African Health Capacity Investment Act of 2006 - Amends the Foreign Assistance Act of 1961 to authorize the President to provide assistance, including through international or nongovernmental organizations, for programs to improve human health care capacity in sub-Saharan Africa.
Directs the President to develop and transmit to the appropriate congressional committees a strategy for coordinating, implementing, and monitoring assistance programs for human health care capacity in sub-Saharan Africa.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 3775 Introduced in Senate (IS)]
109th CONGRESS
2d Session
S. 3775
To amend the Foreign Assistance Act of 1961 to assist countries in sub-
Saharan Africa in the effort to achieve internationally recognized
goals in the treatment and prevention of HIV/AIDS and other major
diseases and the reduction of maternal and child mortality by improving
human health care capacity and improving retention of medical health
professionals in sub-Saharan Africa, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
August 2, 2006
Mr. Durbin (for himself, Mr. Coleman, Mr. DeWine, Mr. Feingold, and Mr.
Leahy) introduced the following bill; which was read twice and referred
to the Committee on Foreign Relations
_______________________________________________________________________
A BILL
To amend the Foreign Assistance Act of 1961 to assist countries in sub-
Saharan Africa in the effort to achieve internationally recognized
goals in the treatment and prevention of HIV/AIDS and other major
diseases and the reduction of maternal and child mortality by improving
human health care capacity and improving retention of medical health
professionals in sub-Saharan Africa, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``African Health Capacity Investment
Act of 2006''.
SEC. 2. DEFINITIONS.
In this Act, the term ``HIV/AIDS'' has the meaning given such term
in section 104A(g) of the Foreign Assistance Act of 1961 (22 U.S.C.
2151b-2(g)).
SEC. 3. FINDINGS.
Congress makes the following findings:
(1) The World Health Report, 2003, Shaping the Future,
states, ``The most critical issue facing health care systems is
the shortage of people who make them work.''.
(2) The World Health Report, 2006, Working Together for
Health, states, ``The unmistakable imperative is to strengthen
the workforce so that health systems can tackle crippling
diseases and achieve national and global health goals. A strong
human infrastructure is fundamental to closing today's gap
between health promise and health reality and anticipating the
health challenges of the 21st century.''.
(3) The shortage of health personnel, including doctors,
nurses, pharmacists, counselors, paraprofessionals, and trained
lay workers is one of the leading obstacles to fighting HIV/
AIDS in sub-Saharan Africa.
(4) The HIV/AIDS pandemic aggravates the shortage of health
workers through loss of life and illness among medical staff,
unsafe working conditions for medical personnel, and increased
workloads for diminished staff, while the shortage of health
personnel undermines efforts to prevent and provide care and
treatment for those with HIV/AIDS.
(5) Workforce constraints and inefficient management are
limiting factors in the treatment of tuberculosis, which
infects over \1/3\ of the global population.
(6) Over 1,200,000 people die of malaria each year. More
than 75 percent of these deaths occur among African children
under the age of 5 years old and the vast majority of these
deaths are preventable. The Malaria Initiative of President
George W. Bush seeks to reduce dramatically the disease burden
of malaria through both prevention and treatment.
Paraprofessionals can be instrumental in reducing mortality and
economic losses associated with malaria and other health
problems.
(7) For a woman in sub-Saharan Africa, the lifetime risk of
maternal death is 1 out of 16. In highly developed countries,
that risk is 1 out of 2,800. Increasing access to skilled birth
attendants is essential to reducing maternal and newborn
mortality in sub-Saharan Africa.
(8) The Second Annual Report to Congress on the progress of
the President's Emergency Plan for AIDS Relief identifies the
strengthening of essential health care systems through health
care networks and infrastructure development as critical to the
sustainability of funded assistance by the United States
Government and states that ``outside resources for HIV/AIDS and
other development efforts must be focused on transformational
initiatives that are owned by host nations''. This report
further states, ``Alongside efforts to support community
capacity-building, enhancing the capacity of health care and
other systems is also crucial for sustainability. Among the
obstacles to these efforts in many nations are inadequate human
resources and capacity, limited institutional capacity, and
systemic weaknesses in areas such as: quality assurance;
financial management and accounting; health networks and
infrastructure; and commodity distribution and control.''.
(9) Vertical disease control programs represent vital
components of United States foreign assistance policy, but
human resources for health planning and management often
demands a more systematic approach.
