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How Communities Can End AIDS

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We're now 30 years since AIDS was first identified as a newly identified killer disease, and roughly a decade since the world finally got organized to fight the pandemic. The global fight against AIDS today is led by a remarkable and committed army of activists, people living with AIDS, scientists, UN agencies, and national governments. Against all odds, it is now succeeding in turning the tide of the epidemic. The global conductor of the effort, Dr. Michel Sidibe of UNAIDS, is a wondrous and inspiring leader, who has enthralled the thousands of participants at this week's UN conference pledging to bring this pandemic to an end during this coming decade.

The HIV virus is an insidious killer, and so we require the best of science and social organization to defeat it. I am proud that the Earth Institute at Columbia University has today added a piece to the solution, by presenting at the UN meeting today a technical report on how Community Health Workers can play a vital role. The report, One Million Community Health Workers For Africa is the work of a technical task force of academic specialists, development practitioners, UN agencies, foundations, and private companies.

The gist of the report is the following. In the poorest countries, where the burden of disease is the greatest, the shortage of doctors and nurses need not prevent the effective control of diseases like AIDS, TB, and malaria. Much of what a doctor or nurse now does can be done as effectively, or sometimes even more effectively, by community health workers operating in the community, and providing home-based care. This may involve the diagnosis and treatment of malaria using cutting-edge diagnostics and medicines; or it may involve the life-saving treatment of diarrhea using oral rehydration; or it may entail the home-based delivery of medicines for AIDS or TB.

The key is to use cutting-edge methods to empower young men and women high-school graduates from the villages to create a new professional health workforce. According to the recommendations of the Community Health Worker Technical Task Force, these village-based workers need about one year training: three months in the classroom, and nine months in the field under supervision and testing. Virtually every village in the world has unemployed or under-employed high-school grads who will jump at the chance to build a career of life-saving skills.

Mobile phones and other information and communications technologies are also changing the game. The most important tool of the community health worker is her phone. The mobile phone can call the ambulance, get advice from the nurse in the clinic, or access a "smart" SMS system to retrieve patient information, get advice on drug doses, or log into a database on diagnostics. The smarter the phones, the smarter these systems are becoming. The progress month to month is mind-boggling.

The Earth Institute and many other partners, for example world-leading NGOs such as Save the Children and AMREF, UN agencies such as UNICEF, UNAIDS, and the UN Population Fund (UNFPA), and private-sector companies such as Merck are intent on working with African governments and communities to scale up these cutting-edge health systems as rapidly as possible. The best evidence suggests the need for one million community health workers in sub-Saharan Africa by 2015. We need to create a global network to accomplish this scale up. My hope is that the US government and European Union will join the effort. Yet if not, civil society can take up the challenge: universities, student groups, NGOs, activist groups, and of course, the communities themselves.

The overarching point of today's global health challenge is that we still lose millions of lives per year to diseases like AIDS and malaria that are wholly preventable or treatable, mainly because people in impoverished regions lack access to public basic health services. Every time that financial and human resources are directed to these challenges - whether fighting smallpox (now eradicated) or polio (almost eradicated), or malaria or AIDS - lo and behold, we achieve great progress: death rates down, new infections down, quality of life improved.

When it comes to public health, the skeptics, cynics, and uncaring have been disproved time and again. This coming decade can be the one in which a million new health leaders from the thousands of villages across Africa take their futures in their own hands, and help to create societies free of the killer scourges of AIDS, TB, malaria, and deaths in childbirth. Even from afar, we can support this effort through volunteer work, donations, social networking, and education programs. As the Community Health Worker Task Force Report makes clear, each of us in our own way can contribute to this safer, brighter, and healthier future.