The World Health Organization has set a goal of providing anti-retroviral treatments to three million HIV-positive people in Africa by the year 2005. The United Nations estimates that currently, only 50,000 Africans get these medications. One major barrier to reaching more people is a lack of qualified health care workers to administer the drugs. This is why many organizations are seeking innovative ways to provide more health workers in Africa, using a Community Health Center model that is popular in America.
In one of Denver, Colorado's poorest neighborhoods, the Inner City Health Center is a busy place. Nestled next to some small apartment buildings, just three blocks from the local middle school and right across the street from a shopping mall, doctors and nurses here saw more than 20,000 patients this year.
"There's two bus lines that go right by the clinic, and then there's a light rail just a few blocks away. We're here to make it easier for them to get to us," said Clinic director Kraig Burleson. He pointed out that the Inner City Health Center also makes health care more affordable for its neighbors by discounting fees for medical services, and it promotes community connections by recruiting clinic workers and volunteers from the local area.
"We have some of our patients on our Board of Directors," said Burleson. "If you look at our staff makeup, you'll see as often as possible we hire from the community. We're very much vested in the community and feel it's an integral part of health and well-being."
Throughout the United States, 3,000 community health care centers serve 11 million people who might otherwise have trouble paying for a visit to the doctor. This leads Mr. Burleson to wonder about the situation in developing countries, such as those in Africa.
"If we need it as desperately as we need it here, then I can only imagine the need for it in a place that doesn't have what we have," he stressed. "It certainly would be much more necessary."
The HIV-AIDS pandemic makes the need in Africa urgent, according physicians attending the recent International Conference on AIDS and Sexually Transmitted Infections in Africa. Affordable medications are essential. But even if there were enough reasonably priced drugs for each HIV-positive African, many experts say that there aren't enough health workers and facilities to deliver the pills, or much of anything else.
"To give birth, you have to come with your own gloves, you have to come with everything," said Mariam Dao, a development expert from Ivory Coast. "So already, the basic needs cannot be matched with our health environment, so just think about a pandemic like HIV or any other pandemic."
Ms. Dao says that without dependable health care, there's no incentive for people to seek treatment, much less to be tested for HIV-AIDS or risk the stigma of inquiring about prevention. To encourage more people to trust the health care system, Ms. Dao's credit institution gives loans to local health leaders usually women, so they can start community run health care centers.
"It's not the government telling them, 'You have to do this, you have to do that.' They organize themselves," said Ms. Dao. 'They fix the fees, they even fix the fees for the doctor. They have a management committee, they supervise the doctor, they supervise the nurses."
To make these health centers accessible, Ms. Dao points out they're often set up next to a local market. "In Africa, a lot of women work in market, and market is a tremendous space of life," she said. "Children are educated in the market. The money for the family comes from the market. So what we are doing now on my organization's side is to help them have a better environment to do their business, but also to put close to this environment a health center and education center for the children."
The concept is supported by other non-governmental agencies, including Plan International, which combines health discussions with business and financial exchanges.
"We organize a kind of meeting, to speak about health," said Rabe Seck, the National Habitat and Livelihood Coordinator for Plan International in Senegal. She says clinic meetings address many needs. "Children's health and HIV, to inform communities, to inform woman about what they have to do to protect themselves," she explained.
What's more, she says, the meetings offer an opportunity to recruit the community's future health care workers. In countries short of doctors and nurses, the World Health Organization is working with governments to train non-professionals to help with HIV care. Mariam Dao says that having accessible health centers, staffed and managed by local people, will make these efforts more likely to succeed, while strengthening connections within the whole community.