Peace Care Policy Proposal

www.peacecare.org
Andrew Dykens MD, MPH peacecareworld@gmail.com
312-21-PEACE (7-3223)

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 1. Executive Summary ................................................................................................................................. 4
2. The Problem ............................................................................................................................................. 7
Global Health Disparities....................................................................................................................... 7
Global Burden of Disease .................................................................................................................. 7
Worldwide Shortage of Health Workers............................................................................................ 7
Need for Primary Care Proficiency in LMICs ................................................................................... 7
Need for Community Health Research in LMICs ............................................................................. 7
U.S. Role in Global Health .................................................................................................................... 8
Need for Global Health Experience for U.S. Health Care Professionals in Training........................ 8
Importance of U.S. Active Role in Global Health Initiatives ............................................................ 8
3. The Vision ................................................................................................................................................. 9
The Proposal ........................................................................................................................................ 10
Peace Care status as Nonprofit Organization................................................................................... 10
Collaboration.................................................................................................................................... 10
The Process ...................................................................................................................................... 10
Description of Stakeholders:............................................................................................................ 11
Peace Corps.................................................................................................................................. 11
Community Health Leaders ......................................................................................................... 11
U.S. Health Care Professionals.................................................................................................... 11
Description of Technology: ............................................................................................................. 11
Communities of Intervention ........................................................................................................... 13
Approach.............................................................................................................................................. 13
Six Phases of Implementation of each Health Collaborative: ......................................................... 13
Community Assessment .............................................................................................................. 13
Project Development (Model Adaptation)................................................................................... 13
Project Implementation................................................................................................................ 14
Project Evaluation........................................................................................................................ 14
Sustainability Plan ....................................................................................................................... 14
Dissemination .............................................................................................................................. 15
4. Critical Evaluation................................................................................................................................. 16
Previous Policy Proposals.................................................................................................................... 16
The Advantages of Peace Care ............................................................................................................ 16
Benefit to Peace Corps..................................................................................................................... 16
Benefit to LMIC Communities ........................................................................................................ 17
Benefit to U.S. Health Care Training Programs .............................................................................. 18
Public Health Focus ......................................................................................................................... 18
Research and Development Innovations.......................................................................................... 19
Sustainability........................................................................................................................................ 19
5. Competitive Analysis ............................................................................................................................. 21
Overcoming Existing Challenges in the Field through an Innovative Approach ................................ 21
Global Health Organizations with Alternative Roles .......................................................................... 22
6. Marketing Strategy................................................................................................................................ 23
Marketing and Promotion .................................................................................................................... 23
Channels of Distribution ...................................................................................................................... 23
Alliances .............................................................................................................................................. 24
Partnered Peace Corps Posts............................................................................................................ 24
Proposed Partnered Intervention Models (Training Programs) ....................................................... 24
Technology Partner.......................................................................................................................... 25
U.S. Health Care Institutional Partners............................................................................................ 25
7. Project Plan ............................................................................................................................................ 26
Location of Operation .......................................................................................................................... 26
Company Structure .............................................................................................................................. 27
Personnel.............................................................................................................................................. 27
Board of Directors............................................................................................................................ 27
Research Team................................................................................................................................. 29
Organizational Challenges ................................................................................................................... 30
8. Social Return on Investment................................................................................................................. 31
Summary of Social Impact................................................................................................................... 31
Metric to Evaluate Return on Investment ............................................................................................ 31
Long Term Impact ............................................................................................................................... 31
9. Conclusion .............................................................................................................................................. 33
10. Bibliography ........................................................................................................................................... 35

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Executive Summary
The World Health Organization estimates there is a shortage of about 4.3 million health care workers
globally. Africa has only about 10% of the world’s population and is affected by about 24% of the
global disease burden but has only 3% of the global health workforce. Sub-Saharan Africa is
deficient the 1.5 million workers that would be necessary to provide adequate health care. In
addition, countries with better developed primary health care systems have been found to have better
health statistics. We have a significant challenge before us, to build a healthier world. Peace Care is a
nonprofit organization that would help us work together toward this goal by positively impacting
global health disparities by specifically addressing the global burden of disease, the global shortage
of health care workers, the deficiency of primary care in low-income countries, and the deficiency of
global health research while improving the role of the United States in global health.

Peace Care, in essence, is a proposed collaboration between the U.S. Peace Corps, U.S. health care
training institutions, U.S. schools of public health, and global communities to improve the health of
these global communities. Through this collaboration, Peace Care could utilize the well respected
institution of the Peace Corps and its volunteers currently living and working alongside community
health leaders throughout the world. Peace Care could, as well, become a significant asset in the
attainment of the first goal of Peace Corps, "Helping the people of interested countries in meeting
their need for trained men and women." Peace Care, therefore, proposes connecting Peace Corps
volunteers to U.S. health experts and educational institutions with the primary goal of training health
care workers in these global communities and, in turn, building sustainable capacity to address local
health care needs.

Peace Care believes strongly that in order to sustainably address global health and adequately reduce
disparity, solutions should originate and be developed, primarily, with community involvement,
through (or with the amelioration of) existing health systems, and with the use of appropriate
technology. All solutions should, as well, prioritize capacity building within the local health care
structure through the utilization and implementation of the principles of primary care and public
health. In this consideration, the Peace Care model, as described subsequently, is an adaptation of
many principles of a Community Based Participatory Research (CBPR) methodology that establishes
an equitable partnership between the community and researchers. There are multiple phases of this
model including partnership formation, assessment, implementation, evaluation, and dissemination.
Within each phase, the community is empowered to ensure full participation and emphasis on
priorities as perceived within the community. CBPR fosters sustainability through health system
change at the local level. Evaluation, in this manner, is critical not only for the successful
implementation of projects and the growth of Peace Care, but will contribute significantly to the
public health and primary care research in global communities, thus, having a much more extensive
effect. Peace Care will act as the project manager as well as provide expert consultation services for
these collaborative relationships.

