Transportation costs, social stigma, lack of information, discrimination, and time constraints are major barriers to medical care in poor communities. Even when treatment is free, these barriers prevent people from accessing necessary health care. For more than two decades, PIH has hired and trained community health workers (CHWs) as a solution to these problems.

CHWs help patients overcome obstacles to health care by accompanying patients through treatment, monitoring needs for food, housing, and safe water, leading education campaigns, and empowering community members to take charge of their own health. As members of the communities they serve, CHWs establish relationships of trust with their patients, bridging the gap between the clinic and the community.

CHWs help health care systems overcome personnel and financial shortages by providing high-quality, cost-effective services to community members in their homes, and by catching serious conditions at an early stage before they become more dangerous and expensive to treat. In addition, CHW programs boost the local economy by creating paying jobs.

Treating HIV and tuberculosis

Across PIH's sites, all patients beginning treatment for HIV/AIDS or tuberculosis (TB) are paired with a community health worker. Every day, these health workers visit patients in their homes to supervise treatment, ensuring they take their medications regularly and correctly. Over time, they teach their patients how to manage complex treatments, cope with side effects, and identify the signs and symptoms of impending illness. This support enables people with HIV or TB to live longer and healthier lives.

In Haiti, CHWs first began providing daily medications for people living with HIV in 1999. At that time, prevailing wisdom in public health claimed it was impossible to provide high-quality treatment and follow-up for people living with HIV in developing countries. But the success of PIH’s patients proved otherwise. CHWs allow PIH to begin treating patients in need of antiretroviral therapy less than two weeks after diagnosis, and keep these patients engaged in care despite the difficult settings.

A study of PIH’s HIV treatment efforts in Rwanda found that PIH’s patients were more likely to be retained in care, less likely to die, and less likely to be lost to follow-up when compared with patients in care at other facilities. In fact, more than 92 percent of PIH patients were still enrolled in care two years after they began HIV treatment. Learn more about PIH's work treating people with HIV/AIDS.

Training and paying community health workers

Despite the success of CHWs, too many developing countries lack the resources for strong public health systems. As a result, many of those who do make use of CHWs classify these positions as “health volunteers," denying essential workers fair payment and adequate training. International donors and many NGOs with much greater resources have followed suit.

There is no excuse for withholding payment for the highly skilled services of CHWs, who accompany patients through their greatest struggles and put themselves at daily risk of contracting deadly diseases. Furthermore, payment directly benefits the health and welfare of the community by providing jobs to local people. PIH provides and advocates for professional treatment of CHWs—including fair payment, ongoing training, and provision of necessary supplies—so they may perform their vital work to the highest standards.

Empowering communities

While making daily rounds to the homes of HIV and TB patients, CHWs strengthen connections between the clinic and the community. By accompanying patients day by day, they develop a deep awareness of the effects of illness and poverty in their communities. This knowledge helps CHWs address broader barriers to health, including oppression, violence, and social and economic injustice.

In Chiapas, Mexico, community health promoters (or promotores), conduct workshops and training sessions on themes such as building local health care systems, mental health, sexually transmitted infections, conflict resolution, and environmental health. In Boston, CHWs from PIH’s Prevention and Access to Care and Treatment Project (PACT), have created a network of support, education, and intervention for people in some of the city's poorest areas.