As I stood in the middle of the Longwood Medical and Academic Area in Boston, I can’t help but be amazed by it all.
There I was, right at the heart of what is known as the “medical mecca” of Massachusetts, staring at the very structures famous the world over for innovations in the field of medicine. Many milestones had taken place here, such as the world’s first transplants, invention of important medical equipment and other research breakthroughs that help save lives to this day.
My amazement, however, was quickly replaced by a sobering thought—that despite the many valuable medical achievements that continue to take place in Longwood, many people also continue to suffer or even die not far away from this glorious area.
The United States (US) is, in fact, suffering from a health crisis.
In 2010 alone, the US spent close to 2.6 trillion on national health.¹ If this trend were to continue until 2025, estimates show that health care will eat up a staggering 25 percent of the country’s GDP.² Despite this outrageous spending, the country’s health indicators are among the worst of high-income countries. A combination of several factors contribute to this problem—the current fee-for-service system, shortage of primary care doctors, and rising poverty in the US are just among the many other reasons.
When I first arrived in the US for the GHC fellowship, I was at a complete loss and I found it very challenging to understand the country’s complex health care system. Colleagues advised me not to be too hard on myself; they explained that one can spend days, years even, trying to comprehend how the system works without getting to the bottom of it all. In the middle of this health care labyrinth, however, I did notice something recurring and undeniable—that the high costs spent on health care do not necessarily translate to high quality for patients.
I currently work with Prevention and Access to Care and Treatment (PACT), a partnership between Partners in Health and the Brigham and Women’s Hospital. Established in 1997, PACT is an expert in mobilizing Community Health Workers (CHWs)—skilled and dedicated interventionists uniquely positioned to address patients’ physical and mental health needs in the home and community.
Established in 1997, the project has helped provide direct services for HIV/AIDS patients in Boston. Guided by the spirit of accompaniment, PACT is dedicated to its social mission of transforming the health care system to better meet the needs of the marginalized and the underserved.
I was fortunate to arrive at a very exciting time; the organization is currently in the process of expanding its services. PACT is now driven to share the lessons it learned in the past 15 years through training and technical assistance to organizations interested in replicating the CHW model.
I am now helping PACT in developing its business and communications strategy to demonstrate the advantages of CHW integration into the US health system. This is something I feel strongly about, having worked with CHWs in my previous jobs. Where I’m from (the Philippines), the strategy of mobilizing CHWs whom we call Barangay (village) Health Workers (BHWs), is not something new. BHWs have, in fact, been inextricable components of the current health system, especially for a country proud of its bayanihan culture.
But I also recognize that there is still much to learn.
I’m glad that in the last few months I’ve been working with PACT, I’ve seen a number of innovative ways on how CHWs’ skills can be developed further to lower costs while enhancing health care, particularly for those who are chronically ill. Never have I also been more certain about my belief in the power of community-based approaches, and in the idea that solutions don’t always have to come in the form of new (or disruptive) technologies.
Based on PACT’s experience, it’s a matter of leveraging community members to help patients deal with various health issues. New technology? Not. But does it work? Yes, and perhaps “cloning this strategy” where it is applicable is one of the best approaches the US can take to improve the system.
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¹Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, National Health Care Expenditures Data, January 2012.