Compañeros en Salud (Fall 2023)

Project Background

Partners In Health (PIH) is an international health organization relentlessly committed to improving the health of the poor and marginalized. PIH partners with local governments to build local capacity and works closely with impoverished communities to deliver high-quality health care, address the root causes of illness, train providers, advance research, and advocate for global policy change.

The organization originally developed as a community health project in Haiti in the 1980s and has since expanded to several countries around the world, including Mexico. Since 2011, Compañeros En Salud (CES), Partners In Health in Mexico, has operated as a non-governmental organization that collaborates with the local Ministry of Health to strengthen healthcare delivery. Over the last decade, CES has developed and implemented numerous healthcare delivery innovations with remarkable outcomes.

Definition of Opportunity

The primary objective of this project is to create a comprehensive inventory of healthcare delivery innovations implemented by CES in Mexico. The inventory will not only highlight CES's achievements but also provide a global context by identifying and comparing similar innovations worldwide. To achieve this, the project will involve a meticulous scope review, thorough publication analysis, interviews with knowledgeable CES personnel, and contextualization with global examples.

Definition of Success

Success for this project entails producing a comprehensive report that showcases CES’ healthcare delivery innovations in an organized manner. The report will vividly describe each healthcare innovation, outlining its key implementation elements, highlighting the significant outcomes achieved, and offering insightful global comparisons. The document will be a valuable resource that not only demonstrates CES's contributions to healthcare delivery but also serves as a source of inspiration and learning for donors, local organizations, and government officials in Mexico. This success will be measured by the report's ability to effectively communicate CES's innovative approaches, engage stakeholders, and foster meaningful collaborations toward advancing healthcare practices and outcomes within Mexico's healthcare landscape.

Meet the Team

Compañeros en Salud (Fall 2022)

Project Background

Partners In Health (PIH) is an international health organization relentlessly committed to improving the health of the poor and marginalized. PIH partners with local governments to build local capacity and works closely with impoverished communities to deliver high-quality health care, address the root causes of illness, train providers, advance research, and advocate for global policy change.

The organization originally developed as a community health project in Haiti and has since expanded to several countries around the world, including Mexico. Since 2011, Compañeros En Salud (CES), Partners In Health in Mexico, has operated as a non-governmental organization that collaborates with the local Ministry of Health to strengthen healthcare delivery. To achieve comprehensive healthcare delivery, CES provides follow-up care for non-communicable diseases and maternal health patients with community health workers, known locally as Acompañantes.

Definition of Opportunity

Acompañantes care for members of their own community who have complex medical and social situations; the impact of their work on their own mental health – both its emotional burden and its therapeutic role – was highlighted in a CES quality improvement project to inform the creation of a comprehensive mental health pathway to care for the acompañantes. Programmatic changes suggestions done by current Acompañantes are being taken into consideration to allow wellness and professional growth opportunities for the whole team.

The Acompañantes program coordinators at CES are looking to develop a curricula through the fall of 2022 to later be implemented in 2023 - 2024 with the Acompañantes and Acompañantes supervisors to improve the personal and collective wellbeing of the current teams through techniques such as mindfulness and relaxation, gratefulness, purpose, creativity; as well as reinforce adequate team dynamics and communication that will allow for each CHW to feel as supported by CES as they care for their patients. Because supportive supervision plays a critical role in ensuring CHWs feel well-prepared to do their work, it is also important to expand training of CHW supervisors to enhance their current activities by gaining more knowledge on 1) other CHW programs, 2) popular education techniques and 3) practical use of Microsoft Office package; as well as developing more leadership skills such as team building and group dynamics, assertive communication, opportune feedback, etc.

Definition of Success

Development and creation of training materials and a work plan on the proposed subjects that can be delivered to the 9 groups of Acompañantes and 3 Acompañantes supervisors during the period of July 2023 – June 2024.

Meet the Team

Final Deliverable

ITESM (Spring 2021)

Project Background:

Since its founding in 1943, Monterrey Tech has quickly become one of the most prestigious universities in Latin America.  With 36 campuses in Mexico, the Tech has stood out for training leaders through quality education, research and innovative educational models. In August 2019, as an initiative by the School of Medicine and Health Sciences, and the School of Government and Public Transformation, the Initiative for the Institute of Global Health Equity (IESG in Spanish) emerged. As the first global health institute in Mexico, it seeks to be a leader in training and education of change agents, through research, innovation and knowledge translation, addressing the health inequities in Mexico and the world, based on the belief that health is a fundamental human right.

