The federal government should create a corps of physicians, nurses, pharmacists, lab technicians and computer specialists and deploy them in the hard-hit countries targeted by the Bush administration's five-year, $15 billion global AIDS program, according to a panel of experts.
That was the idea outlined yesterday by a group asked to come up with specific suggestions on how to create one of the key manpower components of the administration's ambitious AIDS plan.
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The proposed Global Health Service (GHS) would be an overseas cousin of the domestic one that sends medical workers to isolated or underserved parts of the country, according to Fitzhugh Mullan, a former U.S. Public Health Service physician who chaired the panel.
"It would be a Peace Corps for health," Mullan said yesterday.
The service would offer options including three-year stints by qualified federal employees and one-year competitively awarded fellowships. The service would also serve as a clearinghouse of information where health care professionals could learn about overseas opportunities, public and private.
The Office of the Global AIDS Coordinator at the State Department said it is reviewing the Institute of Medicine report. A spokesman said no decision has been made about what, if any, parts of it would be adopted, or whether legislation would be required.
While the panel, convened by the Institute of Medicine, acknowledged it wanted to create a new "brand" of U.S. overseas service aimed primarily at fighting AIDS, it did not offer the idea as a magic bullet against the pandemic.
"It is strategically important, it is symbolically important, but it is not inherently the solution," Mullan said. But, he said, GHS would contribute to the ultimate goal of helping foreign nationals fight AIDS in their own countries.
The law creating the President's Emergency Plan for AIDS Relief (PEPFAR) calls for the creation of a "pilot program for the placement of health care professionals in overseas areas severely affected by HIV/AIDS, tuberculosis and malaria."
Various organizations offer American doctors and nurses chances to work overseas in places of need. For many, the length of time is short, often three months and sometimes as little as two weeks.
The GHS hopes to make it easier for American medical workers to work abroad for longer and more useful periods.
In a 199-page report, "Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS," the panel proposed an initial Global Health Service Corps of 150 members. They would be government employees who would be sent to one of the 15 target countries in PEPFAR -- 12 nations of sub-Saharan Africa, plus Haiti and Guyana in the Caribbean and Vietnam in Southeast Asia -- and would work there for three years, primarily as advisers and trainers to health ministries and organizations.
In addition, the plan envisions about 1,000 people from various health fields receiving fellowships to work abroad for at least one year for $35,000. While the stipend would be less than what a person's regular job pays, the program would be designed to make motivated people believe they can afford to interrupt their career for such work. Ideally, the fellowships would expand their skills and marketability. "I think this gives them [the employees] some leverage that they never had before," said Andre-Jacques Neusy, the director of the Center for Global Health at New York University School of Medicine.
A third component would provide money to newly trained physicians, nurses and other health professionals to pay back school loans. One year of work in an approved overseas AIDS program would earn $25,000 in loan repayment. The minimum commitment would be two years.
The federal government would not find a job or provide a salary for people seeking to work abroad through this mechanism. Instead, the health workers would be employed by organizations, such as charities and academic institutions, with operations overseas.
Christina Polyak, 28, who is in her second year at the University of Maryland School of Medicine, said "debt payment is essential" for many people like her who want to work in the developing world but feel they cannot afford to.
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