The process through which the Peace Care model would function begins within a community where
a Peace Corps Volunteer (PCV) with a background and focus on health is currently working. At the
behest of the community, the PCV would perform a community health assessment, and, along with
local health care workers, identify the assets and needs of the local community. This work will be
accomplished through the local board of health for the purposes of sustainability and in keeping local
interests as paramount. (The PCV will be equipped to help organize this local board if one is not
already in place). These officials then communicate this information to the partnered U.S. health
care professionals with particular expertise in community-based or primary care interventions
designed for the identified needs of the community. The U.S. health care professionals in

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collaboration with the local health care workers, design an intervention or decide to adapt and
implement an established community based or primary care intervention that will address the local
health needs, as identified by the community. This intervention would occur by way of a training
seminar during the course of a visit by the U.S. professionals to the host country. Community
interventions and seminars will be conducted whereby significant and sustainable skills and/or
knowledge transfer will occur, setting in place the potential for sustainable local capacity building.
Through this model, local health leaders will be certified educators or organizers in the focus issue.
In addition, during the visit, U.S. professional trainees and faculty will be able to participate in
clinical practice or perform immediately recognizable goodwill community service activities. After
the U.S. health professional's visit, the PCV, along with his or her counterpart and the local board of
health, will be able to study the effects and impact of the intervention that was implemented. The
community, Peace Corps itself, and the U.S. health care training institution will, as well, have an
opportunity to evaluate the intervention. As well, after the intervention, there will be opportunity for
the collaboration to continue between the host community and the U.S. health care professionals with
the PCV as the liaison through the creative use of information technology. As host country health
leaders will be certified, they will, in turn, be equipped to propagate the acquired knowledge to
surrounding communities and within the existing health care structure with minimal outside support.

Through this collaboration, Peace Care will leverage the training resources and rigorous scientific
approach of the Peace Care Institute including U.S. health and medical professionals and
academicians, as well as, the well respected institution of the Peace Corps and its volunteers
currently living and working alongside community health leaders in over 75 countries worldwide.
Through this developed infrastructure, the impact and reach will be extraordinary in years to come.
The model, will be applicable to multiple categories of disease and illness, and, will, therefore,
significantly advance disease-specific research in LMIC communities while impacting, broadly, the
local health care systems. The potential for significant impact comes from the ability to transfer the
training capacity of the Peace Care Institute (PCI), in collaboration with local physicians and existing
health care workers, to the improving of health care capacity within the LMIC community.
Community health workers will be trained to participate within and support the local health system
and detailed community health education programs will be implemented.

By leveraging the established trust, infrastructure, and resources of the Peace Corps, the Peace Care
model is well positioned to have an immediate and sustainable impact. Peace Corps Volunteers
(PCV), being integrated within the community and trained extensively in cultural competency and
local language, are highly qualified field workers. Peace Care will be working with PCV's who have
training and a background in health. These PCV's, as well, necessarily work in a highly sustainable
manner by collaborating, always, with a local counterpart. The role of Peace Corps, in being a
governmental organization, strengthens this model, as all initial project plans and final outcomes will
be reported directly to the Ministry of Health in each respective country.

Throughout all phases, the Peace Care model will be utilizing a web based communications platform
for project management and collaboration. Peace Care creatively utilizes information technology
through a developed online platform for reliable and efficient communication as an adjunct tool for
project development, management, evaluation, and knowledge dissemination. This platform
functionality includes online guides and instructional manuals, wiki capability for collaboration on
documents, spreadsheets, reports, and presentations, research tools, evaluation tools,
communications resources (texting, messaging, email, VOIP ability), and project management tools.
In addition, the web functionality will include access to, ability to input, and ability to query
multiple relational databases that would contain project information, project successes, resource lists
(personnel, equipment, and methodology), community needs and resources, institutional needs and
resources, and affiliate organizations. This functionality will empower the local community,
encourage a standardized approach and assure sustainability. Minimal bandwidth will be required to

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utilize these resources. Even in remote locations, internet access is becoming more and more
feasible. If access is not available within the target community, itself, all PCVs and counterparts will
be able to access these webtools in a neighboring community.

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The Problem
The key problems that this collaboration would address are twofold. Primarily, Peace Care will
address global health disparities. With nearly 5,000 children dying daily from diarrhea related
illnesses; with HIV/ AIDS ravaging communities worldwide and the under-recognized threat of
chronic diseases overwhelming the health of the world’s communities; with health disparities
widening in all corners of the globe, there is a dire need to build health care capacity in Low and
Middle Income Countries (LMICs). In addition, Peace Care will create opportunity to improve the
U.S. role in global health.

Global Health Disparities

Global Burden of Disease

As concerns global health disparities, Peace Care will address the global burden of disease. LMICs
continue to be gravely affected by unabated epidemics of malaria, tuberculosis, diarrhea related
illnesses, and, of course, the ravages of HIV. Moreover, chronic diseases are the leading cause of
death in the world, causing an estimated 35 million deaths worldwide in 2005, approximately 67% of
all-cause mortality. (1) (2) As an example, the global prevalence of diabetes is expected to increase
from 171 million to 366 million between 2000 and 2030. (3) Furthermore, while the impact of
chronic diseases is growing substantially around the globe, the greatest increase is located in LMICs.

Worldwide Shortage of Health Workers

The World Health Organization estimates that there is a shortage of about 4.3 million health care
workers globally. (4) Peace Care has potential to have a positive impact on this worldwide
shortage. Africa has only about 10% of the world’s population and is affected by about 24% of the
global disease burden but has only 3% of the global health workforce. (4) Sub-Saharan Africa is
deficient the 1.5 million workers that would be necessary to provide adequate health care.

Need for Primary Care Proficiency in LMICs

Peace Care, will, as well, address the need for Primary Care Proficiency in LMICs. Countries with
better developed primary health care systems have been found to have better health indicators. (5)
(6) There is a correlation between primary care and age-standardized mortality. With a 20%
increase in the number of primary care physicians there is a resulting 5% decrease in
mortality. (5) As well, each additional family physician per 10,000 people results in 70 fewer deaths
per 10,000. This is an estimated 9% decrease in the mortality rate. (5) Therefore, Greater access to
primary care results in improved health outcomes and lower costs. (8) (9)

Need for Community Health Research in LMICs

LMICs face a significant challenge in further strengthening their health delivery systems due in a
large part to the lack of reliable data present to inform and guide the national health system focus.
As well, According to the Global Forum for Health Research, of the 73 billion U.S. dollars invested
annually in global health research by the public and private sectors, less than 10% is devoted to
research into the health problems that account for 90% of the global disease burden. (9) Peace Care
would provide a unique opportunity to greatly expand the amount of community health research in
LMICs.

