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Guest Op-Ed: Is global health about gizmos or people?

In Liberia, a health worker takes child's temperature at the FJ Grant District Hospital in Greenvile in the Sinoe County.

By Julia E. Robinson, director of advocacy programs for Health Alliance International at the University of Washington.

It’s an exciting time to be fighting for the “End of AIDS.”

Everyone from Hillary Clinton to Pope Francis is talking about the possibility of turning a corner on the pandemic. Advances in treatment and vaccine research hint there could be an AIDS-free generation in the near future. International donors are ponying up huge amounts of money for developing these new technologies.

Just last week, the United States Agency for International Development  (USAID) announced a $1 billion initiative called the Global Development Lab to keep churning out high tech solutions to some of the toughest public health problems facing the planet, including HIV.

Meanwhile, many poor countries and communities lack enough nurses, doctors and health workers to even carry out the most basic health services.

Global health experts talk about a ‘delivery bottleneck’ for new vaccines – a euphemistic way of describing the fact that Western innovations are piling up because the global south simply lacks the health care workforce and systems to deliver these new health technologies.

In the last few years, for example, research (much of it generated here in Seattle) has shown that earlier initiation of HIV treatment among pregnant woman can save millions of lives by ensuring a healthy life for people with HIV and by preventing the transmission of the virus from mothers to children. This strategy is sometimes called Option B+.

In Mozambique, Option B+ was introduced in the last few years, but despite huge potential, Option B+ implementation has stumbled because there are simply not enough people on the ground to do it.  Putting more people on treatment requires a sophisticated and functional health system to ensure HIV-positive folks stay on treatment, because adherence to medications is the key to success.

Health worker improvises on lack of stethoscope.
Health worker improvises on lack of stethoscope.

Overwhelmed nurses in the busy urban center of Beira, where the University of Washington’s Health Alliance International works, report that Option B+ has generated hundreds of new HIV patients.  Health workers look out on the line of patients snaking out the door – and the 7 hour wait time these pregnant women must endure – and ask how this is going to work.  More trained, qualified health personnel are desperately needed.

Here in Seattle, we sit in a global health mecca, home to some of the biggest players and brightest minds in the business.  We’re talking about the Bill &  Melinda Gates Foundation, PATH, Seattle BioMed and the University of Washington among many others — a host of research institutions creating improved diagnostic machines and complex models for interventions from vaccines to circumcision.  It is truly electrifying work – and yet none of that is quite enough.

Seattle leads in dreaming up gizmos, gadgets, and technologies for health care delivery in some of the areas of the world that could use them the most. And while these devices have the potential to save lives, by themselves these whiz-bang devices are useless. Pretty much all the interventions we’ve invented need human health workers to administer them.  And these health workers are in dreadfully short supply in all low-income countries.

The World Health Organization has declared April 7-12 as World Health Worker Week. WHO estimates the world faces a shortage of about 7.2 million health care workers to provide universal health coverage. By 2035 that number will be almost 13 million.  In Mozambique, there were 1268 doctors in the whole country in 2011 and almost 4000 maternal child health nurses for its population of about 25 million people.  (Just for comparison, the state of Texas has almost 69,000 doctors for its population of about 26 million people.)

It won’t be simple to solve the global workforce shortage, especially in poor countries.  All sectors of government need to work together to train, recruit and retain health workers in low-income countries. It would help if rich countries didn’t poach health workers trained abroad, too (one in four doctors in the U.S. was trained abroad, most of them in a lower income country).

If we are serious about the “End of AIDS,” though, we need to be serious about moving beyond technologies alone and invest in qualified, trained health care workers in the places that need them most.

We need to make sure that along with creating Global Development Labs that grow the private sector, we are also channeling resources towards the public sector and the governments whose responsibility it is to provide health care for their most vulnerable populations.

We need to make sure that along with shiny new gizmos and the billion dollar checks we’re writing to fund them, we are supporting national governments as they develop innovative strategies to help grow their health workforce.

JuliaRobinsonJulia Robinson currently serves as the Director of Advocacy Programs and Deputy Director for Cote d’Ivoire programs at Health Alliance International, a Seattle-based organization working to strengthen public sector health systems around the world.  She has been working in West Africa since 2001, when she was a Peace Corps Volunteer in Benin. She has worked on country programs in Cote d’Ivoire, Sudan, and Timor Leste on programs involving health systems strengthening, HIV programs and services, working in post-conflict regions, and advocating for just macroeconomic and global health policies.


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