Online Program

Adapting the partners in health community-based model of “accompaniment” to Rwanda's community health worker program

Tuesday, November 5, 2013

Didi Bertrand Farmer, MA, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Peter Niyigena, BA, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Elias Ngizwenayo, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Vincent Nsabimana, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Grace Ryan, BA, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Leslie Berman, MPH, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Daniel Palazuelos, MD, MPH, Partners in Health, Boston, MA
Michael L. Rich, MPH, MD, Partners In Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
Background: For more than 25 years, Partners in Health (PIH) has built community-based platforms for health delivery. From roots in Haiti, to countries around the world, this model includes a global network of “accompagnateurs”, community health workers (CHWs) supported by health systems to assist with diagnosis and care for infectious diseases, including TB and AIDS. Adapting accompaniment in rural Rwanda was central to the national goal of decentralizing services for HIV-affected Rwandans. We describe programmatic successes of the PIH-Ministry of Health (MOH) collaboration, and the process of integrating accompaniment within the Rwandan national community health system.

Methods and Results: In 2005, this collaborative model was introduced in Eastern Rwanda to reinforce the health system's capacity for community-based education, case finding, provision of DOT, and patient follow-up, while addressing structural barriers to diagnosis and care. Trusted friends and neighbors were trained as accompagnateurs to support patients' clinical and psychosocial needs, and to provide crucial linkages to social services for those suffering poverty, stigma, and social exclusion. The accompaniment intervention in two districts in Rwanda reported impressive clinical outcomes, demonstrating a 92.3% retention rate, with only 2.7% lost to follow-up.

Conclusions: To increase efficiency and reduce parallel programming, the PIH-MOH partnership works within the MOH management structure to scale up accompaniment. In PIH-supported districts, all CHWs now perform accompaniment for people living with HIV, TB, and other chronic diseases. Through integration, a national network of CHWs will provide community-based treatment and care for non-communicable diseases, and link communities with health facilities.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Program planning

Learning Objectives:
Discuss components of the Partners In Health model of accompaniment Describe the process of integrating a community-based model of care within a national community health worker program

Keyword(s): Community Health Programs, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a medical anthropologist who has been working for the last 15 years as a community organizer, activist for the rights of women and girls, and researcher in Paris, Haiti and Rwanda. Since 2006 I have served as Director of the Community Health Program for Partners In Health Rwanda-Inshuti Mu Buzima, where I am the Principle Investigator on several cross-site studies focusing on community health, reproductive health, and traditional healing.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.