Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘African Health Capac-
ity Investment Act of 2007’’. 
SEC. 2. DEFINITIONS. 
In this Act, the term ‘‘HIV/AIDS’’ has the meaning 
given such term in section 104A(g) of the Foreign Assist-
ance Act of 1961 (22 U.S.C. 2151b–2(g)). 
SEC. 3. FINDINGS. 
Congress makes the following findings: 
(1) The World Health Report, 2003, Shaping 
the Future, states, ‘‘The most critical issue facing 
health care systems is the shortage of people who 
make them work.’’. 
(2) The World Health Report, 2006, Working 
Together for Health, states, ‘‘The unmistakable im-
perative is to strengthen the workforce so that 
health systems can tackle crippling diseases and 
achieve national and global health goals. A strong 
human infrastructure is fundamental to closing to-
day’s gap between health promise and health reality 
and anticipating the health challenges of the 21st 
century.’’. 
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(3) The shortage of health personnel, including 
doctors, nurses, pharmacists, counselors, laboratory 
staff, paraprofessionals, and trained lay workers is 
one of the leading obstacles to fighting HIV/AIDS in 
sub-Saharan Africa. 
(4) The HIV/AIDS pandemic aggravates the 
shortage of health workers through loss of life and 
illness among medical staff, unsafe working condi-
tions for medical personnel, and increased workloads 
for diminished staff, while the shortage of health 
personnel undermines efforts to prevent and provide 
care and treatment for those with HIV/AIDS. 
(5) Workforce constraints and inefficient man-
agement are limiting factors in the treatment of tu-
berculosis, which infects over 1⁄3 of the global popu-
lation. 
(6) Over 1,200,000 people die of malaria each 
year. More than 75 percent of these deaths occur 
among African children under the age of 5 years old 
and the vast majority of these deaths are prevent-
able. The Malaria Initiative of President George W. 
Bush seeks to reduce dramatically the disease bur-
den of malaria through both prevention and treat-
ment. 
Paraprofessionals 
and 
community 
healthworkers can be instrumental in reducing mor-
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tality and economic losses associated with malaria 
and other health problems. 
(7) For a woman in sub-Saharan Africa, the 
lifetime risk of maternal death is 1 out of 16. In 
highly developed countries, that risk is 1 out of 
2,800. Increasing access to skilled birth attendants 
and access to emergency obstetrical care is essential 
to reducing maternal and newborn mortality in sub- 
Saharan Africa. 
(8) The Second Annual Report to Congress on 
the progress of the President’s Emergency Plan for 
AIDS Relief identifies the strengthening of essential 
health care systems through health care networks 
and infrastructure development as critical to the 
sustainability of funded assistance by the United 
States Government and states that ‘‘outside re-
sources for HIV/AIDS and other development efforts 
must be focused on transformational initiatives that 
are owned by host nations’’. This report further 
states, ‘‘Alongside efforts to support community ca-
pacity-building, enhancing the capacity of health 
care and other systems is also crucial for sustain-
ability. Among the obstacles to these efforts in many 
nations are inadequate human resources and capac-
ity, limited institutional capacity, and systemic 
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weaknesses in areas such as: quality assurance; fi-
nancial management and accounting; health net-
works and infrastructure; and commodity distribu-
tion and control.’’. 
(9) Vertical disease control programs represent 
vital components of United States foreign assistance 
policy, but human resources for health planning and 
management often demands a more systematic ap-
proach. 
(10) Implementation of capacity-building initia-
tives to promote more effective human resources 
management and development may require an ex-
tended horizon to produce measurable results, but 
such efforts are critical to fulfillment of many inter-
nationally recognized objectives in global health. 
(11) The November 2005 report of the Working 
Group on Global Health Partnerships for the High 
Level Forum on the Health Millennium Development 
Goals entitled ‘‘Best Practice Principles for Global 
Health Partnership Activities at Country Level’’, 
raises the concern that the collective impact of var-
ious global health programs now risks ‘‘undermining 
the sustainability of national development plans, dis-
torting national priorities, diverting scarce human 
resources and/or establishing uncoordinated service 
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delivery structures’’ in developing countries. This 
risk underscores the need to coordinate international 
donor efforts for these vital programs with one an-
other and with recipient countries. 
(12) The emigration of significant numbers of 
trained health care professionals from sub-Saharan 
African countries to the United States and other 
wealthier countries exacerbates often severe short-
ages of health care workers, undermines economic 
development efforts, and undercuts national and 
international efforts to improve access to essential 
health services in the region. 
(13) Addressing this problem, commonly re-
ferred to as ‘‘brain drain’’, will require increased in-
vestments in the health sector by sub-Saharan Afri-
can governments and by international partners seek-
ing to promote economic development and improve 
health care and mortality outcomes in the region. 
