[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

[[Page S8779]]

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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