(10) Implementation of capacity-building initiatives to
promote more effective human resources management and
development may require an extended horizon to produce
measurable results, but such efforts are critical to
fulfillment of many internationally recognized objectives in
global health.
(11) The November 2005 report of the Working Group on
Global Health Partnerships for the High Level Forum on the
Health Millennium Development Goals entitled ``Best Practice
Principles for Global Health Partnership Activities at Country
Level'', raises the concern that the collective impact of
various global health programs now risks ``undermining the
sustainability of national development plans, distorting
national priorities, diverting scarce human resources and/or
establishing uncoordinated service delivery structures'' in
developing countries. This risk underscores the need to
coordinate international donor efforts for these vital programs
with one another and with recipient countries.
(12) The emigration of significant numbers of trained
health care professionals from sub-Saharan African countries to
the United States and other wealthier countries exacerbates
often severe shortages of health care workers, undermines
economic development efforts, and undercuts national and
international efforts to improve access to essential health
services in the region.
(13) Addressing this problem, commonly referred to as
``brain drain'', will require increased investments in the
health sector by sub-Saharan African governments and by
international partners seeking to promote economic development
and improve health care and mortality outcomes in the region.
(14) Virtually every country in the world, including the
United States, is experiencing a shortage of health workers.
The Joint Learning Initiative on Human Resources for Health and
Development estimates that the global shortage exceeds
4,000,000 workers. Shortages in sub-Saharan Africa, however,
are far more acute than in any other region of the world. The
World Health Report, 2006, states that ``[t]he exodus of
skilled professionals in the midst of so much unmet health need
places Africa at the epicentre of the global health workforce
crisis.''.
(15) Ambassador Randall Tobias, now the Director of United
States Foreign Assistance and Administrator of the United
States Agency for International Development, has stated that
there are more Ethiopian trained doctors practicing in Chicago
than in Ethiopia.
(16) According to the United Nations Development Programme,
Human Development Report 2003, approximately 3 out of 4
countries in sub-Saharan Africa have fewer than 20 physicians
per 100,000 people, the minimum ratio recommended by the World
Health Organization, and 13 countries have 5 or fewer
physicians per 100,000 people.
(17) Nurses play particularly important roles in sub-
Saharan African health care systems, but approximately \1/4\ of
sub-Saharan African countries have fewer than 50 nurses per
100,000 people or less than \1/2\ the staffing levels
recommended by the World Health Organization.
(18) Paraprofessionals can be trained more quickly than
nurses or doctors and are critically needed in sub-Saharan
Africa to meet immediate health care needs.
(19) Imbalances in the distribution of countries' health
workforces represents a global problem, but the impact is
particularly acute in sub-Saharan Africa.
(20) In Malawi, for example, more than 95 percent of
clinical officers are in urban health facilities, and about 25
percent of nurses and 50 percent of physicians are in the 4
central hospitals of Malawi. Yet the population of Malawi is
estimated to be 87 percent rural.
(21) In parts of sub-Saharan Africa, such as Kenya,
thousands of qualified health professionals are employed
outside the health care field or are unemployed despite job
openings in the health sector in rural areas because poor
working and living conditions, including poor educational
opportunities for children, transportation, and salaries, make
such openings unattractive to candidates.
(22) The 2002 National Security Strategy of the United
States stated, ``The scale of the 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.''.
(23) Public health deficiencies in sub-Saharan Africa and
other parts of the developing world reduce global capacities to
detect and respond to potential crises, such as an avian flu
pandemic.
(24) On September 28, 2005, Secretary of State Condoleezza
Rice declared that ``HIV/AIDS is not only a human tragedy of
enormous magnitude; it is also a threat to the stability of
entire countries and to the entire regions of the world.''.
(25) Foreign assistance by the United States that expands
local capacities, provides commodities or training, or builds
on and enhances community-based and national programs and
leadership can increase the impact, efficiency, and
sustainability of funded efforts by the United States.
(26) African health care professionals immigrate to the
United States for the same set of reasons that have led
millions of people to come to this country, including the
desire for freedom, for economic opportunity, and for a better
life for themselves and their children, and the rights and
motivations of these individuals must be respected.
(27) Helping countries in sub-Saharan Africa increase
salaries and benefits of health care professionals, improve
working conditions, including the adoption of universal
precautions against workplace infection, improve management of
health care systems and institutions, increase the capacity of
health training institutions, and expand education
opportunities will alleviate some of the pressures driving the
migration of health care personnel from sub-Saharan Africa.
