PIH ramps up advocacy efforts with focus
on community health workers and XDR-TB

Advocacy on behalf of social justice—standing up for those who cannot do so for themselves—is one of our oldest activities, one of the cornerstones of our agenda of service, training, advocacy, and research. Sometimes working quietly and behind the scenes, sometimes speaking out publicly and vociferously, we have given our support to a wide variety of issues relating to health, human rights, and equality of access to health care. From the halls of Congress and the boardrooms of international policymaking bodies to local rallies on the Boston Common and late-night envelope-stuffing parties, we have shown our commitment to health care for the poor in myriad ways.

Since the beginning of 2007, PIH has ramped up its advocacy activities aimed at having an impact on policy and funding priorities within national and international decision-making bodies. PIH staff have testified in Congress, participated in high-profile press conferences and taken a leading role at meetings organized by the World Health Organization (WHO) in Geneva. Recent advocacy efforts have focused on increasing awareness and funding to address both the health worker crisis in Africa and the global spread of extensively drug-resistant tuberculosis (XDR-TB).

Mobilizing to address the health worker shortage in Africa

PIH has worked closely with the office of Senator Richard Durbin (D-IL) in crafting legislation to address the crippling shortage of health care workers in Africa. According to recent WHO estimates, the region needs at least 1.5 million more healthcare workers, including more than 800,000 doctors, nurses and midwives. PIH has been influential in educating Congress that failing to address this crisis will undermine efforts to treat and prevent HIV/AIDS, reduce child and maternal mortality, and accelerate economic growth and development.

"Increased funding from governments and private donors to expand health services holds the promise of saving millions of lives in Africa," Paul Farmer pointed out. "But a severe shortage of health workers on the ground represents a tight bottleneck slowing the flow of resources to patients who need them."

In particular, PIH has emphasized the invaluable role of community health workers in providing the kind of community-based care that can reach the destitute villages and people who suffer most from poverty and disease. PIH has worked with Senator Durbin's office to incorporate language specifying support for paid community health workers into the African Health Capacity Investment Act. The bill was filed by a bipartisan group of Senators on March 7 and has been referred to the Senate Foreign Relations Committee. Its provisions include funding to help train, recruit and retain doctors, nurses and community health workers, especially in rural areas. The bill also requires the President to develop a coordinated strategy to promote health care capacity in Africa.

PIH's advocacy on behalf of community health workers has not been confined to Washington. In February, Dr. Wesler Lambert of Zanmi Lasante (PIH's partner organization in Haiti) participated in a two-day consultation on "Task Shifting" in Geneva organized jointly by the WHO and the Office of the US Global AIDS Coordinator. The meeting focused on developing a regulatory framework to support recruiting, training, and employing members of the community, including people living with HIV, to take on a wide range of tasks in prevention, testing, care and treatment of HIV. Dr. Lambert was asked to serve on an advisory group that will help develop guidelines to be submitted in November.

Responding to the threat of XDR-TB in HIV-affected areas

Another focus of PIH's reinvigorated advocacy work has been the emergence of extensively drug-resistant tuberculosis. While warning of the devastating impact the disease could have and calling for increased resources to fight it, PIH has rebutted what PIH Medical Director Joia Mukherjee calls "the myth that XDR-TB is untreatable." In fact, as PIH co-founders Paul Farmer and Jim Yong Kim pointed out during a recent press conference, PIH and our partner organizations in Peru and Russia have successfully treated numerous cases of what is now being called XDR-TB. What is new is the eruption of XDR-TB in southern Africa, where as much as one third of the adult population is infected with HIV.

On March 21, Joia Mukherjee testified on the burgeoning XDR-TB crisis before the U.S. House Foreign Affairs Sub-Committee on Africa and Global Health. She was joined by Mario Raviglione, director of the Stop TB Department of the WHO; Julie Gerberding, director of the U.S. Centers for Disease Control and Prevention; Kent Hill, Assistant Administrator for Global Health at USAID; and Ambassador Mark Dybul, the U.S. Global AIDS Coordinator.

After the government officials relayed the latest statistics on the epidemic, Dr. Mukherjee shared PIH's experiences with treating drug-resistant TB. Based on that experience, she concluded, "XDR-TB does not need to be a death sentence. If we can combine good infection control, good prevention strategies, and good therapy, we know from our past experience that we can curb this epidemic and save thousands of lives." She called on Congress to support the WHO's call for at least $650 million in emergency funding worldwide and Archbishop Desmond Tutu's appeal to the U.S. to provide $300 million in 2007.

Advocacy coordination across PIH's "four pillars"

This recent upsurge in advocacy work was spurred by concerted efforts to reinvigorate the Institute of Health and Social Justice as PIH's advocacy arm and to strengthen coordination on policy and advocacy with the other institutional pillars of our work – the Division of Social Medicine and Health Inequalities at the Brigham and Women's Hospital, the Department of Social Medicine at Harvard Medical School and the François-Xavier Bagnoud (FXB) Center for Health and Human Rights at the Harvard School of Public Health. PIH and the FXB Center have formed a joint Policy and Advocacy Coordination Group that meets regularly and has helped coordinate several legislative initiatives.

[published April 2007]