Clinton Global Initiative 2008 Focuses on Global Health

By Mary Dillard

Guest Contributor

Today is the third day of the 2008 Clinton Global Initiative.  This year I decided to focus on listening to the global health panels, which have emphasized the goal of expanding the global health workforce. 

One statistic that was mentioned yesterday is that Africa has 11% of the world’s population, over 20% of the world’s disease burden, but only 3% of the world’s health workers.  This has not always been the case and there are a number of reasons the numbers of health care workers have diminished so precipitously over the past thirty years. These include the Structural Adjustment Programs imposed on a number of African countries during the 1980s and 90s that forced African governments to decrease the amount of money that went into public health.

A second factor was the so-called brain drain- a controversial term referring to the migration of skilled professionals from developing countries to fill human resource needs in wealthier countries.  This process began in the 1970s but accelerated due to the decline in working conditions for health workers in the 1980s and 90s.   

Over the past two days, several panel participants have called for private investors to pay more attention to partnering with the public sector, thus challenging the legacy of structural adjustment.  The clearest call for this came yesterday from Paul Farmer, co-founder of Partners in Health who reminded the audience that the CGI goals (Poverty Alleviation, Energy and Climate Change, Education and Global Health) are particularly relevant for impoverished countries in the global south. 

While Farmer was technically on the panel to speak about global health, he emphasized that the recent devastation that Haiti has faced is due to climate change.  Although this has been little reported in the U.S. corporate press, Haiti has been battered by four hurricanes in the past two months.  These storms have resulted in the deaths of over 1000 people and displacement of close to a million people. 

Farmer argued that with the splintering of NGO groups, it has been more difficult than ever to coordinate efforts or to share best practices of health care delivery but that it is crucial for people to pay attention to what is happening in Haiti in order to avoid an increasingly dire humanitarian crisis.   

Given the fact that there are many immediate healthcare crises occurring in the world, it may seem strange to focus the theme of the Global Health panels on recruiting healthcare workers.  However, this need was echoed by most panel participants over the past two days.  Yesterday, Dr. Nancy Aossey, President and Chief Executive Officer of the International Medical Corps (IMC) argued that this is a crucial priority for post-conflict and active conflict zones where IMC works including Chad, the Central African Republic, Liberia and the Democratic Republic of Congo.

Today was “policy-wonk day” on the health panels.  Most of the speakers on the smaller panels were very well versed in health policy and there was a clear emphasis on practical, replicable solutions to challenges facing health care workers around the world.  This morning’s global health panel featured Craig R. Barrett, Chairman of Intel Corporation,
Tedros Adhanom Ghebreyesus, Minister of Health, Federal Democratic Republic of Ethiopia, 
Aruna Uprety, Director, Rural Health and Education Service Trust of Nepal and Dr. Lola Dare, Executive Secretary of African Council for Sustainable Health Development (ACOSHED).

The Ethiopian Minister of Health reported on initiatives that his government is doing to expand the medical corps.  According to Minister Tedros, when the government set priorities,  “We decided to focus on trying to reach the Millennium Development Goals, particularly the goal of ending poverty by 2015.”  Ethiopia’s per capita health expenditure is only one dollar per person.  With such limited funds directed towards the healthcare, increasing the numbers of low and mid-level providers (traditional birth attendants, nurses, physicians assistants) became a priority and the Ministry decided to strategically allocate resources. 

The current national health plan focuses on what he calls  “Flooding and Retention”.  Flooding refers to exponentially increasing the number of trained doctors, while retention refers to efforts to keep trained healthcare professionals employed in that capacity.  In too many impoverished countries, salaries for health care providers are so low that people cannot afford to work in the sectors where they were trained.  This contributes to skilled workers either leaving the country or finding other employment.  The largest outlay of funds in the health budget will go towards “Flooding” with  the hopes that at least a fraction of the doctors trained will continue to live and work in Ethiopia. It’s a risky strategy but clearly one that the government believes it must take.

Dr. Lola Dare made one of the most compelling arguments to not only increase the number of health care providers but also to provide those workers with the necessary supplies. She reminded the audience, “I worked in pediatric health and I left because I had no supplies in order to do my job.”  Her comments highlight the fact that the best intentions mean nothing to workers on the ground unless they have the supplies necessary to provide the kind of care that they were trained to provide. 

Africa has the highest disease burden but also has the lowest number of health workers.  Clearly the Continent has faced tremendous challenges in providing adequate health care over the past thirty years.  Since CGI is about creating “political will” my hope is that one day we will see real progress, by convincing governments around the world to make their health budgets more important than their military budgets.

Mary Dillard is Associate Professor of African History at Sarah Lawrence College in Bronxville, New York.

Comments

[captivating capiz]

Clinton should have done it a long time ago but it seems that all America does is lunge wars where they can take advantage of the situation for their own favor.