A training session with the new accompagnateurs curriculum  in Burera, Rwanda.

Catalysts to Improving Health Care

PIH’s community-based model of care is designed to strengthen and complement existing public health systems to assure universal and sustained access to high-quality health services.

Often, however, public health facilities are in physical disrepair, with few medications and diagnostics and a poorly paid and disheartened staff. The public health system is especially underfunded and underused in the rural areas where PIH works, such as central Haiti or the mountains of Lesotho. While refurbishing and upgrading these facilities is critical, community health workers (CHWs) are the catalysts for revitalizing and expanding access to health services. They help ensure continuity of care in settings where there are few health professionals, where travel is difficult, and where chronic diseases require complex treatment regimens and ongoing monitoring. CHWs are the bridge between the health system and the community. As respected and knowledgeable members of the community, CHWs also broaden the clinical staff's understanding of the environments in which their patients live.

The key role played by community health workers, often referred to as accompagnateurs at PIH to reflect their role in accompanying patients through their illness, has been borne out by PIH’s success in treating AIDS in rural Haiti and multidrug-resistant tuberculosis (MDR TB) in the shantytowns of Lima, Peru: in both cases, CHWs oversee complex treatment regimens in patients’ homes. CHWs do much more than supervise the ingestion of pills, however; they provide social and emotional support, standing in solidarity with the poorest and most vulnerable members of the community, and help develop trust and confidence in the health sector. Today, PIH’s community-based approach has been adapted to programs in Rwanda, Lesotho, Malawi, Russia, and the United States.

In the following sections you will find descriptions of the main elements of PIH’s CHW programs, with guides and examples highlighting how the basic philosophical underpinnings have been adapted to meet the needs of communities in a variety of settings.

As this a work in progress, we welcome your feedback in the comments area and hope you will exchange ideas with us—sharing your own experiences, lessons learned, examples, and comments to help us promote the delivery of high quality health care to the world’s poorest communities.