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U.S. Role in Global Health

Need for Global Health Experience for U.S. Health Care Professionals in Training

Toward the need for a broader and more informed global health view, there exists a considerable
need for global health training for U.S. health care professionals. In evidence of this, there has been
considerable growth in interest in this realm in the last 30 years. In 1984, 6.2% of U.S. medical
students participated in an international experience and in 2007, 26.3% of U.S. medical students did
likewise. (11) While these statistics speak to medical students, this interest continues into residency
and is, as well, apparent in the training of other disciplines, as well. There are a great number of
benefits of health care training in global health settings including Improved Physical Exam skills,
Increased resource consciousness when making diagnostic and treatment decisions, valuable
experience working with under-served populations, increased interest in primary care, improved
cultural competency, and increased first-hand exposure in working with medical issues that are
uncommon in the U.S.. (12) (13) (14)

Importance of U.S. Active Role in Global Health Initiatives

As well, there is great importance of a U.S. active role in global health initiatives. Now, more than
ever, the health of other nations affects global productivity, stability, security, and good governance.
Therefore, the development of a program such as Peace Care could demonstrate generosity on the
part of the U.S. and could be effectively used as a foreign-policy tool. (15)

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The Vision
The vision of Peace Care is to utilize the idealism of the Peace Corps, the effectiveness of primary
care, and the foresight of public health to positively impact global health disparities by specifically
addressing the global burden of disease, the global shortage of health care workers, the deficiency of
primary care in low-income countries, and the deficiency of global health research while improving
the role of the United States of America in global health by improving global health training for
health care professionals and increasing U.S. capacity for active commitment in global health
initiatives. There exist large disparities in health status, disease distribution, and access to health
care among the various communities of the world and through Peace Care, we could make a World
of a Difference.

About 85% of the world’s population resides in low and middle income countries (LMICs) and these
populations account for approximately 92% of the world’s global burden of disease. The World
Health Organization estimates there is a shortage of about 4.3 million health care workers globally
and only a small percentage of LMIC’s populations have sufficient access to primary care when
compared to their higher income country counterparts. Numerous studies and development goal
setting agendas, commissioned by global health policy and advocacy organizations, have made
repeated calls for development efforts to recruit and retain sufficient numbers of well trained health
care workforce providers and to increase population access to basic primary care services in order to
address the disparity in trends in global disease burden in LMICs. Peace Care seeks to positively
impact global health disparities by specifically addressing the global burden of disease, the global
shortage of health care workers, the deficiency of primary care in low-income countries, and the lack
of community partnered global health research while improving the role of the United States in
global health. The Peace Care Initiative is a collaboration between the U.S. Peace Corps posts, U.S.
health care professionals and global communities to improve the health of individuals living in
selected communities in the Peace Corps host countries. Through this collaboration, Peace Care
utilizes the well respected volunteer personnel of the Peace Corps currently living and working
alongside community health leaders in the target communities. In addition, the Peace Care initiative
connects Peace Corps volunteers to U.S. health experts with the primary goal of training health care
workers in the target communities and, in turn, builds sustainable capacity to address local health
care needs. Peace Care believes strongly that in order to sustainably address global health and
adequately reduce disparity, approaches should originate and be developed primarily with
community involvement, through existing health systems, and with the use of appropriate and
accessible technologies. All approaches proposed through Peace Care prioritize capacity building
within the local health care structure through the utilization and implementation of the principles of
primary care and public health. In this consideration, the Peace Care framework is anchored in a
social determinants of health perspective that advocates for health equity in its community oriented
research, workforce educational training and clinical service efforts.

The Specific Aims for Peace Care are:

• Create within the existing health care delivery systems, health collaboratives which will
develop new local research and clinical service capacities through skills transference to: a)
develop and retain local health care workforce; b) enhance quality of care; and, c) improve
clinical and population health outcomes as part of a service delivery enhancement; and to
assess the impacts of these changes to foster greater improvements in health to promote
health equity

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 • Create a practice based comparative effectiveness research network “Peace Care CER
Network” among the health collaboratives which will provide a globally-linked network in
which the effectiveness of skills transference techniques can be compared, training in
research methods and evidenced based clinical and population health practice strategies for
the local community health workforce can be delivered and opportunities for U.S. trained
health professions faculty and students to have research, training and clinical work
experiences in LMICs can be provided

• Disseminate project methods and findings to other communities within country and to other
countries to replicate ‘best practices’ for the conduct of sustainable community-linked
research and high quality clinical service provision

The Proposal

Peace Care status as Nonprofit Organization

Peace Care, as a nonprofit, functions to coordinate collaboration between the Peace Corps, U.S.
health care training institutions, and global communities. The basis of Peace Care being that Peace
Corps Volunteers with a background in health coordinate a project by acting as a liaison between the
host community board of health (establishing this entity if necessary) and a U.S. health care training
institution that would enable the transfer of knowledge, skills, and other resources while sustainably
impacting the health care capacity of the local community.

Collaboration

The Peace Corps Volunteer organizes opportunities for professional exchange between U.S. health
care professionals and Host Country health care professionals. U.S. professionals would act
essentially as consultants, and could present educational seminars for Host Country doctors and
health care workers, help establish improved systems of performance and patient care, and, offer
clinical services during a visit to the host country.

The established trust, infrastructure, and resources of the Peace Corps are in place to assure the
community-oriented nature of the intervention and the sustainability of the project by working with
established host country public and private organizations. Peace Care acts to connect U.S. health
care training institutions with the infrastructure of the Peace Corps.