(28) While the scope of the problem of dire shortfalls of
personnel and inadequacies of infrastructure in the sub-Saharan
African health systems is immense, effective and targeted
interventions to improve working conditions, management, and
productivity would yield significant dividends in improved
health care.
(29) Failure to address the shortage of health care
professionals and paraprofessionals, and the factors pushing
individuals to leave sub-Saharan Africa will undermine the
objectives of United States development policy and will subvert
opportunities to achieve internationally recognized goals for
the treatment and prevention of HIV/AIDS and other diseases, in
the reduction of child and maternal mortality, and for economic
growth and development in sub-Saharan Africa.
SEC. 4. SENSE OF CONGRESS.
It is the sense of Congress that--
(1) the United States should help sub-Saharan African
countries that have not already done so to develop national
human resource plans within the context of comprehensive
country health plans involving a wide range of stakeholders;
(2) comprehensive, rather than piecemeal approaches to
advance multiple sustainable interventions will better enable
countries to plan for the number of health care workers they
need, determine whether they need to reorganize their health
workforce, integrate workforce planning into an overall
strategy to improve health system performance and impact,
better budget for health care spending, and improve the
delivery of health services in rural and other underserved
areas;
(3) in order to promote systemic, sustainable change, the
United States should seek, where possible, to strengthen
existing national systems in sub-Saharan African countries to
improve national capacities in areas including fiscal
management, training, recruiting and retention of health
workers, distribution of resources, attention to rural areas,
and education;
(4) because foreign-funded efforts to fight HIV/AIDS and
other diseases may also draw health personnel away from the
public sector in sub-Saharan African countries, the policies
and programs of the United States should, where practicable,
seek to work with national and community-based health
structures and seek to promote the general welfare and enhance
infrastructures beyond the scope of a single disease or
condition;
(5) paraprofessionals and community-level health workers
can play a key role in prevention, care, and treatment
services, and in the more equitable and effective distribution
of health resources, and should be integrated into national
health systems;
(6) given the current personnel shortages in sub-Saharan
Africa, paraprofessionals represent a critical potential
workforce in efforts to reduce the burdens of malaria,
tuberculosis, HIV/AIDS, and other deadly and debilitating
diseases;
(7) it is critically important that the governments of sub-
Saharan African countries increase their own investments in
education and health care;
(8) international financial institutions have an important
role to play in the achievement of internationally agreed upon
health goals, and in helping countries strike the appropriate
balance in encouraging effective public investments in the
health and education sectors, particularly as foreign
assistance in these areas scales up, and promoting
macroeconomic stability;
(9) public-private partnerships are needed to promote
creative contracts, investments in sub-Saharan African
educational systems, codes of conduct related to recruiting,
and other mechanisms to alleviate the adverse impacts on sub-
Saharan African countries caused by the migration of health
professionals;
(10) colleges and universities of the United States, as
well as other members of the private sector, can play a
significant role in promoting training in medicine and public
health in sub-Saharan Africa by establishing or supporting in-
country programs in sub-Saharan Africa through twinning
programs with educational institutions in sub-Saharan Africa or
through other in-country mechanisms;
(11) given the substantial numbers of African immigrants to
the United States working in the health sector, the United
States should enact and implement measures to permit qualified
aliens and their family members that are legally present in the
United States to work temporarily as health care professionals
in developing countries or in other emergency situations, as in
S. 2611, of the 109th Congress, as passed by the Senate on May
25, 2006;
(12) the President, acting through the United States
Permanent Representative to the United Nations, should exercise
the voice and vote of the United States--
(A) to ameliorate the adverse impact on less
developed countries of the migration of health
personnel;
(B) to promote voluntary codes of conduct for
recruiters of health personnel; and
(C) to promote respect for voluntary agreements in
which individuals, in exchange for individual
educational assistance, have agreed either to work in
the health field in their home countries for a given
period of time or to repay such assistance;
(13) the United States, like countries in other parts of
the world, is experiencing a shortage of medical personnel in
many occupational specialties, and the shortage is particularly
acute in rural and other underserved areas of the country; and
(14) the United States should expand training opportunities
for health personnel, expand incentive programs such as student
loan forgiveness for Americans willing to work in underserved
areas, and take other steps to increase the number of health
personnel in the United States.
SEC. 5. ASSISTANCE TO INCREASE HUMAN CAPACITY IN THE HEALTH SECTOR IN
SUB-SAHARAN AFRICA.