The Institute of Global Health Equity aspires to partner and work with leading local, national,and global organizations, including Partners In Health (PIH) and its sister organization in Mexico, Compañeros en Salud (CES).  PIH has created an organization to work with community members and university students called PIH Engage to help build a global movement for the right to health,  as well as recruit, train, and equip dedicated teams of volunteer community leaders who mobilize their communities in the fight for health equity. 

The IGHE is launching the first PIH Engage community outside of the United States, and already 15-20 Monterrey Tech students (most medical school students) from Guadalajara, Monterrey and Mexico City have indicated an interest in working together with PIH and CES as “CES Embajadores” (CES Ambassadors) in community building, fundraising, and advocacy on issues of health equity and social justice.

Opportunity:

IGHE is interested in partnering with this DAT and CES Embajadores to explore building new skills and capacities for advocacy on critical health care issues in Mexico. While PIH has built out PIH Engage Advocacy Resources resources in the US, there is nothing similar in Mexico. Our hope is to build these advocacy resources and capacity, sensitive to and adapted for the Mexican context.

 

Definition of Success:

Create and expand significantly the capacity of a student-led force for positively influencing health and equity policy in meaningful ways in Mexico. At the end of this collaboration we would like to have a solid and replicable framework for the rest of the teams that will emerge in the future, with strategies designed and adapted to the Mexican context.

Meet the Team:

Final Deliverables:

Advocacy Manuel

Fundraising Guide

Building a new university-based, interdisciplinary center for global health - ITESM, Mexico (Fall 2018)

Client Profile

The Tecnológico de Monterrey and its network of campuses throughout Mexico is committed to providing quality education, world-class research, and building innovative models for the benefit of society. With the leadership of ITESM’s School of Medicine and the School of Government, the University is looking to build a new interdisciplinary center for global health training and research with strong links to practice.

The DGHSM aims to be a global center of excellence that generates health through training, research, innovation and knowledge translation, addressing in a profound and interdisciplinary way the existing inequities in Mexico and the world, based on health as a human right.  The DGHSM aspires to lead in training, research, implementation and public policy development in Global Health and Social Medicine in Latin America, through the creation of integral solutions to address social factors and strengthen health systems with a preferential option for vulnerable populations.

Definition of Opportunity

ITESM’s DGHSM is currently exploring the possibility of partnerships with the Program on Global Surgery and Social Change (PGSSC) and the Partner In Health’s sister organization, Compañeros en Salud in Chiapas, Mexico.  The Program on Global Surgery and Social Change (PGSSC) is a collaborative effort between the Harvard teaching hospitals, Harvard Medical School/ Department of Global Health and Social Medicine, Boston Children’s Hospital (BCH) and Partners In Health (PIH).  This organization emerges out of work of the Lancet Commission on Global Surgery, tled by Dr. John Meara at Harvard Medical School (a 1986 ND graduate).  PGSSC’s objective is to advocate for Universal access to safe, affordable surgical and anesthesia care when needed. Compañeros en Salud is affiliated with Partners In Health and works in rural Chiapas Mexico to provide quality health care to underserved communities and hopes to serve as an inspiring model to train and accompany health professionals and community health workers, and to deliver quality health care in low resource settings in Mexico and elsewhere. Both PGSSC and PIH have deep ties to Notre Dame, and have served as clients on DAT projects over multiple semesters.

Initial Ideas

The ITESM Department of Global Health & Social Medicine is looking for models of university-based, interdisciplinary centers that work in the international context in close partnership with health service providers and policy makers.

●      ITESM is interesting in exploring different models of partnership that have been established for developing, first-rate, interdisciplinary global health centers that have strong links to practice, that highlight different institutional structures, incentives, and potential partnerships.

●      ITESM hopes to explore and expand partnerships with international development and health organizations, such as Compañeros en Salud, the Harvard Medical School and the University of Notre Dame, consistent with its strategic objectives.

●      ITESM is interested in implementing a framework to develop international partnerships.

Definition of Success

That ITESM uses the systematic examination of different examples and models for building an interdisciplinary, university based Center for Global Health with a strong link to practice in ways that it might serve as a roadmap for a path forward.

