The term health professional means a
person whose occupation or training helps to identify, prevent, or treat
illness or disability.
(4)The
term HIV/AIDS has the meaning given such term in section 104A(g)
of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b–2(g)).
(e)Authorization
of Appropriations
(1)There are authorized to be appropriated to the President
to carry out the provisions of this section—
(A)$100,000,000 for
fiscal year 2007;
(B)$150,000,000 for
fiscal year 2008; and
(C)$200,000,000 for
fiscal year 2009.
(2)Amounts made available under
paragraph
(1) are authorized to remain available until expended and are
in addition to amounts otherwise made available for the purpose of carrying out
this
section.
.