Last week’s presidential candidate forum on national service highlighted the theme of volunteerism common to the campaigns of John McCain and Barack Obama. Both promised to make service a priority and emphasized the value of expanding domestic and international service opportunities. CGD senior fellow Mead Over proposes one such opportunity in the Center’s latest book, The White House and the World: A Global Development Agenda for the Next U.S. President. Modeled after the Peace Corps, the U.S. Global Health Corps would provide young American doctors and nurses to help strengthen weak health systems. Over discussed the concept in a Q&A:
Q: What is your reaction to the attention given to national service in the presidential election?
A: It’s great, and I am pleased that the candidates are proposing expansion of overseas as well as domestic opportunities. But this is a different world than when I served in the Peace Corps 40 years ago. In those days, my bachelor’s degree seemed like valuable background to offer developing countries. While the Peace Corps can still find some positions for people who lack specialized training, recipient countries are asking for people with higher skills. The spirit of the Peace Corps in the 21st century can best be fulfilled if we create ways for highly skilled people to volunteer in poor countries.
Q: When did you first start thinking about the idea of a Global Health Corps, and why have you decided to put forward this proposal at this time?
A: I was very lucky to serve in the Peace Corps for two years in Burkina Faso, digging water wells from 1967 to 1969. Experiencing the hospitality of those villagers and learning something of their privations and their joys transformed me—I had been considering a career in advertising. So I began thinking about expanding the Peace Corps back then. More recently, as I studied the U.S. efforts to respond to the HIV/AIDS epidemic in poor countries, I tracked the debate about whether massive U.S. funding for the disease is undermining health systems by drawing skilled health personnel to work on HIV/AIDS instead of other serious health problems.
It occurred to me that the United States could partially address this issue by taking advantage of the extraordinary interest in the health of people in poor countries expressed by American students in college and medical school. Why couldn’t these American students of medicine, nursing and the other health sciences have a Peace Corps-like experience delivering basic health services to people like those villagers I had known in Burkina Faso? I started thinking this would be a win-win proposition. We would be helping the recipient country fill gaps in their health care system while simultaneously improving the quality of American health workers. Just like the original Peace Corps in other sectors.
Q: How do you envision the Global Health Corps matching the desires of Americans to serve with the needs of developing countries?
A: A young American college graduate who would like to teach in a poor country doesn’t necessarily need the Peace Corps or a similar government agency. He or she could travel to Africa, Latin America or Asia on his own to try to find a job. Or they could stay home and search the Web, applying to overseas jobs that are announced. But neither of these approaches is likely to work well. The magic of the Peace Corps is that it identifies the volunteer job opportunities in recipient countries, selects applicants who are likely to succeed, trains the volunteers for a few weeks in essential facts about the history, language and culture of the destination country and about the position to be filled, provides a safety net of support services in case of emergencies, and pays a small readjustment allowance to returning volunteers.
For health care volunteers, who are older and are likely to carry more debt than the average Peace Corps Volunteer, these services are even more critical in enabling overseas service. We propose that volunteers would receive an annual salary which would be smaller than what they would earn in the United States but substantially larger than that earned by U.S. Peace Corps Volunteers. However, all of that salary except a small living allowance would be paid to the volunteer on his or her return. In addition, we propose that the volunteer receive some student loan forgiveness, which would be indexed to the amount of debt on a sliding scale.
Q: Who would be the main actors involved in the creation and administration of this program?
A: There are several alternative approaches to realizing a Global Health Corps. The fact that so many U.S. schools of medicine, public health or health sciences have already begun to train and deploy Global Health Corps-type graduates on their own is a heartening sign that students and some educational institutions are eagerly seeking ways for students to serve overseas. So a minimalist approach would be to just expand funding for the global health service programs at U.S. medical and health institutions.
Other important actors are the medical schools and faculties and the practicing specialists located in recipient countries. In The White House and the World, we propose that every American volunteer doctor, nurse or other health worker be paired with a “mentor” from the same specialty who lives and works in the host country. The mentor would help the volunteer to adjust to the host institution, which will often lack the resources available in U.S. health care settings.
Q: Should the Global Health Corps be added to the responsibilities of the Peace Corps or should it be set up as a new and independent U.S. government agency?
A: We have proposed that the Global Health Corps start small, recruiting only 200 health workers the first year and rising to 1,700 in the third year. I think the first 200 candidates should be recruited, trained and deployed by the Peace Corps. As the program matures over the subsequent 3 or four years, Congress could decide to spin it off into a separate agency or to add a new department to Peace Corps to accommodate this role.
Q: With the United States facing many domestic and international challenges, how would you respond to those that argue scarce government funds could be put to better use elsewhere?
A: The U.S. Congress has just authorized $38 billion of new spending on AIDS over the next five years. We estimate the four-year cost of the Global Health corps to be $341 million. This seems a small cost to pay in order to offset some of the negative effects of PEPFAR on the health care systems of poor countries, especially if, as I believe, overseas service inspires medical volunteers to be better doctors, nurses and medical workers when they return.