A report is calling for the creation of a U.S. Global Health Service comprised of doctors, nurses and other health care workers to help combat HIV/AIDS in the world's hardest hit countries. The authors of the study say the current lack of highly trained medical personnel is the biggest obstacle to caring for people with the life-long illness.

The study conducted by the non-partisan Institute of Medicine outlines a federal "service corps" made up of full-time, salaried medical professionals. Medical personnel would be offered monetary incentives, such as loan repayments and fellowships, to sign up for the service program.

Under the proposed Global Health Service, doctors, nurses and other health-care workers, would at first be sent to 15 countries hardest hit by HIV/AIDS, including Haiti, Botswana, Ivory Coast, Ethiopia, Guyana, Kenya, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam, and Zambia.

The report recommends stationing 150 highly-trained GHA workers overseas during the first year to help administer anti-retroviral therapy to infected individuals, many of whom may not be receiving the regimen properly, if at all, because of its complexity.

At present, the problem is a lack of qualified and trained medical personnel, according to Fitzhugh Mullan of George Washington University in Washington, who chaired the committee that issued the report. The report notes there are 11 pharmacists in all of Rwanda, among other severe shortages.

"There is about one physician for every 350 people in the United States. In Mozambique, there is one physician for every 30,000 people," Mr. Mullan said. "So the human resource circumstance is dramatically and devastatingly different as we enter into an epoch [era] when new treatment and prevention capabilities are at hand."

In 2003, Congress enacted President Bush's Emergency Plan for AIDS Relief, or PEPFAR, a five-year strategy which set aside $15 billion to fight the disease globally. The plan's goal is to treat two million people with anti-AIDS drugs, prevent seven million new infections and care for 10 million people living with HIV/AIDS. Fifty five percent of the plan's funds are earmarked for anti-AIDS therapy.

The Emergency Plan for AIDS Relief has provided treatment in countries where the disease is rampant. But the commission report says the shortage of health-care workers is so severe, it could ultimately get in the way of efforts to distribute medication.

The report, entitled Healers Abroad: Americans Responding to the Human Resource Crisis in HIV/AIDS, is a blueprint on how best to use the AIDS treatment dollars.

Commission member Harrison Spencer of the Association of Schools of Public Health says the idea is to make nations struggling with the chronic illness both stronger and more independent of donor countries.

"Because countries in which these programs are being carried out do not have the human capacity to actually be able to treat the people with AIDS and with malaria and TB [tuberculosis] as well, we think that a volunteer and even a paid global health service from the United States can actually help build sustainable workforce capacity and be able to actually have something sustainable that helps these countries address their health needs better," Mr. Spencer said.

The report proposes that Global Health Service workers have a range of technical skills, from managing finances to strengthening public health care systems.

The Institute of Medicine report calls for an international advisory committee to make suggestions to the Global Health Service.

The study was requested by the U.S. Global AIDS Coordinator at the State Department.