DECEMBER 2004/JANUARY 2005

Gilbert Kombe was told early that he would be an engineer. The men in the Kombe family in Zambia were always engineers. But little by little, as he realized that health, not engineering, was what his family talked about, as he watched his relatives struggle with illness year after year, even as he began to pursue his university degree in electrical engineering, he realized what he had to do. This family has enough engineers, Kombe thought. What we need is a doctor.

He discovered that the bilateral agreement between China and Zambia provided full medical scholarships for young Zambians, and he quit his engineering studies and made his way first to Beijing Language Institute-where he had eight months to learn enough Chinese to do his degree — and then to Tongji Medical University, China, where he received a Bachelor of Medicine and Bachelor of Surgery degree in 1989.

Returning to Zambia after graduation, he spent the next four years not only practicing medicine but also building and managing health programs, including a training program for the Zambian Red Cross Society, a diarrhea prevention program for the city of Kitwe, and a program to manage the implementation of health reform in the Kitwe Central Hospital.

Not surprisingly, Kombe was developing a career combining the compassion of the dedicated physician with the engineer's ability to design things on a large scale without missing crucial details. What he was helping to design and to build, program by program and eventually country by country, was better health systems.

Kombe is a gentle man who speaks with a soft intensity. He is always restless to do more, to build more. When he arrived in Washington, DC with his wife, Karin, in 1993 (they met at Tongji Medical University, where she was an instructor), he began riding his bicycle around the city, stopping in homeless shelters and offering his services.

Eventually he worked on a medical team, providing health care to the homeless. In the process he discovered something that surprised him: the medical issues facing the city's homeless — issues of access to care, and serious chronic illnesses and infectious diseases such as sexually transmitted diseases — were similar to those faced by the underserved populations in Zambia. The scope of his work has grown since then, yet it always has a way of circling back to Zambia.

Kombe eventually took a position as an assistant research professor at The George Washington University, where he directed a program that trained leaders of health systems in Eastern and Central Europe. He also co-directed a team of researchers that gave the District of Columbia data on the substance abuse problem among Hispanics in the city that they had not had before, and the city followed up with the same work for African Americans, focusing on mothers and children. His work has produced changes in how DC handles drug problems.

He has done consulting for the World Bank, the UN Economic Commission on Africa and other organizations. He serves as temporary technical advisor for the World Health Organization on issues of tuberculosis management and planning for Eastern and Central Europe. Recently he served as committee member for the Board on Global Health of the Institute of Medicine to look at the use of antiretroviral treatment in low resource settings.

His focus is often infectious diseases, a subject he cares deeply about. When he was a clinician in Zambia he witnessed too many preventable deaths from infectious illnesses, he says. Relatives and friends died unnecessarily.

Kombe has found that teaching is one of his first loves. It gives him a chance to spread his knowledge and passion. "Both my parents were teachers," he says. "Teaching is something I've always wanted to do. If I can teach someone to do something, that investment is long-term and will have effects for years to come."

When he joined Abt Associates in 2001, his experiences came together. As senior HIV/AIDS technical advisor for the Partnerships for Health Reformplus Project, funded by the US Agency for International Development, he works with low resource countries to develop national policies and plans, train healthcare workers and government officials, and generally plant seeds that will improve health systems to handle HIV/AIDS and other infectious diseases. He sees two principal challenges facing these countries: How to meet the requirements of international donors, which are sending billions of dollars to developing nations to address HIV/AIDS, tuberculosis and malaria, and how to sustain their health systems and programs when these funds run out, as most may by 2008.

In Uganda, he assisted in developing a national antiretroviral therapy policy, and for his native Zambia, he helped the government to estimate the resource requirements for scaling up antiretroviral treatment. The work for which he has received the most recognition, though, may be his studies on the next level of HIV/AIDS issues — the issues beyond the cost of drugs that are emerging as vital to sustaining the effort to arrest the pandemic. One of the principal issues is the effect of the international effort to fight HIV/AIDS on human resources.

"Money is not the issue now," Kombe says. "The issue is bodies to deliver the services." He notes that Zambia has a mere 687 doctors for its 10.9 million people, graduating just 49 new doctors every year. In even more severe straits, Ethiopia has just over 1,200 doctors for a population of 72 million. Kombe believes Ethiopia would need an additional 4,000-5,000 doctors just to meet the basic needs in the country.

The problem, he says, is the low salaries and benefits in each nation. Zambia loses half its new doctors every year, as they leave for more lucrative positions in foreign countries or with foreign organizations. The issue has received worldwide attention since Kombe started his research. A recent article in The New York Times noted that, according to the research group Joint Learning Initiative, "Africa needs to nearly triple the number of its health workers if it is to reverse plummeting life expectancies and combat pandemics of disease."

Kombe speaks out constantly on the issue. With the world still focused mainly on the cost of drugs, and on whether rich countries are contributing enough monetary resources to purchase the medicines needed for HIV/AIDS patients, Kombe sees the human resource issue as getting too little attention. "Human resource constraints may be as important as budgetary constraints," he told the XV International HIV/AIDS Conference in Bangkok, Thailand this past July.

Kombe is doing what he can to change how the world handles serious health problems. In many ways still the restless young man ready to learn and to build, he spends only a few days in the office every month. Besides conducting broad analytical activities, he leads management training programs in Africa as well as Eastern and Central Europe, and he continues to teach at The George Washington University. He mentors young people at Abt Associates whom he hopes eventually can do the work that he is doing.

But Kombe knows his heart. Zambia, after all, is still his home, and he believes that some day he will return to help his nation fight its battles against disease.

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