Global Fund must fund salaries of health workers to deliver HIV, TB and malaria treatments

In this week's PLoS Medicine, a team of international health experts issue a bold call to the Global Fund to Fight AIDS, TB, and Malaria: fund the salaries of health workers or else risk a situation in which medicines for these three diseases are made available in poor countries but there are no health professionals to deliver them.

"Recent comments from the inside of the Global Fund," say Gorik Ooms (Medecins Sans Fronti'res, Belgium) and colleagues, "suggest an intention to focus more on the three diseases, and to leave the strengthening of health systems and the support to the health workforce to others. This might create "Medicines Without Doctors" situations: situations in which the medicines to fight AIDS, Tuberculosis and Malaria are available, but not the doctors or the nurses to prescribe those medicines adequately."

It would be a strategic mistake, say the authors, for the Global Fund to create such a "Medicines Without Doctors" situation.

"The Global Fund has an advantage that makes it a key actor in the field of supporting health workforces," they say. "Most other donors are forced to aim for sustainability in the conventional sense, implying that beneficiary countries should gradually replace international funding with domestic resources, whereas the Global Fund has been promised sustained funding by the international community, allowing it to make sustained commitments to beneficiary countries. This is what some of the countries most affected by AIDS, Tuberculosis and Malaria need to increase their health workforce. Their health workforce challenges are too big to consider a gradual replacement of international funding with domestic resources."

Ooms and colleagues use the examples of two countries -- Mozambique and Malawi -- trying to fight against a full-blown AIDS epidemic with a fragile health system to underline the crucial role of Global Fund support to the health workforce. Mozambique, for example, estimates that in order to roll out HIV drug therapy across the country, it would need 8 health workers per 1000 patients receiving treatment. And yet currently, per 1000 people there are only 0.36 full-time equivalents of health workers. Mozambique simply does not have the domestic resources needed to pay for additional health workers, and Ooms and colleagues urge the Global Fund to step in and fund such a workforce.