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

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.