Recommendations

Continuing Understanding and Implementation of Accompaniment Strategies - PIH (Spring 2018)

Client Profile

Partners In Health (PIH) is an NGO that was founded on the principle of a preferential option of the poor in healthcare. Headquartered in Boston, the organization originally developed as a single community health project in Haiti, and has since expanded throughout Haiti and into a dozen other countries including Peru, Russia, and Mexico. PIH works in partnership with governments and local communities in each of these countries. The main goals of the organization are to provide healthcare to those most in need, to work to alleviate the causes of disease, and to share the ideas and lessons learned. 

Definition of Problem

 One of PIH’s key ideas is an approach to service through the model of accompaniment. The accompaniment approach to aid delivery is based on pragmatic solidarity with the poor.  It proposes to build long-term relationships and mandates walking side by side in partnership rather than leading.  This accompaniment model informs all of PIH's work; however, many within the organization of some 12,000 people are not terribly familiar with the accompaniment concept, and even among those who are familiar, most lack a deeper and more meaningful understanding of the idea of accompaniment and its applications to their work and lives.

Initial Ideas & Options

We will begin by working closely with the PIH Director of Human Resources in Boston, Cynthia Maltbie, and the Director of Clinical Practice and Quality Improvement, Anatole Manzi. This project proposes to organize the existing work that has been done on accompaniment training, and explore how it might be best utilized within PIH, especially in the relationships between the staff in the headquarters in Boston in partnership with those in the field.

Definition of Success

Refine and engage effective training/dialogue materials and other ways of engaging the PIH community on the understanding and use of the concept of accompaniment in all their work.

 

Development Team

Enhancing Understanding & Engagement in Accompaniment - PIH (Fall 2017)

Client Profile

Partners in Health (PIH) is an NGO that was founded on the principle of preferential option of the poor in healthcare. Headquartered in Boston, the organization originally developed as a single community health project in Haiti, and has since expanded throughout Haiti and into a dozen other countries including Peru, Russia, and Mexico. PIH works in partnership with governments and local communities in each of these countries. The main goals of the organization are to provide health care and education to those most in need, to work to alleviate the causes of disease, and to share the ideas and lessons learned . 

Definition of Opportunity

One of PIH’s central ideas is an approach to service through the model of accompaniment. The accompaniment approach to aid delivery is based on pragmatic solidarity with the poor.  It proposes to build long-term relationships and mandates walking side by side rather than leading.  This accompaniment model informs all of PIH's work; however, many within the organization are interested in a deeper and more meaningful understanding of the idea of accompaniment and its applications.

Initial Ideas & Options

·      Identify the key principles of accompaniment that can be shared within the organization (globally there are some 15,000 people working with PIH) to promote awareness and understanding of accompaniment and its applications. Identify the most effective training, engagement, and other modalities to help build awareness and engagement around this idea within the organization.  

·      Focus on opportunities related to the University of Notre Dame that highlight accompaniment in connection with liberation theology as seen in the book In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez.  There are mutiple opportunities for drawing from the work of past Notre Dame student teams on this topic, as well as an anticipated volume on the concept of accompaniment led by Paul Farmer, with co-editors Jennie Block and Steve Reifenberg. 

Definition of Success

Development and use of new, effective training materials and other ways of engaging the PIH community on the understanding and use of the concept of accompaniment in all their work.

Development Advisory Team

Recommendation

Rendering Accompaniment Visible - Partners in Health (Fall 2016)

Client Profile

Partners In Health (PIH) was originally founded as a community health project in Haiti in 1987 and has since expanded to sites in a dozen countries. The main goals of the organization are to provide quality health care to those most in need, while working to alleviate the causes of disease and to share lessons more broadly. PIH partners with governments to build effective health systems, as well as works to train members of the local community.  The great majority of the 13,000 people who work for PIH are community health workers typically called accompagnateurs – “those who accompany.” This approach is deeply informed by Catholic Social Teaching and the work of Fr. Gustavo Gutierrez.  PIH’s approach to service through accompaniment is a vision shared by an increasing number of development organizations, among them the Association of Volunteers in International Service (AVSI), Catholic Relief Services, and Caritas International.