The core pillars of the Peace Care collaborative (the Peace Corps and U.S. health care training
institutions) are well-established and well-respected around the globe. The U.S. health care training
institutions that would be excellent collaborative partners through Peace Care include primary care
medical training programs (medical schools, family medicine, internal medicine, emergency
medicine, pediatrics, and obstetrics and gynecology residencies), physician assistant programs,
nursing programs, and other allied health professional programs as well as community health centers
not associated with a training program.

The Process

The Peace Care Initiative (PCI) will implement the Peace Care model to provide research methods
and improved health care delivery for low and middle income country (LMIC) professional and lay
health providers and community stakeholders and will provide training in global health and cultural
competency for U.S. health care professionals. In this regard, the PCI will implement, within the
existing health care delivery systems, health collaboratives which will enhance new local research
and clinical service capacities through skills transference to:

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 a. develop and retain local health care workforce;
b. enhance quality of care; and,
c. improve clinical and population health outcomes as part of a service delivery
enhancement.
Through each health collaborative, the Peace Care CER Network will assess the impact of these
changes to foster greater health equity and improved health services outcomes.

Description of Stakeholders:

Peace Care is a model of collaboration between established, well-respected stakeholders in global

health and models of health care delivery interventions.

Peace Corps

By leveraging the established trust, infrastructure, and resources of the Peace Corps, the Peace Care
model is well positioned to have an immediate and sustainable impact. Peace Corps Volunteers
(PCV), being integrated within the community and trained extensively in cultural competency and
local language, are highly qualified field workers. Peace Care will be working with PCV's who have
training and a background in health. These PCV's, as well, necessarily work in a highly sustainable
manner by collaborating, always, with a local counterpart. The role of Peace Corps, in being a
governmental organization, strengthens this model, as all initial project plans and final outcomes will
be reported directly to the Ministry of Health in each respective country. By working in conjunction
with PCV's and providing them with technical expertise, Peace Care is a significant asset in the
attainment of the first goal of Peace Corps, "Helping the people of interested countries in meeting
their need for trained men and women."

Community Health Leaders

Peace Corps has an extensive history of working directly with the health care leaders in the
communities they serve. Peace Care will, thus, be in a position to quickly develop a trusting and
collaborative relationship with the PCV counterparts and local health professionals, leaders, and lay
health workers. Peace Care will collaborate extensively through the board of health or will provide
guidance on developing a local board of health if one does not already exist. In addition, the
ministry of health, will, be invited to send health leaders from the national level or other
communities to participate in each health collaborative.

U.S. Health Care Professionals

The PCI is comprised of health professionals such as experienced and highly skilled primary care
physicians, public health specialists, nurses, midlevel providers, community health workers,
information technology and health systems specialists, global health researchers, and training
specialists. Multidisciplinary teams have been formed to provide the training and research needs
suitable for each individual project.

Description of Technology:

Each health collaborative within the Peace Care model is implemented through six phases:
community assessment, project development, project implementation, project evaluation,
sustainability planning, and dissemination.

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Throughout all phases, the Peace Care model utilizes a web based communications platform for
project management and collaboration.
Peace Care creatively utilizes information technology through this developed online platform for
reliable and efficient communication as an adjunct tool for project development, management,
evaluation, and knowledge dissemination. This platform functionality includes online guides and
instructional manuals, wiki capability for collaboration on documents, spreadsheets, reports, and
presentations, research tools, evaluation tools, communications resources (texting, messaging, email,
VOIP ability), and project management tools. In addition, the web functionality will include access
to, ability to input, and ability to query multiple relational databases that would contain project
information, project successes, resource lists (personnel, equipment, and methodology), community
needs and resources, institutional needs and resources, and affiliate organizations. This functionality
will empower the local community, encourage a standardized approach and assure sustainability.
Minimal bandwidth will be required to utilize these resources. Even in remote locations, internet
access is becoming more and more feasible. If access is not available within the target community,
itself, all PCVs and counterparts will be able to access these webtools in a neighboring community.

During the Community Assessment and Project Evaluation phases, the Peace Care model will be
utilizing:

EpiSurveyor
EpiSurveyor was developed by DataDyne and provides free mobile phone data collection and other
technologies for international development and global health worldwide. The increasing ability to
leverage mobile phones and web access across the developing world have made possible this
scalable, sustainable application which is a mobile-phone-and-web-based data collection system that
is simple to use and maintain.

During the project implementation phase, we will be utilizing and adapting a selected community-
based or primary care intervention directed at a specific illness or issue as identified in the needs
assessment phase. Some select models of intervention are described here (Peace Care currently has a
formalized relationship with these models):

Operation ASHA - India

Operation ASHA, developed in India, is a new paradigm in TB treatment. This model's approach of
decentralizing Directly Observed Treatment, Short-Course (DOTS) therapy drastically reduces the
effort, time and money the patients have to invest in taking their medicines. This is the key to
ensuring that the patients complete the entire therapy while eliminating default and drug resistance.
Through Operation ASHA we will teach health leaders the methodology of establishing a network of
community based centers allowing patients to obtain their medicine at a convenient place and time.
The goal is that no patient should have to walk for more than 20 minutes to reach a treatment center.
This creates a patient centered model allowing the patient to easily procure their medicine without
default. Simultaneously, a focus is placed on patient education and counseling to avoid drug
resistance.

Chronic Disease and Diabetes Self Management Programs - Stanford University

These programs were created through the Division of Family and Community Medicine in the
School of Medicine at Stanford University by a returned PCV as a community-based self-
management program that assists people with chronic illness. The program is designed to help
people gain self-confidence in their ability to control their symptoms and how their health problems
affect their lives. The small-group workshops are 6 weeks long, and this format fits nicely with goals
that Peace Care intends to accomplish. Health leaders in the focus communities will be certified,
qualifying them to implement this program in their own communities and surrounding communities,

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thus, expanding the reach of the Peace Care model, and impacting, greatly, the skillset of the local
health care workforce. This will allow local health leaders to very favorably affect outcomes
associated with many chronic diseases and diabetes, in particular, through a low-cost, effective, and
sustainable method.

