Health Worker Shortages Challenge PEPFAR Options for Strengthening Health Systems

When the President’s Emergency Program for AIDS Relief (PEPFAR) was launched in 2003, Congress overtly recognized the well-documented fact that the physical and human infrastructures essential to achieve the program’s ambitious goals in select HIV/AIDS-affected countries were deficient and that special steps would be warranted.

The United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (PL 108-25):

• Affirmed the need for “the strengthening of health care delivery systems and infrastructure”;
• Required a five-year strategy that includes:
  “training (particularly of health care workers),” and “
  incentives and programs…to stabilize health institutions by encouraging critical personnel to remain in their home countries”;
• Required spending on: “
  assistance to establish and implement programs to strengthen and broaden indigenous health care delivery systems and the capacity of such systems…including clinical training,” and “
  improved infrastructure and institutional capacity to develop and manage education, prevention, and treatment programs, including training…”; and
• Required an annual report that details “the progress made toward improving health care delivery systems (including the training of adequate numbers of staff) and infrastructure to ensure increased access to care and treatment.”