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Amigas de la salud - Juntos vivimos mejor

"Much of what a doctor or nurse now does can be done as effectively, or sometimes even more effectively, by community health workers operating in the community, and providing home-based care." - Jeffrey SachsEconomist and Director of the Earth Institute, Columbia University (6/9/11) - http://www.huffingtonpost.com/jeffrey-sachs/how-communities-can-end-a_b_874415.html

Photo of Juan Cajiao
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See video for explanation -  http://www.youtube.com/watch?v=upf2ZX2VMow

How do you envision this idea making money?

1. Daily micro payments from families involved in the program. For example for every 1000USD of monthly expenses, 100 families could pay 0.50 US$ (cents) per working day (20days/month). This concept is a build up from Victor Perl's concept: "Food subscription + Food insurance". 2. Sponsorships coming from the promotion of health related initiatives and products, including other activities within "Juntos vivimos mejor". 3. Donations. 4. Other: this will reduce the number of patients in the national health system. if there are resources allocated in the public budget that could be use in this type of initiative.

How does this idea create social impact, particularly around improving health?

1. Spreads health care knowledge promoting prevention. 2. Reduces impact of high impact easy curable diseases(diarrhea, flu (pneumonia)) due to timely diagnosis and treatment. 3. Provides jobs. 4. Provides opportunities for personal/professional development. 5. Creates a network to reach the community around health related aspects. 6. Promotes community values.

How does this idea add social value at every step of the process?

Similar to previous answer. 1. Spreads health care knowledge promoting prevention. 2. Reduces impact of high impact easy curable diseases(diarrhea, flu (pneumonia)) due to timely diagnosis and treatment. 3. Provides jobs. 4. Provides opportunities for personal/professional development. 5. Creates a network to reach the community around health related aspects. 6. Promotes community values.

What are the short term steps we could take to implement this idea tomorrow?

1. Define Job Description. 2. Create training program. 3. Invest on medicines. 4. Recruit families 5. Recruit potential "Amigas de la Salud" through current community groups (religious, arts, sports, school, etc). 6. Provide training 7. Start the program

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Photo of Liz Cameron-Smith

Great idea Juan. I'm working on a similar project in Australia which aims to strengthen and empower a workforce of Aboriginal and Torres Strait Islander Health Workers. (Aboriginal and Torres Strait Islander people are far sicker than other Australians - on average men die 11 years younger and women die 9 years younger). Aboriginal and TSI Health Workers are absolutely essential to helping Aboriginal and Torres Strait Islander people feel culturally safe accessing health services (culturally/historically some are afraid of doctors and mainstream health services) and introducing illness prevention behaviours. The work of Health Workers has been demonstrated to be effective in improving health outcomes in their communities. Australia is currently looking at the roles they perform, the education/career pathways, how to support them, etc - if you want more info that could build up this idea then let me know. They do a very similar role to the one you are proposing and their could be some useful lessons learnt to share with you. Liz

Photo of Juan Cajiao

Hi Liz, thank you for the comment!

You mentioned something that I consider very important which is the cultural aspect.

In the past 60-40 years the Latin America health systems were aiming to provide centralized, institutionalized and professionalized services. One strong weakness of this approach is that it replaced the personal and customized contact with a series of processes in the shape of forms, appointments, calls. Many of them ended up becoming real nightmares for people with low income/education levels.

The HW have the potential to brake those cultural barriers. They resemble better the traditional approach, which was based on people who inherited basic knowledge on how to use natural products to cure others (chamán, curanderos or hierberos) and were highly approachable and respected in the community.

I am not sure how are the concepts/proposal taken forward from now on. But I can see that you have valuable expertise on the topic. Hopefully we will get back to it and improve it. If that is the case, I will per sure get back in touch with you.

Thanks!

Photo of Liz Cameron-Smith

Hey Juan,

There are definitely similarities with the experience of Aboriginal and Torres Strait Islander people here in Australia... Traditionally their culture involves a holistic approach to health care that includes total physical, emotional, spiritual, environmental, economical and community wellbeing. These aspects are all considered to be deeply interlinked. Mainstream western medicine involving a 10 minute doctor consultation and a few pills, with little time taken to explain the way western treatments work, are not culturally appropriate for many Aboriginal and Torres Strait Islander people --> this creates a barrier to health care, leading to poor identification and intervention, poor treatment compliance, and poor health outcomes. HWs have a huge impact in breaking down these cultural barriers and contributing to better health in their communities. This is why I like your idea! Similar models are working well here.

For me the challenge will be in turning it into a social business. In Australia these services are paid for by government funding so there is less opportunity to turn the model into a successful social enterprise given that people can get the same service for free (even though HWs need more funding than the government provides). I don't know as much about the Latin American context, but I'd be interested to see this idea in action to see whether it is able to create sustainable revenue streams.

Good luck with it! Would love to contribute what I can if you get the chance to take it further.

All the best,

Liz

Photo of Liz Cameron-Smith

Hey Juan,

There are definitely similarities with the experience of Aboriginal and Torres Strait Islander people here in Australia... Traditionally their culture involves a holistic approach to health care that includes total physical, emotional, spiritual, environmental, economical and community wellbeing. These aspects are all considered to be deeply interlinked. Mainstream western medicine involving a 10 minute doctor consultation and a few pills, with little time taken to explain the way western treatments work, are not culturally appropriate for many Aboriginal and Torres Strait Islander people --> this creates a barrier to health care, leading to poor identification and intervention, poor treatment compliance, and poor health outcomes. HWs have a huge impact in breaking down these cultural barriers and contributing to better health in their communities. This is why I like your idea! Similar models are working well here.

For me the challenge will be in turning it into a social business. In Australia these services are paid for by government funding so there is less opportunity to turn the model into a successful social enterprise given that people can get the same service for free (even though HWs need more funding than the government provides). I don't know as much about the Latin American context, but I'd be interested to see this idea in action to see whether it is able to create sustainable revenue streams.

Good luck with it! Would love to contribute what I can if you get the chance to take it further.

All the best,

Liz

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