(14) Virtually every country in the world, in-
cluding the United States, is experiencing a shortage 
of health workers. The Joint Learning Initiative on 
Human Resources for Health and Development esti-
mates that the global shortage exceeds 4,000,000 
workers. Shortages in sub-Saharan Africa, however, 
are far more acute than in any other region of the 
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world. The World Health Report, 2006, states that 
‘‘[t]he exodus of skilled professionals in the midst of 
so much unmet health need places Africa at the 
epicentre of the global health workforce crisis.’’. 
(15) According to the United Nations Develop-
ment Programme, Human Development Report 
2003, approximately 3 out of 4 countries in sub-Sa-
haran Africa have fewer than 20 physicians per 
100,000 people, the minimum ratio recommended by 
the World Health Organization, and 13 countries 
have 5 or fewer physicians per 100,000 people. 
(16) Nurses play particularly important roles in 
sub-Saharan African health care systems, but ap-
proximately 1⁄4 of sub-Saharan African countries 
have fewer than 50 nurses per 100,000 people or 
less than 1⁄2 the staffing levels recommended by the 
World Health Organization. 
(17) Paraprofessionals and community health 
workers can be trained more quickly than nurses or 
doctors and are critically needed in sub-Saharan Af-
rica to meet immediate health care needs. 
(18) Imbalances in the distribution of countries’ 
health workforces represents a global problem, but 
the impact is particularly acute in sub-Saharan Afri-
ca. 
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(19) In Malawi, for example, more than 95 per-
cent of clinical officers are in urban health facilities, 
and about 25 percent of nurses and 50 percent of 
physicians are in the 4 central hospitals of Malawi. 
Yet the population of Malawi is estimated to be 87 
percent rural. 
(20) In parts of sub-Saharan Africa, such as 
Kenya, thousands of qualified health professionals 
are employed outside the health care field or are un-
employed despite job openings in the health sector in 
rural areas because poor working and living condi-
tions, including poor educational opportunities for 
children, transportation, and salaries, make such 
openings unattractive to candidates. 
(21) The 2002 National Security Strategy of 
the United States stated, ‘‘The scale of the public 
health crisis in poor countries is enormous. In coun-
tries afflicted by epidemics and pandemics like HIV/ 
AIDS, malaria, and tuberculosis, growth and devel-
opment will be threatened until these scourges can 
be contained. Resources from the developed world 
are necessary but will be effective only with honest 
governance, which supports prevention programs and 
provides effective local infrastructure.’’. 
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(22) Public health deficiencies in sub-Saharan 
Africa and other parts of the developing world re-
duce global capacities to detect and respond to po-
tential crises, such as an avian flu pandemic. 
(23) On September 28, 2005, Secretary of 
State Condoleezza Rice declared that ‘‘HIV/AIDS is 
not only a human tragedy of enormous magnitude; 
it is also a threat to the stability of entire countries 
and to the entire regions of the world.’’. 
(24) Foreign assistance by the United States 
that expands local capacities, provides commodities 
or training, or builds on and enhances community- 
based and national programs and leadership can in-
crease the impact, efficiency, and sustainability of 
funded efforts by the United States. 
(25) African health care professionals immi-
grate to the United States for the same set of rea-
sons that have led millions of people to come to this 
country, including the desire for freedom, for eco-
nomic opportunity, and for a better life for them-
selves and their children, and the rights and motiva-
tions of these individuals must be respected. 
(26) Helping countries in sub-Saharan Africa 
increase salaries and benefits of health care profes-
sionals, improve working conditions, including the 
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adoption of universal precautions against workplace 
infection, improve management of health care sys-
tems and institutions, increase the capacity of health 
training institutions, and expand education opportu-
nities will alleviate some of the pressures driving the 
migration of health care personnel from sub-Saharan 
Africa. 
(27) While the scope of the problem of dire 
shortfalls of personnel and inadequacies of infra-
structure in the sub-Saharan African health systems 
is immense, effective and targeted interventions to 
improve working conditions, management, and pro-
ductivity would yield significant dividends in im-
proved health care. 
(28) Failure to address the shortage of health 
care professionals and paraprofessionals, and the 
factors pushing individuals to leave sub-Saharan Af-
rica will undermine the objectives of United States 
development policy and will subvert opportunities to 
achieve internationally recognized goals for the 
treatment and prevention of HIV/AIDS and other 
diseases, in the reduction of child and maternal mor-
tality, and for economic growth and development in 
sub-Saharan Africa. 
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SEC. 4. SENSE OF CONGRESS. 
