Remarks to the AIDS Advisory Committee

Prepared Remarks of Elizabeth M. Duke, Ph.D.
Acting Administrator, Health Resources and Services Administration

Meeting of the AIDS Advisory Committee
Bethesda, Md..
November 1, 2001

Thank you for inviting me to be with you today.

I’d like to talk about HRSA’s budget, the reorganization we’re going through, and our plans for the future.  There is a common thread that runs through all that we’ve done and all that we will do, and that is this:  this president is determined to use HRSA to get more direct health care services to the people who need them.

In his fiscal year 2002 budget request, President Bush asked Congress for $1.3 billion to support our health centers program – that’s an additional $124 million over the FY 2001 appropriation. The increase is part of the President’s five-year plan to add 1,200 new health center sites and double the number of people who are served by the centers.

Health centers programs each year provide family-oriented preventive and primary health care services to more than 10.5 million people at 3,200 access points nationwide.  And they serve the people most affected by the AIDS epidemic.  If Congress approves the president’s plan, the number of access points would increase to 4,400 and the number of people served annually would grow to more than 20 million.

We’ve already begun working toward that goal.  In FY 2001, the fiscal year that ended Sept. 30, HRSA’s New Start/Expansion grants sent more than $38 million to health centers in 97 underserved communities to help them expand health care access for hundreds of thousands of individuals.

The President also asked for $1.8 billion for Ryan White programs in his FY 2002 budget, the same as the FY 2001 level and $214 million over FY 2000.

As you know, Congress has not yet passed HHS appropriations for FY 2002.  We have been operating under a continuing resolution since Oct. 1 and we continue to do so today.

As I said, President Bush and Secretary Thompson are determined to get as much of our money as they can into direct medical services for the people we serve.  I have been directed to take a number of internal changes to make sure we save money, streamline operations, and increase our efficient delivery of services.

Travel has been cut.  Speaking engagements have been curtailed.  HRSA has a great deal of modern video and computer technology that we can use to give people from remote locations electronic access to meetings and events.  We need to use those resources.  We’re going to save money on airplanes, hotels and restaurants because we want to spend as many HRSA dollars as is reasonably possible on the underserved across America.

We’re reorganizing HRSA to improve efficiency and streamline duplicative operations.  These changes, announced July 26, more equitably distribute the agency’s workload, improve our focus on key Presidential initiatives, and expand vital health care services to Americans.

The restructuring plan moved the National Health Service Corps, the Division of Scholarship and Loan Repayment, and the Division of Shortage Designation from the Bureau of Primary Health Care to its sister entity within HRSA, the Bureau of Health Professions.

The restructuring made sense because it put in a single bureau the entire spectrum of HRSA’s recruitment, training, loan, scholarship and placement programs for health professionals.  Consolidating responsibility for HRSA’s health professions programs within BHPr increases the internal coordination needed to ensure that the right number of health care professionals serve in the right places.

The restructuring also streamlined BPHC, enabling the bureau to target staff and resources on its core responsibility – expanding the health center system as President Bush wants.

This expansion will be a top priority for HRSA for many years and it will be a very visible task of great importance to the nation.  BPHC’s leadership in building and maintaining the health center network is widely respected.   Now, with this restructuring, they can turn their full attention toward making the planned expansion a success.  

The shift of the NHSC to BHPr also gives that bureau responsibility for a Presidential reform initiative designed to improve the Corps’ service to America’s neediest communities.  The initiative will examine several issues, including the ratio of scholarships to loan repayments, and will consider amending the Health Professional Shortage Area definition to include non-physician providers and J-1 and H-1C visa providers practicing in communities.  These efforts will enable the NHSC to more accurately define shortage areas and target placements to areas of greatest need.

More recently, further changes have been announced.

We’ve streamlined and centralized functions previously splintered throughout the agency by creating a single, unified office of communications and a new office of legislation.  Both will be located in my office, the Office of the Administrator.

These functions are logically concentrated there, since communicating the President’s message on our issues to the press, the public and members of Congress calls for discipline, clarity and direction from HRSA’s senior leadership.

Additionally, we’ve transferred the Office of Information Technology into my office.  This change gives additional prominence to OIT, which will play an increasingly decisive role in HRSA’s success, as more and more of our work goes online.  Given the growing complexity and astonishing range of today’s computer and video technology, we decided to establish OIT as an entity that can help us shape the future of HRSA’s initiatives and products – and not just the office we call when the darn computer freezes up.  They’ll still help us with that, of course.

We’re continuing to consolidate entities that do similar or complementary work at the Bureau of Health Professions, building on the earlier restructuring.  I know all of you have an interest in the National Health Service Corps as a source of clinicians for HIV programs.  We’ve bolstered them by abolishing the former Division of Scholarships and Loan Repayments and placing its functions in the Division of National Health Service Corps.

The HIV/AIDS Bureau will be adding the functions of two entities: the Office for the Advancement of Telehealth and the Center for Quality, both previously housed in the Administrator’s office.

Because the Office for the Advancement of Telehealth focuses on the use of telehealth technology to educate health professionals and share vital treatment information among them, it no longer fits in my office, whose communications emphasize broader messages to large groups.  But the work and missions of OAT and HAB logically coincide, since the health professionals the bureau supports can benefit greatly from this telehealth technology.

Few health providers in America are as reliant on the latest information on treatment, drug regimens and program evaluations to save their patients as the medical professionals who treat people with HIV/AIDS.  Telehealth technology can play a decisive role in getting life-saving information to HIV care providers in their home communities and in providing consultations on HIV care to physicians and nurses in remote locations.  The placement of OAT’s functions in HAB offers obvious benefits to all.

All of these changes have a single impetus at their core: to further HRSA’s mission to expand access to quality health care for all Americans who need it.  We are duty-bound to take whatever actions we can that will strengthen our ability to provide more direct medical care to the people who rely on us.  That’s what we’ve been doing since I came to HRSA in March, and that’s what we’ll continue to do in the future.

Thank you.