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Poverty Trap Formed by the Ecology of Infectious Disease Matthew H. Bonds, Pejman Rohani, Donald Keenan, Jeffrey Sachs

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Poverty Trap Formed by the Ecology of Infectious Disease Matthew H. Bonds, Pejman Rohani, Donald Keenan, Jeffrey Sachs

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    2. Three Paradigms of Global Health One major innovative aspect of this approach is its use of CHWs. Trained CHWs have been the foundation of the Consortiums work over 2 decades, and in just 3 years the Consortium has developed a network of more than 1000 CHWs in Rwanda. CHWs are the missing link between the clinic and the community. They perform essential services such as monitoring and supporting patients with chronic diseases in their own homes; identifying clinical, social and emotional problems before they become critical and encouraging community members to seek care when they are sick. With ongoing training and support, CHWs can rapidly become essential health personnel in settings where health systems are weak or underutilized. The Consortiums CHW model is designed to counteract obstacles to morale, retention and efficacy that can hinder success. For example, CHWs in many other programs may perform a limited set of activities; not be integrated with health center staff; have minimal training; be poorly equipped and be uncompensated. The Consortium has had considerable success in addressing these issues and, as a result, is currently working with GOR to develop a standard CHW model that can be used nationwide. Development of this national model is a central element in to GORs rural health care plan, and the work of the PHIT Partnership will be critical to eventual roll-out nationwide. Community-based Strengthening: 1. A cadre of CHWs of approximately 120 per health center, each serving a population of 20,000 to 30,000 persons, will be trained in health promotion and disease prevention services, including active case finding of the sick and vulnerable (as classified by a vulnerability index to be developed based on household characteristics such as child-headed households, malnutrition, etc.); 2. Comprehensive coverage will be achieved by assigning each CHW a geographical area encompassing 40-50 households, each of which will be visited at least one a month, and for which the CHW will be responsible for maintaining a household register/chart; 3. A strategy of Community Integrated Management of Childhood Illness (Community IMCI) will be implemented in all areas. The strategy includes two complementary and interrelated components: 1) growth monitoring, health promotion and illness prevention at home and in the community, and 2) integrated case management of childhood illnesses (with emphasis on malaria, diarrhea, pneumonia and malnutrition), neonatal and maternal care, including prenatal, postpartum and the provision of family planning services;(32) 4. Support from CHWs for patients with HIV and TB, e.g. daily accompaniment, social support, contact tracing, and adherence counseling; 5. Maintenance of a strong relationship with the closest health center will facilitate prompt referrals and serve as the base of CHW supervision and training; 6. A strong relationship with local government for coordination of health education campaigns, mutuelles enrollment and water and sanitation interventions. One major innovative aspect of this approach is its use of CHWs. Trained CHWs have been the foundation of the Consortiums work over 2 decades, and in just 3 years the Consortium has developed a network of more than 1000 CHWs in Rwanda. CHWs are the missing link between the clinic and the community. They perform essential services such as monitoring and supporting patients with chronic diseases in their own homes; identifying clinical, social and emotional problems before they become critical and encouraging community members to seek care when they are sick. With ongoing training and support, CHWs can rapidly become essential health personnel in settings where health systems are weak or underutilized. The Consortiums CHW model is designed to counteract obstacles to morale, retention and efficacy that can hinder success. For example, CHWs in many other programs may perform a limited set of activities; not be integrated with health center staff; have minimal training; be poorly equipped and be uncompensated. The Consortium has had considerable success in addressing these issues and, as a result, is currently working with GOR to develop a standard CHW model that can be used nationwide. Development of this national model is a central element in to GORs rural health care plan, and the work of the PHIT Partnership will be critical to eventual roll-out nationwide. Community-based Strengthening: 1. A cadre of CHWs of approximately 120 per health center, each serving a population of 20,000 to 30,000 persons, will be trained in health promotion and disease prevention services, including active case finding of the sick and vulnerable (as classified by a vulnerability index to be developed based on household characteristics such as child-headed households, malnutrition, etc.); 2. Comprehensive coverage will be achieved by assigning each CHW a geographical area encompassing 40-50 households, each of which will be visited at least one a month, and for which the CHW will be responsible for maintaining a household register/chart; 3. A strategy of Community Integrated Management of Childhood Illness (Community IMCI) will be implemented in all areas. The strategy includes two complementary and interrelated components: 1) growth monitoring, health promotion and illness prevention at home and in the community, and 2) integrated case management of childhood illnesses (with emphasis on malaria, diarrhea, pneumonia and malnutrition), neonatal and maternal care, including prenatal, postpartum and the provision of family planning services;(32) 4. Support from CHWs for patients with HIV and TB, e.g. daily accompaniment, social support, contact tracing, and adherence counseling; 5. Maintenance of a strong relationship with the closest health center will facilitate prompt referrals and serve as the base of CHW supervision and training; 6. A strong relationship with local government for coordination of health education campaigns, mutuelles enrollment and water and sanitation interventions.

