The Household Model: Improving Healthcare through Prevention and Connectedness

Hana Geadah is a 2020 Social Connectedness Fellow working with Partners in Health Liberia to analyze the impact of the household model in Liberia on the communities’ well-being, health, and sense of social connectedness. Hana has long been interested in the efficacy of health care and is dedicated to the realization of anti-oppressive policy at the community and structural levels. Dr. Daniel Palazeulos is a global health implementor-educator who holds positions at Harvard Medical School, the Brigham and Women’s Hospital (BWH), and Partners In Health (PIH). Dr. Palazuelos is a Policy Advisor for Community Health Systems at PIH and Co-founder/Chief Strategist of PIH Mexico.

Universal health coverage was touted at the 2019 UN General Assembly as the future of healthcare across the globe. Despite the commitment of governments towards this laudable goal, the actual manner in which this goal could be achieved was only superficially sketched out. Now, nine months later, in the throes of a global pandemic where we see viscerally that vulnerability anywhere is vulnerability everywhere, what is clear is that we need relevant answers and functional systems now more than ever. We can look to the new household model in Liberia to glean insight as to what these health delivery systems could look like.

During the Ebola epidemic of 2014-16, Partners In Health (PIH) Liberia and the Liberian Ministry of Health made a partnership to strengthen the healthcare delivery system in rural southeast Liberia. Working within the Liberian system and harnessing the potential of local staff, PIH and the Maryland County Health Team were able to increase access and health outcomes for locals in tuberculosis, HIV, leprosy, and mental health treatments. Since then, PIH Liberia has served as a shining example of what is possible in the Liberian context. Most recently, this has included a new take on the long-appreciated Community Health Worker (CHW) approach, where trusted community members deliver treatment and information to locals in their community. This pilot program is called the household model, and what makes it so special is that it offers a population who scarcely has access to even basic care the ability to address whatever ailment they might encounter. Having the right information about any illness and feeling that your health and well-being matter are key factors in beginning the healing process for any disease.

The PIH household model is a modernized and updated approach to what has been proven to work in other places, most notably Cuba and Brazil. Unlike traditional CHW systems in which CHWs are assigned to individual patients with preexisting conditions, under the household model, CHWs are assigned to entire households, meaning that they check in on families  regardless of whether they are sick or not. This way, the CHW in the household model has a greater chance of catching patients who might otherwise fall through the cracks of CHW programs that only focus on specific diseases. The power of this new model is that CHWs can make a difference for individuals through their focus on preventative measures and connections with their patients.

One role of CHWs in the household model is to give household health talks during their routine visits. These household health talks are important for a few reasons. Because the health talk is in the home, it removes the burden for the individual to attend a community health talk or face social stigma for seeking to learn about a certain disease. The health talks then supply individuals and households with critical information and knowledge about common diseases, so that when the CHW is gone, members of the household are better equipped if someone in the household gets sick. This means that not only can individuals monitor their own health, but they can also look out for family members with whom they are living.

Additionally, because CHWs routinely check on their households, they are able to catch health issues early on and ensure that potential patients get the treatment that they need when they are most likely to benefit from that treatment. When household members do get sick, the CHW is there to encourage them to seek care and direct them to the appropriate resources. In some cases, CHWs can actually escort the patient to the health center to assure that they get expedited access to the health system. CHWs can also check on and support individuals who need ongoing longitudinal care – such as pregnant women and people with mental health issues.

An especially unique component of the household model is that it allows CHWs to build relationships with individuals before they get sick. When a person has somebody routinely checking in on them to make sure they are okay, they receive the clear message that their health matters. When they do get sick, they will already trust their CHW and have a support system in place, helping to remove many early barriers in treatment.

The household model is a comprehensive approach to health care that puts individuals at the center of the intervention and recognizes the value of easy access to health care. It removes early barriers to healthcare through prevention and social connectedness, giving people the tools and support they need to care for their health.

While this model is being piloted in Liberia right now, it provides lessons for health systems everywhere. If individuals feel that their health matters and they have the information and systems necessary to seek care when they need it, people everywhere, especially those at the margins of society, whether because of age or insurance status, will be more likely and willing to advocate for their own health.

As the coronavirus pandemic unravels globally, it continues to highlight and emphasize weak links in many of our systems, especially in our healthcare and information distribution systems. The coronavirus is a new disease that researchers are learning new things about every day. As such, it is extremely important that people get correct and updated information about the symptoms, their risk, and what to do if they feel sick. We’ve now witnessed multiple cases globally, even in advanced healthcare systems, where individuals have died from the coronavirus because they did not have the right information. It is devastating to think that these people could have survived had they been given the right knowledge and care. Looking forward, it is heartening to think that if a community health household model exists everywhere, we can meet new pandemics and everyday diseases with greater courage, hope, and a functional partnership with the people most affected.