Maternal and Child Health Training Guides – World Health Organization

The Peace Care model, for the purpose of this study will utilize a series of training manuals
developed by the World Health Organization to impact the illness category of Maternal and Child
Health. The specific manuals will include, Midwife Training: Making Pregnancy Safer, The
Program on Adolescent Health for Health Care Providers, Counseling Skills Training in Adolescent
Sexuality and Reproductive Health, and Integrated Management of Childhood Illnesses. The
specific manual to be used for the intervention will depend on a needs assessment of the
community’s health delivery system in the focus area of maternal and child health.

Communities of Intervention

The PCI has developed a working relationship with the individual Peace Corps posts of Jordan,
Senegal, and Uganda. The communities in which we will work will depend on Ministry of Health
Priorities as well as the location of Peace Corps Volunteers at the time of project implementation.
We will be implementing programs in a range of community sizes (rural and urban) as well as a
range of health system development. We are continuing to reach out to additional Peace Corps posts
around the world.

Approach

Each individual project will implement the Peace Care model of skills transference to a multi-level
audience consisting of lay workers, nurses, and health and medical officers. The focus is to directly
and sustainably improve the health delivery system, leading to better quality of care and health
outcomes. The focus on culturally appropriate, mindful skill transference is to limit attrition and
enforce work force capacity.

Six Phases of Implementation of each Health Collaborative:

Community Assessment

The process through which the Peace Care model would function begins within a community where
a Peace Corps Volunteer (PCV) with a background and focus on health is currently working. The
PCV will organize and manage, through the direction of the PCI, a general data collection effort to
gain an appreciation of the true health situation within that community in each of the three illness
categories of communicable disease, noncommunicable disease, and maternal and child health. At
the behest of the community, the PCV would then perform a focused assessment of the local health
care delivery system directed at one of the select illnesses, and, along with local health care workers
and the guidance of the PCI, identify the assets and needs of the local community in this regard. This
work will be accomplished through the local board of health for the purpose of sustainability and in
keeping local interests as paramount and in collaboration with a health data collections expert under
the direction of the PCI.

Project Development (Model Adaptation)

Upon gaining insight as to the assets and barriers that exist within the current health delivery system,
the stakeholders then communicate this information to the partnered U.S. health care professionals

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with particular expertise in the identified need of the community. The local board of health and PCV
will provide feedback concerning cultural norms, realities on the ground, logistical concerns, and
priority areas as together with the U.S. health care professionals and the model intervention team,
they adapt the designed intervention to be most effective within the local milieu. During this phase,
the PCV in collaboration with the PCI will plan a training in cultural competency for the U.S. health
care professionals.

Project Implementation

The implementation phase will be relatively brief and will occur during a short term visit by the U.S.
health care professionals. Early in the visit, the U.S. team will participate in a cultural orientation
and will become personally acquainted with the community leaders and community at large,
including the health system in place. The U.S. health care professionals, then, in collaboration with
the local health care workers, will implement the adapted intervention as developed in the previous
phases. This intervention would start with a train-the-trainer course for the local health leaders (this
may include some community health workers and/or patients carrying the target diagnosis). Upon
completion of the train-the-trainer course, the new trainers with the guidance of the model
intervention team and the PCI will be able to practically apply their skills through a training seminar
or conference that will be the cornerstone of the community or primary care based intervention. The
training seminar or conferences that will be conducted will result in significant and sustainable skills
transfer for local health leaders or community health workers, setting in place the potential for
sustainable local capacity building. Through this model, local health leaders (as trained trainers) will
be certified educators or organizers in the focus issue. During the implementation phase, the health
workers will, as well, learn a standardized method of data collection consistent with health ministry
priorities and with the creative use of appropriate technology. This will be accomplished with the
EpiSurveyor technology utilizing mobile phone and / or web based data collection technology.

Project Evaluation

Upon completion of the U.S. health professional's visit, the PCV, along with his or her counterpart
and the local board of health, will be able to study the effects and impact of the intervention that was
implemented by collecting outcomes measures. This will be under the guidance and direction of the
PCI and will utilize the data derived through the implemented EpiSurveyor technology. The
community, Peace Corps itself, and the U.S. health care professionals will, as well, have an
opportunity to participate in a process evaluation of the intervention, itself. This will provide the
knowledge necessary to adapt the approach for future projects managed by the PCI such that local
considerations are kept in the forefront, thus assuring sustainability.

Sustainability Plan

Upon completion of the intervention, there will be opportunity for the collaboration to continue
between the host community and the U.S. health care professionals with the PCV as the liaison
through the creative use of information technology. As host country health leaders will be certified
or trained to train, they will, in turn, be equipped to propagate the acquired knowledge to
surrounding communities and within the existing health care structure with minimal outside support.
In addition, the EpiSurvey health data collection system will remain in place with local personnel
trained in management and implementation of this model.

14
Dissemination

Peace Care will disseminate project outcomes to other communities within country and to other
countries to replicate best practices for development of community-linked research and service
infrastructure. A project website will be jointly maintained by the community and the PCI to publish
the results of the project and share knowledge with other interested communities. The PCI will
maintain a catalogue of intervention models and completed project reports accessible by anyone.

15
Critical Evaluation
Previous Policy Proposals

A review of previous policy proposals reveals that the need for a more active U.S. role in global
health has been addressed in various forms in the past including through the Global Health Corps Act
of 2005 as proposed by Senator William Frist (17), the Global Poverty Act of 2005 (18), the United
States Commitment to global Child Survival Act of 2007 (19), and the Global Poverty Act of
2007 (20). Other proposals include the Global Service Fellowship Program Act of 2008 (21), and the
Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/ AIDS, Tuberculosis,
and Malaria Reauthorization Act of 2008 (22).

The Global Health Corps Act of 2005 is the program most closely aligned with many of the goals of
the proposed Peace Care. Though it did not make it out of committee, the purpose of the Global
Health Corps was to improve the health, welfare, and development of communities in certain foreign
countries and regions, to advance United States public diplomacy in these locations, and to provide
individuals in the United States with the opportunity to serve communities by providing a broad
range of needed health care and related services in these communities. (17) The Global Health Corps
would have been comprised of non-federal volunteers, employees through the National Health
Service Corps, and Peace Corps Volunteers. (17) While this particular proposal is comprehensive
and broad-reaching in its effect, there are many aspects of this program that the proposal of Peace
Care would complement. The Global Health Corps Act would have been administratively very large
and for this reason, quite expensive. In addition, this program would rely on a long term
commitment or volunteerism from U.S. professionals who, after extensive schooling, are often in
great debt.

