• Background
• Policy Base

Background
Churches and faith-based communities throughout the developing world – representing existing, sustainable infrastructure that is often underutilized -- are uniquely positioned to identify critical areas of improvement necessary to meet the goals of both the United States and the international community in responding to the global HIV and AIDS pandemic. From the perspective of our partners and programs on the ground, the critical shortage of health care workers and weak health systems is one of the key obstacles to scaling up access to effective HIV and AIDS prevention, treatment and care. As a community that intentionally seeks to serve the poor, it is clear that sustained commitment and creative action are necessary to develop and support the health workforce needed to ensure the well-being of those greatest in need while genuinely striving to achieve international commitments such as guaranteeing universal access to AIDS treatment by 2010.

Community health workers are a key building block needed to ensure the success and durability of the United States’ historic investments in the fight against global HIV and AIDS. Many mission clinics and hospitals have great experience training community-based health care workers. We have learned that with a minimal investment of time and money community-based health workers can be trained to respond to a wide-variety of the local populations’ health needs. In the face of a relentless AIDS pandemic and other poverty related health challenges, the fruits of this local capacity are immeasurable.

However, the faith community cannot adequately respond to the structural challenges of weak health systems and the severe shortage of health workers. The need is simply too great. Experts from the Joint Learning Initiative estimate that sub-Saharan Africa requires at least 1 million new health workers to meet essential health needs. We urge the U.S. to work with individual country governments to identify their specific needs and to work collaboratively in establishing best practices for community health workers and a sustainable commitment to health systems.

For example, a sustainable health workforce initiative will:
1. Train, retain and support at least 250,000 women & people living with HIV/AIDS community health workers in sub-Saharan Africa, who are paid a living wage, provided ongoing, onsite in-service training, and are integrated into public and private primary health systems;
2. Ensure that the increase in community-based health workers is accompanied by commensurate increases in funding for training, compensation and support targeted at increasing the supply of health professionals in numbers needed to effectively oversee and utilize these workers;
3. Where possible, the training and support for these new community health workers and health professionals should come from strengthened existing facilities, in particular public-sector health centers, rather than bringing in more expensive US subcontractors or faith based organizations without an ongoing field presence;
4. Invest new money into facilities as well as training and retention for local doctors and nurses to oversee the new numbers of health care workers.

In order to launch this sustainable initiative:
1. Money must be new and taken neither from, nor at the expense of AIDS or other health and poverty focused development accounts. We are only beginning to turn a corner that allows us to talk of long term, sustainable solutions. We must keep up the momentum by fully funding US AIDS programs as well as the Global Fund to fight AIDS, TB and Malaria. Any upcoming announcement of a U.S. Health Workforce Initiative should be considered a down-payment on a more substantial initiative to be included in the fiscal year 2008 budget request.
2. Any new health care worker initiative should be developed in consultation with host countries, responsive to local priorities and conditions, and working to support country ownership;
3. Volunteers and expatriates can play a role, but the most important task at hand is to build local capacity to deliver care with a local workforce.
4. Skills training should be done locally and decisions about appropriate prevention commodities or reproductive health information and referrals should be made by front line workers in the homes of the sick, not by US policy makers.
 

ELCA Policy Base
The ELCA social statement “For Peace in God’s World” affirms that “our nation has responsibility to contribute a portion of its wealth to people in poorer nations through effective economic assistance,” and that the purpose of such assistance “should be to reduce hunger and poverty in sustainable and environmentally sounds ways.” (16)

For Peace in God's World also acknowledges that "While the United States has been generous in providing humanitarian aid, our nation dramatically trails the rest of the industrialized world in providing development assistance relative to our production of wealth." (16)

The ELCA social statement “Sufficient, Sustainable Livelihood for All,” states that “Outrage over the plight of people living in poverty is a theme throughout the Bible. The poor are those who live precariously between subsistence and utter deprivation. It is not poor people themselves who are the problem, but the their lack of access to the basic necessities of life. Without such, they cannot maintain their human dignity.” (5)

“Sufficient, Sustainable Livelihood for All” also calls for “addressing the barriers individuals face in preparing for and sustaining a livelihood (such as lack of education, transportation, child care, and health care.)