From Aid to Accompaniment - Kellogg Institute for International Studies

From Aid to
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
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”
Making the market work for the poor
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
2. Policy/Government/Organization
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
Focus: how to most effectively deliver
foreign aid via a human rights-based
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?
Accompaniment in Practice
Critiques of Development Addressed By
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
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
Critiques it addresses
● Donor-Recipient
● Short-term,
● Static
Final Discussion
1. How do you understand accompaniment as a model
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:
Haiti case study

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