Need To Know: Social Support

Partners In Health staff often talk about the five “S’s” essential to quality health care: staff, stuff, space, systems, and social support. Each piece is equally important in building a strong public health system and in caring for patients—not just their current illness or chronic condition, but their ability to thrive in their communities.

Social support, the fifth “S,” is an essential part of how PIH uniquely approaches patient care. It comes in many forms, but mostly entails the provision of food, housing, transportation, education, and job security to patients and their families.

The need for social support has been magnified as a result of the spread of COVID-19, globally and within the United States. Patients who test positive for the virus are asked to quarantine for up to 14 days, but that is a nearly impossible task for people who are “essential workers” or are part of the informal economy, live in close quarters with extended families, and do not have electricity or running water.

We spoke with Basimenye Nhlema, community health director for Abwenzi Pa Za Umoyo, as PIH is known in Malawi, and with Jorge Tamaki, deputy director of Socios En Salud, as PIH is known in Peru. They spoke about social support, the difference it makes in patients’ lives, and why it’s particularly essential in the time of COVID-19. 

What is social support?

PIH’s social support programming varies by country. Generally, though, we provide transportation to and from clinic appointments, food, housing, educational fees and supplies, and financial support, such as startup loans for small businesses.

The reality is that a high-quality health care system isn’t always enough, especially in the world’s poorest countries. Patients now battling COVID-19, tuberculosis, HIV/AIDs, malaria, non-communicable diseases, malnutrition, and mental and maternal health issues often lack access to amenities we take for granted.

Why is it important?

Our social support programming treats the whole patient, not just his or her disease. That difference means that patients will not only reach a cure for common illnesses or manage a chronic condition, but also maintain their good health over the long term.

Take as an example patients living with a chronic disease, such as diabetes or hypertension. Getting to and from regular appointments at a government hospital may entail walking hours along poor roads or taking crowded public transportation.

But if patients are too ill to walk far or can’t afford transportation fees, they don’t regularly make appointments. Helping them solve the transportation question ensures they remain in care and stay healthy.

Can you share an example of how social support has changed lives?

When PIH began providing social support seven years ago in rural Neno, Malawi, a seriously ill woman arrived. She was diagnosed with and treated for HIV. To ensure this woman was nourished and could provide for her family, PIH gave her goats to raise at home. In a region where most earn their income from small-scale farming, she went on to breed them and now has a herd of over 12 goats that she is able to use to support her family needs and to start a vegetable business in the market.

This extra income means she can grow or buy enough food for her family and purchase other goods they need to stay healthy.

Taking another example from Peru, Harold*, 27, had been supporting his parents and brother in a small home in one of the most vulnerable communities north of Lima, the country’s capital. He lost his job a week after Peru declared a state of emergency due to the COVID-19 pandemic and could no longer help his brother pay for school. His dad tested positive for COVID-19, and before long, with no space for social distancing, the virus had spread to the two brothers. They ran out of money and food, and without medication, his father’s health began to decline.

Harold reached out to PIH for help and was greatly relieved when staff showed up at his door with food, followed by two months of continued support until they recovered.

“If Socios En Salud had not provided me with the isolation guidelines and food, perhaps we wouldn’t be here,” Harold said.

We know PIH is reaching 90 percent of 132,000 households in Malawi’s rural Neno District, and that HIV outcomes have been better there than in districts across the country.

In Peru, where 72 percent of the population is informally employed, social support has assisted tens of thousands of people in the past two decades. Since the national government declared a state of emergency in March, PIH has provided social support to more than 2,000 households.

Why is social support crucial now, as we work to slow the spread of COVID-19?

Strengthening health systems and social support programming are the best defenses against a public health crisis.

We rely on social support now more than ever in Peru, where the government’s stay-at-home measures have paralyzed 60 percent of the economy. As a result, an estimated 80 percent of family businesses are projected to declare bankruptcy. The state also closed all primary health care, leaving patients without medication or treatment.

We are working tirelessly to provide food and basic needs to those who have lost their primary means of income. That way they aren’t forced to break quarantine to look for a way to support their families.

In Malawi, PIH is working closely with officials in Neno District to ramp up screening and implement contact tracing and treatment protocols to keep the number of positives cases relatively low. PIH is providing food, supplies, and sanitation products to individuals and their families who’ve contracted or been in contact with the virus.

*Name has been changed for privacy.