From Aid to Accompaniment:

Building a Global Movement

Paul Farmer, Partners In Health, and the Accompaniment Model

Paul Farmer Bio

• • • • American anthropologist and physician MD and PhD from Harvard University Co-founder of Partners In Health (PIH) Serves on the Global Advisory Council of GlobeMed Dr. Paul Farmer, “the man who would cure the world”

What is Accompaniment?

“To accompany someone is to go somewhere with him or her, to break bread together, to be present on a journey with a beginning and an end...We’re not sure exactly where the beginning might be, and we’re almost never sure about the end. There’s an element of mystery, of openness, in accompaniment: I’ll go with you and support you on your journey wherever it leads. I’ll keep you company and share your fate for awhile. And by “a while,” I don’t mean a little while. Accompaniment is much more often about sticking with a task until it’s deemed completed by the person or people being accompanied, rather than by the accompagnateur.” -Dr. Paul Farmer, in address to Harvard Kennedy School of Government (May 2011)

An “O” for the “P”

• Creating a “preferential option for the poor” o Making the market work for the poor o How can first-rate healthcare be made available in a sustainable fashion?

Discussion Questions

1. Recall a time when you were accompanied. What was the context of your experience? 2. What did that feel like to be accompanied? 3. Can you describe a time when you accompanied another?

4. What was it like to accompany someone?

Three Tiered Understanding

1. Patient/Individual Level 2. Policy/Government/Organization Level 3. Social Movement Level

• •

1. Patient/Individual Level

Focus: the patient; most intimate level Community health workers, or “accompagnateurs,” visit homes of patients, attending appointments

2. Policy/Government/Organizational Level

• Focus: how to most effectively deliver foreign aid via a human rights-based approach • Partnering with governments to build the public sector through an accompaniment lens--meaning monetary, informational, and structural support

• • •

3. Social Movement Level

Focus: building a social movement Harness the power of large numbers through education, accompany the accompagnateurs Advocate for a transformation at the policy level in aid delivery

• • •

Why should you care?

Evidence Accompaniment in Practice Critiques of Development Addressed By Accompaniment

Effective

• • Rwanda HIV study-May 2012 -After 2 years, 92% of 1000 HIV patients who received daily visits from community health workers and other forms of social support still took ART medications regularly-- compare to 70% in sub-Saharan Africa and 55% in North America Haiti Cholera Vaccination study- October 2013 -3 years after the outbreak, 45, 417 people received the first of two doses, representing ~85% targeted audience; 91% received second dose

Accompaniment in Practice

Eight Principles for Effective Aid Delivery 1. Favor institutions that the poor identify as representing their interests 2. Fund public institutions to do their job 3. Make job creation a benchmark of success 4. Buy and hire locally 5. Co-investment with governments to build a strong civil service 6. Provide cash to the poorest 7. Support regulation of non-state service providers 8. Apply evidence based standards that offer the best outcomes

Critiques it addresses

• • Partnerships Long-term sustainability • Scalable

Not...

● Donor-Recipient ● Short-term, Project-based ● Static

Final Discussion

1. How do you understand accompaniment as a model now?

2. In what ways do we see accompaniment in our own work as GlobeMed members? 3. Though it is unrealistic to assume that everyone can directly accompany the poor in foreign countries, how is it possible to accompany those who are accompanying?

Learn More!

• • • • • •

Mountains Beyond Mountains: The Quest of Dr. Paul Farmer, a Man Who Would

Cure the World by Tracy Kidder Pathologies of Power: Health, Human Rights, and the New War on the Poor by Paul Farmer Foreign Affairs article : “Partners in Help: Assisting the Poor Over the Long Term” “Accompaniment as Policy”: Address to the Harvard Kennedy School of Government, May 2011 Rwanda case study: http://www.pih.org/blog/rwanda-study-community-based-hiv program-yields-high-success-rates Haiti case study http://www.pih.org/blog/research-on-pih-cholera-vaccine-project released-in-journal