The Advantages of Peace Care

As the Global Health Corps Act calls for the establishment of a separate office within the
Department of Health and Human Services, it does not fully take advantage of the efficiency and
integration of existing structures such as Peace Corps to the degree that Peace Care would. In
contrast, the established trust, infrastructure, and resources of the Peace Corps would be in place,
through the proposed Peace Care, to assure the community-oriented nature of the intervention and
the sustainability of the project by working with established host country public and private
organizations. U.S. health care training institutions would, as well, benefit by exposing their
professionals-in-training to the type of service that will assure their preparedness to address health
care in their own communities back home. Peace Care would be quite feasible, initially, as minimal
funding would be necessary to have a significant impact quickly. The program could easily be
expanded in the future to encompass a wide range of impacts and interventions that could have a
lasting and significant positive effect on global health. As concerns impact, Peace Care has the
potential to reach the 75 corners of the globe where Peace Corps is currently well
established. Therefore, Peace Care would be a natural and very beneficial complement or critical first
step to the overarching and comprehensive goal of a Global Health Corps.

Benefit to Peace Corps

Peace Care would also align well with the goals of Peace Corps, as established in 1961 by John F
Kennedy. (23) The first goal of Peace Corps is helping the people of interested countries in meeting
their need for trained men and women. Peace Care has the potential to greatly impact education in
the realm of primary care for health care workers in LMICs. The second goal is helping promote a

16
better understanding of Americans on the part of the peoples served. Peace Corps volunteers would
be more deeply attuned to the health care needs of the communities they are serving. As well, the
health care professionals and trainees who participate would develop a more global view and become
more sensitive to a broader range of cultural and socioeconomic considerations. The third goal of
Peace Corps is helping promote a better understanding of other peoples on the part of
Americans. Peace Care would respond to this, as experiences by U.S. institution participants will be
brought back to be shared with colleagues and applied in professional practice in the U.S..

Benefit to LMIC Communities

The proposed collaboration of Peace Care is with the host country community, a health care
training institution (often tied to a larger academic institution), and a U.S. school of public
health. While physicians in LMICs are just as proficient as U.S. physicians, all physicians and health
care workers need Continuing Medical Education. The capacity to offer, plan, and institute this type
of training is much more available in U.S. institutions. Thus, the ability of U.S. institutions to assist
in the continued education of physicians and health care workers around the world is reasonable and
would have a considerable impact.

The potential for greater impact comes from the ability to transfer the training capacity of the U.S.
institution, in collaboration with local physicians and existing health care workers, to the building of
health care capacity within the LMIC community. Community health workers could be trained to
participate within and support the local health system and detailed community health education
programs could be developed and implemented. This is where primary care is emphasized--through
health education and preventive medicine. Resident physicians could be valuable participants in
educating community health workers (again--by way of a program organized through local
consideration). This example, of course, highlights a medical residency training program, but as
Peace Care could accommodate a broad spectrum of health care training institutions, the possibilities
are extensive.

Lastly, the third role of the resident physicians and U.S. institutions, in this example, would be to
participate clinically while in country. (This, of course, is the least sustainable aspect of the idea--
though by educating residents explicitly prior to participation, a program of this sort could avoid
offering services / medicines that could have a long-term negative impact while, at the same time,
offering some patient care that would have positive immediate impact and demonstrate good will).

There are several reasons why it would be very beneficial to have resident physicians collaborate
with health care workers in communities in LMICs. As resident physicians are licensed while in
training, they can be valuable team members and increase the impact of community
interventions. Under the guidance and direction of host country physicians and U.S. attending
physicians, residents can contribute greatly to the planning and implementation of seminars and
community interventions. However, contrary to what some may suppose, there is usually not a
knowledge or skill gap on the part of the trained physicians and health care workers in LMICs. In
fact, the experience and clinical skills of physicians practicing in low resource settings often
surpasses those of their Western counterparts. Resident physicians, through the Peace Care program,
should not be considered to, or expected to, replace the valuable existing workforce in LMICs. The
essence of utilizing training programs in the U.S. through this collaboration is to provide "helping
hands" and, more importantly, establish a sustainable exchange to allow the shared use of resources
for the betterment of all involved communities.

This relationship also would be extremely beneficial for the training of health care professionals in
the U.S.. Studies have shown that physicians in training who gain a global view through a global
health experience during their residency training exhibit improved physical exam skills, increased

17
resource consciousness when making diagnostic and treatment decisions, valuable experience
working with under-served populations, increased interest in primary care, improved cultural
competency, and increased first-hand exposure in working with medical issues that are uncommon in
the U.S.. Resident physicians exposed to global health experiences, are, as well, more likely to go on
to practice in under-served areas (domestically and internationally).

Benefit to U.S. Health Care Training Programs

Peace Care could be one solution to the difficulty that U.S. health care training institutions face in
the process of organizing global health tracks and global health experiences. Peace Care would offer
a standardized process for establishing an affiliated site in a manner that would be more sustainable
while providing, for programs without global health expertise, the guidance of global health
experienced specialists to facilitate the process. This could be extremely valuable to all programs
seeking to organize a global health experience as well as those with an existing global health
structure in the following ways. Peace Care could...
1. Provide a consistent source of funding to assist U.S. institutions in organizing global health
activities.
2. Facilitate initial contact with possible sites for affiliation with interested U.S. institutions.
3. Be flexible in consideration of the strengths and challenges of individual programs in
providing an affiliated global community site.
4. Encourage reliably sustainable solutions in the organization of global health programs.
5. Provide a structured framework for health care institutions that would emphasize the public
health components of global health experiences.
6. Provide access to developed technology to facilitate long-term collaboration with global
community sites.
7. Conduct standardized evaluations for all affiliated institutions and host communities.
8. Provide reliable and professional translation services for participating programs.
9. Organize reliable transportation in country.
10. Provide assurance of a clear and precise role for the program, participants, and the host
community.
11. Assure the safety of all participants through well-established protocol -- including an
established evacuation plan.
12. Provide a means of reliable communication for participants
13. Assure a satisfactory living environment of all participants during their global experience to
protect the health and safety of the participants
14. Provide standardized tools for the evaluation of the participants themselves.
15. Facilitate the exchange of ideas and feedback between participating programs including
experiences of interventions and organization of educational seminars.
16. Organize the exchange of research and intervention findings and conclusions among
participating institutions and communities.
17. Facilitate collaboration between programs working in different areas of the world.
18. Facilitate professional exchange allowing host country health personnel to come to the U.S.
to give lectures and discuss projects.

