Current challenges

The magnitude and urgency of identified health disparities, as well as the rapid growth of funding and political will among donor nations, has created a mandate to mount a major response quickly. Laudable goals, such as getting effective antiretroviral therapy to three million HIV/AIDS-infected individuals by the end of 2005, have been set without the operational and health services planning required for such a mammoth undertaking, and as a result the programs have not achieved their goals.

The Peace Corps ideal has spawned suggestions for donor-country basic scientists to build the scientific community in low- and middle-income countries, and for a clinical and preventive medical Peace Corps to provide services and training in areas of greatest need. WHO is addressing workforce issues to respond to emerging diseases, and the World Bank is expanding its health focus to meet the projected needs in surveillance, outbreak investigation, clinical care, and research. Other countries and non-government organizations are planning additional large-scale programs. We believe that the principles outlined in this chapter apply to these efforts, and that great care must be exercised in attempting such ambitious programs.

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