Definition of Problem

How do we render more visible the concept and work of Accompaniment? Over the past two years, the Kellogg Institute has organized a project called “From Aid to Accompaniment” to explore and enhance the understanding of the concept of accompaniment. Public Affairs will publish a book on accompaniment in the spring 2017.  The lead author is Dr. Paul Farmer, and Steve Reifenberg and Jennie Block are co-editors. The title will be (something like) “A Partnership with the Poor: A Radical New Vision for More Effective Aid, Philanthropy, and Services.” The launching the book in spring 2017 provides a unique opportunity to raise awareness about the accompaniment concept. There will likely a book conference at ND in the fall 2017. The DAT will have access to manuscript as well as other related materials.

 Initial Ideas and Options

• Review the Kellogg Institute’s existing work on accompaniment http://kellogg.nd.edu/events/calendar/spring2016/accompaniment.shtml and the previous DAT projects through the International Development in Practice class https://intdev.squarespace.com/partners-in-health/  

• Survey "what works" to build the understanding and practice of accompaniment by health care providers- what is being done to teach and foster accompaniment as a practice and value right now in current education programs?  Speak with health care educators, curriculum designers and others who are training practitioners in the field.

• Explore the multiplicity of ways to share awareness and expand engagement of accompaniment through social media, film, advocacy campaigns, leadership development, etc. Think creatively. One past DAT developed a curriculum on accompaniment for GlobeMed, while another explored lessons from successful social movements.

• Imagine the concept of accompaniment serving as a feature of training and leadership development programs, exploring ways the practice of accompaniment is teachable and provides a pragmatic approach to implementing patient-centered thinking, community/family engagement, local empowerment and long term, sustainable health care improvement and systems change.

• How can the forthcoming book, conference, and related activities engage people in thinking about and better understanding accompaniment?

Development Advisory Team

Final Report

Hello, World!

Healthcare Delivery Expansion in Rural Mexico - Partners in Health (Fall 2015)

Client Profile

Partners in Health (PIH) is a global healthcare NGO founded in 1987 to provide a preferential option for the poor in healthcare. The organization originally developed as a community health project in Haiti and has since expanded to several countries around the world—Mexico being one of the most recent in 2012.  In Mexico, PIH operates through its sister organization, Compañeros en Salud (CES).  CES partners directly with the Mexican government to strengthen healthcare delivery in the rural state of Chiapas (the southernmost and poorest state in Mexico) by providing mentorship to recently graduated Mexican medical students serving in primary health clinics, training community health workers to support chronic diseases patients, and accompanying patients requiring higher level care as they navigate the health system.  

Definition of Problem

A young organization, CES is still working to develop new programs and expand its existing services in order to better deliver care to rural communities in Chiapas.  Beginning in 2012 with clinics in just two communities, the organization now operates clinics in ten communities and supports community health workers in six.  For many years, it was nearly impossible to find medical doctors to serve the rural clinics in Chiapas. Today, CES’s global health education model attracts medical students from top medical schools throughout all of Mexico.  Through its “Right to Health” reference program, CES is able to assist patients requiring more specialized attention beyond just primary care coverage.  Given the diversity of these operations, there are many paths for CES to pursue in the future, and it is still uncertain where the organization should best invest its resources to maximize impact.  CES would like to work with a Development Advisory Team to investigate and evaluate different strategic options for the organization’s future.

 Initial Ideas and Options

• Explore the costs and the benefits of options such as:
  • Expanding the number of clinics supported in Chiapas
  • Expanding the types of health coverage provided
  • Expanding services to another state in Mexico
  • Increasing focus on the policy level
  • Increasing focus on medical education
• Work closely with CES staff to understand the organization and its current operations.
• Identify organizations that have faced similar dilemmas in expansion and development.  Write short case studies that draw lessons from those experiences.

Definition of Success

 A systematic report exploring options for CES’s future activities, based on evaluation of each of the above potential options and comparative analysis of similar organizations, that helps us to understand how each strategy would increase our impact, and provide the basis for dialogue within the organization to consider these strategic options.

Recommendation 

Presentation

Report

From Aid to Accompaniment -Partners in Health (Fall 2014)

Client Profile

Partners in Health (PIH) was founded in 1987 to bring quality medical care to rural Haiti.  Since then, PIH has expanded to several countries around the world including Rwanda, Lesotho, Malawi, Russia, Peru, and Navajo Nation in the United States.  PIH also partners with several sister organizations to increase its ability to further its mission.  In 2012, PIH launched its newest project in the Chiapas region of Mexico.  PIH draws on the world’s best medical institutions to provide a preferential option for the poor in health care.  According to PIH’s mission statement, its mission is both medical and moral, and it is based on solidarity rather than charity alone.

