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More Health Workers, Yes. But Only Within Better Systems

*This post is co-authored by Ruth Levine
In the Washington Post today, three doctors with sterling reputations in the AIDS world (Lola Daré, executive secretary of the African Council for Sustainable Health Development International and a member of CGD's working group on IMF programs and health spending; Paul Farmer, pioneer of new AIDS treatment programs in Haiti and Rwanda; and chief of Harvard Medical School's Department of Social Medicine Jim Kim, a member of CGD's working group on the Global Fund), call on the Bush Administration to spend $8 billion on training of community workers, nurses and doctors in Africa to deal with AIDS treatment.
Their proposition that many more community-level health workers be deployed to provide essential services, breaking the implicit and costly monopoly of health "professionals" on health delivery, makes eminent sense. But more money for training, without complementary institutional changes that fundamentally alter the incentives for workers at all levels, won't get the outcomes sought by those who are working on AIDS, or any other health challenges.

Knowledge = Better HIV Prevention

New findings from rigorous evaluations show some very encouraging results in HIV prevention, as Nancy Birdsall noted in yesterday's blog post: girls who are told that older men are more likely to be HIV- positive tend to avoid contact with them; when given free school uniforms, girls are more likely to stay in school and less likely to become pregnant; a curriculum that includes debates and essay-writing about preventing HIV increases condom use but not sexual activity.