[Congressional Record Volume 152, Number 106 (Thursday, August 3, 2006)]
[Senate]
[Pages S8778-S8779]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
AFRICAN HEALTH CAPACITY INVESTMENT ACT
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
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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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