Chapter 1 of part I of the Foreign Assistance Act of 1961 (22
U.S.C. 2151 et seq.) is amended by adding at the end the following new
section:
``SEC. 135. ASSISTANCE TO INCREASE HUMAN CAPACITY IN THE HEALTH SECTOR
IN SUB-SAHARAN AFRICA.
``(a) Assistance.--
``(1) Authority.--The President is authorized to provide
assistance, including providing assistance through
international or nongovernmental organizations, for programs in
sub-Saharan Africa to improve human health care capacity.
``(2) Types of assistance.--Such programs should include
assistance--
``(A) to provide financial and technical assistance
to sub-Saharan African countries in developing and
implementing new or strengthened comprehensive national
health workforce plans;
``(B) to build and improve national and local
capacities and sustainable health systems management in
sub-Saharan African countries, including financial,
strategic, and technical assistance for--
``(i) fiscal and health personnel
management;
``(ii) health worker recruitment systems;
``(iii) the creation or improvement of
computerized health workforce databases and
other human resource information systems;
``(iv) implementation of measures to reduce
corruption in the health sector; and
``(v) monitoring, evaluation, and quality
assurance in the health field, including the
utilization of national and district-level
mapping of health care systems to determine
capacity to deliver health services;
``(C) to train and retain sufficient numbers of
health workers, including paraprofessionals, to provide
essential health services in sub-Saharan African
countries, including financing, strategic technical
assistance for--
``(i) health worker safety and health care,
including HIV/AIDS prevention and off-site
testing and treatment programs for health
workers;
``(ii) increased capacity for training
health professionals and paraprofessionals in
such subjects as human resources planning and
management, health program management, and
quality improvement;
``(iii) expanded access to secondary level
math and science education;
``(iv) expanded capacity for nursing and
medical schools in sub-Saharan Africa, with
particular attention to incentives or
mechanisms to encourage graduates to work in
the health sector in their country of
residence;
``(v) incentives and policies to increase
retention, including salary incentives;
``(vi) modern quality improvement processes
and practices;
``(vii) continuing education, distance
education, and career development opportunities
for health workers;
``(viii) mechanisms to promote productivity
within existing and expanding health
workforces; and
``(ix) achievement of minimum
infrastructure requirements for health
facilities, such as access to clean water;
``(D) to support sub-Saharan African countries with
financing, technical support, and personnel, including
paraprofessionals and community-based caregivers, to
better meet the health needs of rural and other
underserved populations by providing incentives to
serve in these areas, and to more equitably distribute
health professionals and paraprofessionals;
``(E) to support efforts to improve public health
capacities in sub-Saharan Africa through education,
leadership development, and other mechanisms;
``(F) to provide technical assistance, equipment,
training, and supplies to assist in the improvement of
health infrastructure in sub-Saharan Africa;
``(G) to promote efforts to improve systematically
human resource management and development as a critical
health and development issue in coordination with
specific disease control programs for sub-Saharan
Africa; and
``(H) to establish a global clearinghouse or
similar mechanism for knowledge sharing regarding human
resources for health, in consultation, if helpful, with
the Global Health Workforce Alliance.
``(3) Monitoring and evaluation.--
``(A) In general.--The President shall establish a
monitoring and evaluation system to measure the
effectiveness of assistance by the United States to
improve human health care capacity in sub-Saharan
Africa in order to maximize the sustainable development
impact of assistance authorized under this section and
pursuant to the strategy required under subsection (b).
``(B) Requirements.--The monitoring and evaluation
system shall--
``(i) establish performance goals for
assistance provided under this section;
``(ii) establish performance indicators to
be used in measuring or assessing the
achievement of performance goals;
``(iii) provide a basis for recommendations
for adjustments to the assistance to enhance
the impact of the assistance; and
``(iv) to the extent feasible, utilize and
support national monitoring and evaluation
systems, with the objective of improved data
collection without the imposition of
unnecessary new burdens.
``(b) Strategy of the United States.--
``(1) Requirement for strategy.--Not later than 180 days
after the date of enactment of this Act, the President shall
develop and transmit to the appropriate congressional
committees a strategy for coordinating, implementing, and
monitoring assistance programs for human health care capacity
in sub-Saharan Africa.
