San Francisco Chronicle - December 1, 2004
Haile T. Debas

Both Tobias and WHO Director General Lee Jong-wook identified the same overwhelming barrier to rapid delivery of desperately needed anti-HIV medications -- the lack of trained health-care providers in the countries hardest hit by the AIDS epidemic. Indeed, Dr. Lee noted that for all of sub- Saharan Africa (population 682 million), there are only 600,000 health-care providers -- less than 1 per 1,000 people.

Experiences on two recent committees I chaired have reinforced the truth of their statements. In 2003, I co-chaired an Institute of Medicine committee that was charged to make recommendations on what would be required to increase the delivery of antiretroviral drugs -- those that stop the virus from replicating -- in developing countries. In addition, I serve on a U.N. Commission on HIV/AIDS and Governance in Africa. The information made available both through the institute and U.N. committees has led me to the conviction that the critical shortage of trained health-care providers threatens the success of all antiretroviral programs, and the only way to solve the health-care workforce problem in a sustainable and responsible way requires a dual strategy.

-- First, novel approaches to training the required health-care workers must be developed rapidly.

-- Second, these efforts must be driven and coordinated by the governments of the affected countries themselves.

More than 2 million individuals above age 15 in Tanzania -- to cite just one African county affected -- are estimated by WHO to be living with HIV, and an escalating tuberculosis crisis is driven by HIV infection (60,000 cases of TB in 2000). In addition, malaria is a major health problem exacerbated by HIV infection. Although Tanzania has an established health-care training and delivery infrastructure, the health-care provider shortages have threatened to diminish the impact of $207 million in approved funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

This situation gave UCSF Global Health Sciences an opportunity to collaborate with Tanzanian officials, with training as the central activity of the partnership. The first major joint effort will be aimed at training the workforce necessary to respond effectively to the need to increase delivery of antiretroviral treatment. An important resource UCSF and the Bay Area can provide is skilled physicians and nurse practitioners able to spend time abroad as trainers.

The need to respond aggressively and effectively to the AIDS pandemic will prompt increases in health-care providers not only for HIV/AIDS, but for all of the neglected diseases associated with poverty in Tanzania. If successful, the model that UCSF and Tanzania are developing to build workforce capacity in health care can be replicated in other poor countries suffering a high burden of disease.

Following the Bay Area's historic leadership in responding to the HIV/AIDS epidemic and recognizing the crucial role an academic health-sciences center must play in addressing global health issues, of which HIV/AIDS is arguably the most urgent, UCSF chancellor J. Michael Bishop established Global Health Sciences at UC San Francisco in 2003. This new campuswide initiative is providing leadership in global health and facilitates communication among different health-care providers in different disciplines -- medicine, nursing, pharmacy and allied-health technologies across international boundaries.

In keeping with UCSF's primary mission in education, a graduate program in Global Health Sciences will train a new generation of scientists who will redefine public health approaches for the 21st century. Thus, UCSF keeps faith with the historic commitment of the Bay Area to world health.

Dr. Haile T. Debas, a native of Eritrea, is executive director of UCSF Global Health Sciences, dean emeritus of the UCSF School of Medicine, vice chancellor emeritus for medical affairs at UCSF and a professor of surgery.

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