See all Development Advisory Team projects with Partners in Health

Definition of Problem

One of PIH’s principal ideas is the approach to service, partnership, and engagement through accompaniment. The accompaniment approach to aid delivery is based on pragmatic solidarity with the poor. It proposes to build a different long-term relationship between that is traditional called “donor” and “recipient” and mandates walking side-by-side rather than leading. This model informs all the PIH does, including the way in which PIH uses funds to invest in the local community and meets the needs identified by local people. PIH believes that this idea—“from aid to accompaniment”—needs to become a much great part of the dialogue on international development, including the ways that an organization like PIH needs to “accompany” the public sector in the countries where it works. Although people inside and outside the organization often hear the term “accompaniment” many would have a hard time defining it and articulating how the principles impact the work of PIH. We hope to build awareness of this idea, and see how it can be integrated more fully into the training of PIH staff and friends, as well as serve as a training model for other interested organizations.

Initial Steps and Options

• Identify key principles of teaching of the concept “accompaniment” and how those concepts could most usefully be developed in an organizational context
• Working with the client, identify three to five non-profit or for-profit organizations that are particularly effective in training about key organizational concepts. Write short case studies that draw lessons from those experiences that would be useful to PIH as it is designing its own training programs.
• Promote awareness of this concept on a wider scale. How can PIH and other development organizations effectively engage people in a deeper understanding of the concept of accompaniment?

Definition of Success

It would be enormously helpful to have 1) an excellent set of three to five case studies of organizations particularly effective at training about key organizational concepts, and 2) outline (ideally with lesson plans) of a model for training new PIH staff members on the concept of accompaniment.

Recommendation

Presentation

Report

Development Advisory Team Biographies  

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From Aid to Accompaniment - Partners in Health (Spring 2014)

Client Profile

Partners in Health (PIH) was founded in 1987 to bring quality medical care to rural Haiti.  Since then, PIH has expanded to several countries around the world including Rwanda, Lesotho, Malawi, Russia, Peru, and Navajo Nation in the United States.  PIH also partners with several sister organizations to increase its ability to further its mission.  In 2012, PIH launched its newest project in the Chiapas region of Mexico.  PIH draws on the world’s best medical institutions to provide a preferential option for the poor in health care.  According to PIH’s mission statement, its mission is both medical and moral, and it is based on solidarity rather than charity alone.

See all Development Advisory Team projects with Partners in Health

Recommendation

Development Advisory Team Biographies

From Aid to Accompaniment - Partners in Health (Fall 2013)

Client Profile

Partners in Health (PIH) is an NGO that was founded in 1987 in Boston. The organization originally developed as a community health project in Haiti, and since then has expanded with multiple other sites in Haiti as well as sites in a dozen other countries. The main goals of the organization are: providing health care and education to those most in need, working to alleviate the causes of disease, and sharing the ideas and lessons learned from experiences with other countries and NGOs. PIH also trains members of the community and partners with public health systems to involve local people in their initiatives.

See all Development Advisory Team projects with Partners in Health

Definition of Problem

One of PIH’s principal ideas is the approach to service through accompaniment. The accompaniment approach to aid delivery is based on pragmatic solidarity with the poor.  It proposes to build a different long-term relationship between partners and mandates walking side by side rather than leading.

This model informs all that PIH does, including the way in which PIH uses funds to invest in the local community and meets the needs identified by local people. PIH believes that this idea — “from aid to accompaniment” – needs to become a much great part of the dialogue on international development. We hope to build awareness of this idea, and see how it can be integrated into the work of other organizations.

Initial Steps and Options

• Identify key principles of the concept “aid to accompaniment”: How might aid be invested on the local level to improve public services, accompany governments, create jobs, and directly empower the people?
• Promote awareness of this concept on a wider scale.  How can other development organizations effectively be partners in promoting the idea of accompaniment? What are the most effective modalities to help build a “social movement” around this idea? What similar language/themes are used by other organization to convey similar concepts to accompaniment?
• Focus on particular opportunities related to Notre Dame, that include the publication of a book in the early fall 2013 by Orbis Press called In the Company of the Poor: Conversations with Dr. Paul Farmer and Fr. Gustavo Gutiérrez, possibility of a conference on the topic, engagement of faculty and staff.

Recommendation