It is the sense of Congress that— 
(1) the United States should help sub-Saharan 
African countries that have not already done so to 
develop national human resource plans within the 
context of comprehensive country health plans in-
volving a wide range of stakeholders; 
(2) comprehensive, rather than piecemeal ap-
proaches to advance multiple sustainable interven-
tions will better enable countries to plan for the 
number of health care workers they need, determine 
whether they need to reorganize their health work-
force, integrate workforce planning into an overall 
strategy to improve health system performance and 
impact, better budget for health care spending, and 
improve the delivery of health services in rural and 
other underserved areas; 
(3) in order to promote systemic, sustainable 
change, the United States should seek, where pos-
sible, to strengthen existing national systems in sub- 
Saharan African countries to improve national ca-
pacities in areas including fiscal management, train-
ing, recruiting and retention of health workers, dis-
tribution of resources, attention to rural areas, and 
education; 
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(4) because foreign-funded efforts to fight HIV/ 
AIDS and other diseases may also draw health per-
sonnel away from the public sector in sub-Saharan 
African countries, the policies and programs of the 
United States should, where practicable, seek to 
work with national and community-based health 
structures and seek to promote the general welfare 
and enhance infrastructures beyond the scope of a 
single disease or condition; 
(5) 
paraprofessionals 
and 
community-level 
health workers can play a key role in prevention, 
care, and treatment services, and in the more equi-
table and effective distribution of health resources, 
and should be integrated into national health sys-
tems; 
(6) given the current personnel shortages in 
sub-Saharan Africa, paraprofessionals and commu-
nity health workers represent a critical potential 
workforce in efforts to reduce the burdens of ma-
laria, tuberculosis, HIV/AIDS, and other deadly and 
debilitating diseases; 
(7) it is critically important that the govern-
ments of sub-Saharan African countries increase 
their own investments in education and health care; 
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(8) international financial institutions have an 
important role to play in the achievement of inter-
nationally agreed upon health goals, and in helping 
countries strike the appropriate balance in encour-
aging effective public investments in the health and 
education sectors, particularly as foreign assistance 
in these areas scales up, and promoting macro-
economic stability; 
(9) public-private partnerships are needed to 
promote creative contracts, investments in sub-Saha-
ran African educational systems, codes of conduct 
related to recruiting, and other mechanisms to al-
leviate the adverse impacts on sub-Saharan African 
countries caused by the migration of health profes-
sionals; 
(10) colleges and universities of the United 
States, as well as other members of the private sec-
tor, can play a significant role in promoting training 
in medicine and public health in sub-Saharan Africa 
by establishing or supporting in-country programs in 
sub-Saharan Africa through twinning programs with 
educational institutions in sub-Saharan Africa or 
through other in-country mechanisms; 
(11) given the substantial numbers of African 
immigrants to the United States working in the 
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health sector, the United States should enact and 
implement measures to permit qualified aliens and 
their family members that are legally present in the 
United States to work temporarily as health care 
professionals in developing countries; and 
(12) the President, acting through the United 
States Permanent Representative to the United Na-
tions, should exercise the voice and vote of the 
United States— 
(A) to ameliorate the adverse impact on 
less developed countries of the migration of 
health personnel; 
(B) to promote voluntary codes of conduct 
for recruiters of health personnel; and 
(C) to promote respect for voluntary agree-
ments in which individuals, in exchange for in-
dividual educational assistance, have agreed ei-
ther to work in the health field in their home 
countries for a given period of time or to repay 
such assistance. 
SEC. 5. ASSISTANCE TO INCREASE HUMAN CAPACITY IN 
THE HEALTH SECTOR IN SUB-SAHARAN AFRI-
CA. 
Chapter 1 of part I of the Foreign Assistance Act 
of 1961 (22 U.S.C. 2151 et seq.) is amended— 
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(1) by redesignating the section 135 that was 
added by section 5 of the Senator Paul Simon Water 
for the Poor Act of 2005 (Public Law 109–121; 22 
U.S.C. 2152h note) as section 136; and 
(2) by adding at the end the following new sec-
tion: 
‘‘SEC. 137. ASSISTANCE TO INCREASE HUMAN CAPACITY IN 
THE HEALTH SECTOR IN SUB-SAHARAN AFRI-
CA. 
‘‘(a) ASSISTANCE.— 
‘‘(1) AUTHORITY.—The President is authorized 
to provide assistance, including providing assistance 
through international or nongovernmental organiza-
tions, for programs in sub-Saharan Africa to im-
prove human health care capacity. 
‘‘(2) TYPES OF ASSISTANCE.—Such programs 
should include assistance— 
‘‘(A) to provide financial and technical as-
sistance to sub-Saharan African countries in de-
veloping and implementing new or strengthened 
comprehensive national health workforce plans; 
‘‘(B) to build and improve national and 
local capacities and sustainable health systems 
management in sub-Saharan African countries, 
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including financial, strategic, and technical as-
sistance for— 
‘‘(i) fiscal and health personnel man-
agement; 
‘‘(ii) health worker recruitment sys-
tems; 
‘‘(iii) the creation or improvement of 
computerized health workforce databases 
and other human resource information sys-
tems; 
‘‘(iv) implementation of measures to 
reduce corruption in the health sector; and 
‘‘(v) monitoring, evaluation, and qual-
ity assurance in the health field, including 
the utilization of national and district-level 
mapping of health care systems to deter-
mine capacity to deliver health services; 
‘‘(C) to train and retain sufficient numbers 
of health workers, including paraprofessionals 
and community health workers, to provide es-
sential health services in sub-Saharan African 
countries, including financing, strategic tech-
nical assistance for— 
‘‘(i) health worker safety and health 
care, including HIV/AIDS prevention and 
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