This is a partial list of the possible advantages that Peace Care could provide if enacted. Possibilities
are limited only by imagination.

Public Health Focus

Peace Care, in essence, brings together the two worlds of medicine and public health by including
professionals (or professionals in training) in each locale through the respected and well-ingrained
structure of the Peace Corps. In addition, Peace Care will make it possible for health care training

18
institutions to quickly and efficiently set up global health tracks that hold these values and strive for
sustainability. This would be possible simply by applying for an affiliated site through Peace Care
and organizing the relationship. This could be accomplished in a matter of months with reasonable
effort as opposed to the, now, routine and burdensome process of a few years--including finding a
site by establishing contacts, visiting, setting up expectations, designing a process of intervention,
discovering local resources, etc--all of which is sometimes done from afar with little local input.
Thus, sustainability and appropriate technology is often overlooked. Programs, currently, may often
be designed primarily with the needs of the U.S. institution's n in mind -- instead of a collaborative
effort. Again, Peace Care, would have in place, a primary focus on the community, as much of the
organization would take place in the field via the Peace Corps Volunteer in communication with the
local health care workforce and board of health. While visits to the host community for interventions
would be of a short duration, likely lasting only one month at a time, the focus of Peace Care would
be a continued collaboration over time including long-term planning of initiatives and appropriate
follow-up of interventions.

Research and Development Innovations

The Peace Care model is innovative in terms of building research capacity in LMICs. The PCI will
connect Peace Corps Volunteers (PCV) to U.S. health care professionals with the primary goal of
skill transference to health care workers in global communities. This will, in turn, build sustainable
local capacity to address health care needs. Through this collaboration, Peace Care will leverage the
training resources and rigorous scientific approach of the PCI including U.S. health and medical
professionals and academicians, as well as, the well respected institution of the Peace Corps and its
volunteers currently living and working alongside community health leaders in over 75 countries
worldwide. Through this developed infrastructure, the impact and reach will be extraordinary in
years to come, in line with goals of the grants program and Recovery Act. The model, will be
applicable to multiple categories of disease and illness, and, will, therefore, significantly advance
disease-specific research in LMIC communities while impacting, broadly, the local health care
systems.

The potential for significant impact comes from the ability to transfer the training capacity of the
PCI, in collaboration with local physicians and existing health care workers, to the improving of
health care capacity within the LMIC community. Community health workers will be trained to
participate within and support the local health system and detailed community health education
programs will be implemented.

Sustainability

The potential for sustainability of having U.S. health care training institutions collaborate through
a Peace Corps Volunteer is excellent for several reasons. Peace Care would directly connect a
community with a U.S. institution for a long-term collaborative relationship that can easily continue
even while the institution is not visiting. Information Technology (which will be an important aspect
of this project as it moves forward) will be critical for this relationship--and nowadays is much more
possible even in remote villages. In addition, the program can very easily be "individualized" for
each collaborative relationship and can grow and mold to fit the needs of the community and the
U.S. institution. As well, Peace Corps believes strongly in sustainability, and, to this end, all projects
are carried out directly with a counterpart from the local community--this ensures that the
relationship will continue even after the Peace Corps Volunteer has finished his or her service. The
fact that Peace Corps remains in country continuously, the Peace Corps Volunteer is well trained in
cultural competence, and that the Volunteer completes a two year service working closely with a
community counterpart who can continue the work after the Volunteer leaves all ensures greater
sustainability for the collaborative relationship. Through this relationship, the input and needs of the

19
community are requisite, and the residency program can utilize the resources available to it to
collaborate with the community in finding a solution. This could be as simple as the following
examples: A Family Medicine Residency Program presenting an Advanced Life Support in
Obstetrics conference for the health workers at that community, or if a knowledge gap is not the
issue--aiding in scholarly activity to study an aspect of the health of the community to design health
interventions that address the health challenge, or collaborating with other departments on campus to
address other aspects of the health of that particular community. In essence, this program would
expand our current definition of community and pull persons from two corners of the globe together
to act in unison for the betterment of all--creating one "community" that is able to utilize the
resources in each geographic location.

The PCI believes strongly that in order to sustainably address global health and adequately reduce
disparity, solutions should originate and be developed, primarily, with community involvement,
through (or with the amelioration of) existing health systems, and with the use of appropriate
technology. All solutions will, as well, prioritize capacity building within the local health care
structure through the utilization and implementation of the principles of primary care and public
health. In this consideration, the Peace Care model, as described, is based on a methodology that
establishes an equitable partnership between the community and researchers. Within each phase of
the Peace Care model, the community is empowered to ensure full participation and emphasis on
priorities as perceived within the community. This fosters sustainability through health care delivery
improvement at the local level.

20
Competitive Analysis
Overcoming Existing Challenges in the Field through an Innovative Approach

In recent years, reflecting the rising awareness of global health disparities, organizations addressing
global health are becoming more prominent. Among the many organizations (multinational,
governmental, and nongovernmental) that exist, the focus, methodology, and impact may vary
considerably. These organizations may differ substantially in terms of degree of management
decentralization, degree and nature of community input into program development, relative emphasis
on primary health care versus selective specialized health services, relative emphasis on urban versus
rural programs, emphasis on and role of health in development, relative emphasis on the public
versus private sector, relative emphasis on narrowly defined projects versus broad sectoral programs,
extent and type of conditionality used to promote change, and relative emphasis on public versus
private funding of services.