    3. Three Paradigms of Global Health One major innovative aspect of this approach is its use of CHWs. Trained CHWs have been the foundation of the Consortiums work over 2 decades, and in just 3 years the Consortium has developed a network of more than 1000 CHWs in Rwanda. CHWs are the missing link between the clinic and the community. They perform essential services such as monitoring and supporting patients with chronic diseases in their own homes; identifying clinical, social and emotional problems before they become critical and encouraging community members to seek care when they are sick. With ongoing training and support, CHWs can rapidly become essential health personnel in settings where health systems are weak or underutilized. The Consortiums CHW model is designed to counteract obstacles to morale, retention and efficacy that can hinder success. For example, CHWs in many other programs may perform a limited set of activities; not be integrated with health center staff; have minimal training; be poorly equipped and be uncompensated. The Consortium has had considerable success in addressing these issues and, as a result, is currently working with GOR to develop a standard CHW model that can be used nationwide. Development of this national model is a central element in to GORs rural health care plan, and the work of the PHIT Partnership will be critical to eventual roll-out nationwide. Community-based Strengthening: 1. A cadre of CHWs of approximately 120 per health center, each serving a population of 20,000 to 30,000 persons, will be trained in health promotion and disease prevention services, including active case finding of the sick and vulnerable (as classified by a vulnerability index to be developed based on household characteristics such as child-headed households, malnutrition, etc.); 2. Comprehensive coverage will be achieved by assigning each CHW a geographical area encompassing 40-50 households, each of which will be visited at least one a month, and for which the CHW will be responsible for maintaining a household register/chart; 3. A strategy of Community Integrated Management of Childhood Illness (Community IMCI) will be implemented in all areas. The strategy includes two complementary and interrelated components: 1) growth monitoring, health promotion and illness prevention at home and in the community, and 2) integrated case management of childhood illnesses (with emphasis on malaria, diarrhea, pneumonia and malnutrition), neonatal and maternal care, including prenatal, postpartum and the provision of family planning services;(32) 4. Support from CHWs for patients with HIV and TB, e.g. daily accompaniment, social support, contact tracing, and adherence counseling; 5. Maintenance of a strong relationship with the closest health center will facilitate prompt referrals and serve as the base of CHW supervision and training; 6. A strong relationship with local government for coordination of health education campaigns, mutuelles enrollment and water and sanitation interventions. One major innovative aspect of this approach is its use of CHWs. Trained CHWs have been the foundation of the Consortiums work over 2 decades, and in just 3 years the Consortium has developed a network of more than 1000 CHWs in Rwanda. CHWs are the missing link between the clinic and the community. They perform essential services such as monitoring and supporting patients with chronic diseases in their own homes; identifying clinical, social and emotional problems before they become critical and encouraging community members to seek care when they are sick. With ongoing training and support, CHWs can rapidly become essential health personnel in settings where health systems are weak or underutilized. The Consortiums CHW model is designed to counteract obstacles to morale, retention and efficacy that can hinder success. For example, CHWs in many other programs may perform a limited set of activities; not be integrated with health center staff; have minimal training; be poorly equipped and be uncompensated. The Consortium has had considerable success in addressing these issues and, as a result, is currently working with GOR to develop a standard CHW model that can be used nationwide. Development of this national model is a central element in to GORs rural health care plan, and the work of the PHIT Partnership will be critical to eventual roll-out nationwide. Community-based Strengthening: 1. A cadre of CHWs of approximately 120 per health center, each serving a population of 20,000 to 30,000 persons, will be trained in health promotion and disease prevention services, including active case finding of the sick and vulnerable (as classified by a vulnerability index to be developed based on household characteristics such as child-headed households, malnutrition, etc.); 2. Comprehensive coverage will be achieved by assigning each CHW a geographical area encompassing 40-50 households, each of which will be visited at least one a month, and for which the CHW will be responsible for maintaining a household register/chart; 3. A strategy of Community Integrated Management of Childhood Illness (Community IMCI) will be implemented in all areas. The strategy includes two complementary and interrelated components: 1) growth monitoring, health promotion and illness prevention at home and in the community, and 2) integrated case management of childhood illnesses (with emphasis on malaria, diarrhea, pneumonia and malnutrition), neonatal and maternal care, including prenatal, postpartum and the provision of family planning services;(32) 4. Support from CHWs for patients with HIV and TB, e.g. daily accompaniment, social support, contact tracing, and adherence counseling; 5. Maintenance of a strong relationship with the closest health center will facilitate prompt referrals and serve as the base of CHW supervision and training; 6. A strong relationship with local government for coordination of health education campaigns, mutuelles enrollment and water and sanitation interventions.

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