As the Bush administration shapes its plan to combat AIDS in Africa, Botswana's president, Festus G. Mogae, said Wednesday that one of the biggest obstacles to a rapid expansion of treatment for people with AIDS in his country is not so much a lack of money or drugs as a dearth of doctors, nurses, pharmacists and other health workers.
The nonprofit groups, foreign governments and international organizations that have come to help Botswana cope with its AIDS crisis have hired away many skilled health professionals in the country's public health system with offers of better pay and benefits, he said.
Mr. Mogae, who spoke at a day-long conference on the lessons of Botswana's experience sponsored by the Center for Strategic and International Studies, a research organization in Washington, said this internal brain drain had been compounded by the departure of doctors and nurses for other countries. Britain alone has recruited more than 120 of Botswana's nurses, Mr. Mogae said.
Botswana, where more than a third of adults in their prime are infected with H.I.V., the virus the causes AIDS, has sought to counter the loss of talent by recruiting health professionals from poorer African countries, which have their own AIDS crises, as well as from India and Cuba. "We'll be lucky if we get them," Mr. Mogae said at a news conference on Wednesday.
The shortage of people and a slower-than-expected pace in building clinics, laboratories and drug warehouses have delayed the expansion of Botswana's AIDS program.
It has been almost two years since Botswana -- one of the most prosperous, well-run countries in Africa -- began a national effort to provide free drug treatment to the estimated 110,000 people who need it.
So far only about 10,000 people are getting the help -- far fewer than Mr. Mogae had expected.
Botswana is paying for 70 percent of its AIDS program and the Bill and Melinda Gates Foundation and the Merck Company Foundation, the philanthropic arm of the pharmaceutical company, have each donated $50 million.
The Senate majority leader, Bill Frist, in introducing Mr. Mogae, hailed his outspoken leadership on AIDS in Botswana and noted Mr. Mogae's decision to publicly announce that he had been tested for H.I.V. Dr. Frist, who visited Botswana this year with a delegation of senators, said, "We can't underestimate the need for knowledgeable people."
President Bush has committed to a five-year, $15 billion AIDS plan for Africa and the Caribbean, more than half of it for drug treatment. Congress is expected to appropriate about $2 billion this year.
Dr. Ernest Darkoh, operational manager for Botswana's effort to expand treatment with antiretroviral drugs, said the loss of skilled people to the government's private partners, who can pay 5 to 10 times as much as the government, was a serious problem.