``(2) Content.--The strategy required by paragraph (1)
shall include--
``(A) a description of a coordinated strategy,
including coordination among agencies and departments
of the Federal Government with other bilateral and
multilateral donors, to provide the assistance
authorized in subsection (a);
``(B) a description of a coordinated strategy to
consult with sub-Saharan African countries and the
African Union on how best to advance the goals of this
Act; and
``(C) an analysis of how international financial
institutions can most effectively assist countries in
their efforts to expand and better direct public
spending in the health and education sectors in tandem
with the anticipated scale up of international
assistance to combat HIV/AIDS and other health
challenges, while simultaneously helping these
countries maintain prudent fiscal balance.
``(3) Focus of analysis.--It is suggested that the analysis
described in paragraph (2)(C) focus on 2 or 3 selected
countries in sub-Saharan Africa, including, if practical, 1
focus country as designated under the President's Emergency
Plan for AIDS Relief (authorized by the United States
Leadership Against Global HIV/AIDS, Tuberculosis, and Malaria
Act of 2003 (Public Law 108-25)) and 1 country without such a
designation.
``(4) Consultation.--The President is encouraged to develop
the strategy required under paragraph (1) in consultation with
the Secretary of State, the Administrator for the United States
Agency for International Development, including employees of
its field missions, the Global HIV/AIDS Coordinator, the Chief
Executive Officer of the Millennium Challenge Corporation, the
Secretary of the Treasury, the Director of the Bureau of
Citizenship and Immigration Services, the Director of the
Centers for Disease Control and Prevention, and other relevant
agencies to ensure coordination within the Federal Government.
``(5) Coordination.--
``(A) Development of strategy.--To ensure
coordination with national strategies and objectives
and other international efforts, the President should
develop the strategy described in paragraph (1) by
consulting appropriate officials of the United States
Government and by coordinating with the following:
``(i) Other donors.
``(ii) Implementers.
``(iii) International agencies.
``(iv) Nongovernmental organizations
working to increase human health capacity in
sub-Saharan Africa.
``(v) The World Bank.
``(vi) The International Monetary Fund.
``(vii) The Global Fund to Fight AIDS,
Tuberculosis, and Malaria.
``(viii) The World Health Organization.
``(ix) The International Labour
Organization.
``(x) The United Nations Development
Programme.
``(xi) The United Nations Programme on HIV/
AIDS.
``(xii) The European Union.
``(xiii) The African Union.
``(B) Assessment and compilation.--The President
should make the assessments and compilations required
by subsection (a)(3)(B)(v), in coordination with the
entities listed in subparagraph (A).
``(c) Report.--
``(1) In general.--Not later than 1 year after the date on
which the President submits the strategy required in subsection
(b), the President shall submit to the appropriate
congressional committees a report on the implementation of this
section.
``(2) Assessment of mechanisms for knowledge sharing.--The
report described in paragraph (1) shall be accompanied by a
document assessing best practices and other mechanisms for
knowledge sharing about human resources for health and capacity
building efforts to be shared with governments of developing
countries and others seeking to promote improvements in human
resources for health and capacity building.
``(d) Definitions.--In this section:
``(1) Appropriate congressional committees.--The term
`appropriate congressional committees' means the Committee on
Foreign Relations and the Committee on Appropriations of the
Senate and the Committee on International Relations and the
Committee on Appropriations of the House of Representatives.
``(2) Brain drain.--The term `brain drain' means the
emigration of a significant proportion of a country's
professionals working in the health field to wealthier
countries, with a resulting loss of personnel and often a loss
in investment in education and training for the countries
experiencing the emigration.
``(3) Health professional.--The term `health professional'
means a person whose occupation or training helps to identify,
prevent, or treat illness or disability.
``(4) HIV/AIDS.--The term `HIV/AIDS' has the meaning given
such term in section 104A(g) of the Foreign Assistance Act of
1961 (22 U.S.C. 2151b-2(g)).
``(e) Authorization of Appropriations.--
``(1) In general.--There are authorized to be appropriated
to the President to carry out the provisions of this section--
``(A) $100,000,000 for fiscal year 2007;
``(B) $150,000,000 for fiscal year 2008; and
``(C) $200,000,000 for fiscal year 2009.
``(2) Availability of funds.--Amounts made available under
paragraph (1) are authorized to remain available until expended
and are in addition to amounts otherwise made available for the
purpose of carrying out this section.''.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S8778-8780)
Read twice and referred to the Committee on Foreign Relations. (text of measure as introduced: CR S8614-8616)
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line