Opinions: Community-based health care models; U.S. leadership in reproductive health care

Dec 22 2009

'Accompaniment' Can Reform Health Care Around The World

"We don't need to start fresh to create patient-centered medical homes. We just need to look to community-based models of care that are effective but often go unrecognized," according to a Boston Globe opinion piece by Heidi Behforouz, the director of the Prevention and Access to Care and Treatment project, which is based on "a model that Partners in Health pioneered to fight HIV in rural Haiti and drug-resistant tuberculosis in Peru." According to Behforouz, community-based models of care might be overlooked "because much of the care is being delivered by 'paraprofessionals'' who have not been extensively schooled in the biomedical model and don't practice office-based care." She notes that community health workers' "schooling and expertise is in the art and science of what we call 'accompaniment.'"

"What do we mean by accompaniment? We mean that you walk with the patient - not behind or in front of her - lending solidarity, a shoulder, a sounding board, a word of counsel or caution. Empowering not enabling." According to Behforouz, "Accompaniment is a beautiful thing. As practiced in the central plateau of Haiti, the shantytowns of Peru, or Boston, it may just be what is needed to reform health care, here and abroad" (12/21).

U.S. Should Show 'Sustained' Leadership To Improve Women's Access To Reproductive Health Care

"The new [Obama] administration faces many urgent issues, but few are more critical or touch more people than the need to ensure that sisters, daughters, mothers and wives around the world all enjoy basic reproductive health and rights," Elizabeth Maguire - president and CEO of the nonprofit Ipas, who directed the U.S. government's international family planning assistance program between 1993 and 1999 - writes in a News & Observer opinion piece.

"Despite many challenges, solutions are within reach and affordable, and sustained U.S. leadership is critical," writes Maguire, who calls for the permanent repeal of the Mexico City policy. Maguire writes that "the good intentions of the Obama administration are hampered by harmful restrictions, including the ban on foreign aid for abortion known as the Helms amendment. Even without overturning the ban, the United States could do much more to support safe abortion care in cases of rape, incest or pregnancy that threatens a woman's life or health, including training and equipping health workers to provide safe abortions in these circumstances. Such assistance would help to reduce substantially complications of unsafe abortions" (12/19).