In light of these defining characteristics, Peace Care is quite unique among global health
collaboration models for many reasons. Peace Care places an emphasis on selective decentralization
in the management and sustainability of the projects. This is accomplished by assuring that all
projects work within the host country's existing health structure with direct communication with the
Ministry of Health, as in the case of all Peace Corps projects. Thus, the projects would require
strong local and national buy-in. At the same time, Peace Care would encourage local community
involvement and ownership of the projects by working directly with local health officials and the
local board of health longitudinally, pre- and post- intervention, with the onsite long-term liaison
being the Peace Corps Volunteer. Peace Care strongly emphasizes primary health care, however, in
a flexible manner that would allow individual communities to collaborate with U.S. professionals
and gain the advantage of these available resources in a manner that would benefit them the most.
Peace Care encourages the development of health systems and the building of health care capacity
by providing the means of quality training in health delivery as well as data collection for local
health care workforce. Peace Care is positioned to operate in both urban and rural environments and
to approach narrowly defined projects as well as impact broad sectoral programs. Peace Care is ready
to have an impact in all places where Peace Corps currently operates, thus creating immediate
potential for wide-reaching significance. All projects would necessarily be longitudinal and,
therefore, sustainable. In addition, there would be an emphasis on research in order that positive
interventions would be more likely to be replicated. Communication between the U.S. professionals
and the communities would be paramount for the completion of each individual project. Moreover,
with a highly developed medium of communication in place, LMIC communities would, as well, be
able to exchange skills and knowledge with each other. In this regard, Peace Care, may be most
unique. Peace Care would assist in sustainable development, but allow and encourage, in turn,
impacted communities to carry out a similar role with other communities, perhaps in a completely
separate geographical location. In this manner, thus, the effect of Peace Care could be exponential.
This being possible through utilizing an invaluable and ingrained resource already in place, the
Peace Corps.

Peace Care, is, as well, in an excellent position to avoid many negative impacts that some
organizations unwillingly inflict. There would be less distortion of government health programs as
all interventions would necessarily be in line with the Ministry of Health. Siphoning of host country
personnel would be avoided entirely as one primary goal of Peace Care is to train the local health
care workforce. The structure of Peace Care avoids the possibility of U.S. professionals primarily
acting on their own agenda to the detriment of the host community. Instead, Peace Care fosters the
needs and priorities of the local community.

21
Global Health Organizations with Alternative Roles

Peace Care is unique among all Global Health Organizations for the reasons stated previously. There
do exist other organizations that fill other roles. Some of these are the following:

Nongovernmental Organizations
Shoulder to Shoulder http://www.shouldertoshoulder.org/
Heart to Heart International http://www.hearttoheart.org/
Physicians with Heart http://www.aafpfoundation.org/online/foundation/home/programs/
humanitarian/internationalfund/pwh.html
INMED Institute for International Medicine http://inmed.us/
Global Health Corps http://ghcorps.org/
International Medical Corps http://www.imcworldwide.org/
PATH http://www.path.org/
Partners in Health http://www.pih.org/
InSTEDD http://instedd.org/
Child Family Health International http://www.cfhi.org/
Unite For Sight http://www.uniteforsight.org/
Global Service Corps http://www.globalservicecorps.org/
Africare http://www.africare.org/
USAID http://www.usaid.gov/

22
Marketing Strategy
Marketing and Promotion

Peace Care will rely on multiple avenues to promote our work and recruit interested Peace Corps
posts, communities, and institutions. We will provide information concerning our organization and
activities through our website at www.peacecare.org. In addition, we will utilize multiple aspects of
the web to inform the public, recruit interest, and fund raise. We will continue to actively utilize
social networking tools such as Facebook and Change.org to reach a broad audience. Monthly
newsletters will be distributed to keep the public informed and keep benefactors updated on project
successes.

Peace Care projects will as well be routinely presented at medical and public health conferences.
Successful interventions will be written up and published in scientific journals. Presentations and
publications will be central to the role of Peace Care as this will be integral to carrying out the
necessary research component. In doing so, successful interventions can be easily replicated and in
this manner will promote the practices of Peace Care.

Peace Care will, as well, rely heavily on word of mouth marketing as health care personnel and
trainees will take an active interest in discussing their experiences. Peace Corps Volunteers and host
country posts will as well be in a position to communicate with their colleagues and sister
organizations, thus creating the possibility that projects will be requested within various
communities. Health professionals in the communities of intervention will also be in a position to
relate their experiences and inform other communities in their region and beyond of the many
successful interventions. It is, of course, as well, a primary object to collaborate, officially, with
Peace Corps in the future. At which time, the services of Peace Care would be openly available and
in a position to be directly requested by host country Ministries of Health.

Channels of Distribution

Traditional channels of distribution will be less necessary for the services of Peace Care to be
transferred as information technology and a developed online platform for reliable and efficient
communication will be the cornerstone of project development, tracking, and follow-up. This
platform functionality will include online guides and instructional manuals, wiki capability for
collaboration on documents, spreadsheets, reports, and presentations, research tools, evaluation tools,
communications resources (texting, messaging, email, VOIP ability), project management tools, and
blogging, advocacy, and fundraising capabilities. In addition, the web functionality would include
access to, ability to input, and ability to query multiple relational databases that would contain
project information, project successes, resource lists (personnel, equipment, and methodology),
community needs and resources, institutional needs and resources, and affiliate organizations. This
functionality will empower the local community, encourage a standardized approach and assure
sustainability. Minimal bandwidth will be required to utilize these resources. Even in remote
locations, internet access is becoming more and more feasible.

Concerning project implementation, after thorough planning is in place, the U.S. institution will
travel to the community of intervention for a short term visit, during which time a primary project
focusing on health care capacity building, multiple secondary projects such as health education
interventions, and, possibly, clinical work will occur. This is when the transfer of skills and
knowledge will primarily occur. However, the effectiveness of Peace Care will be assured through

23
the ongoing communication and collaboration via the online platform, after the U.S. institution
returns home.

Alliances

Peace Care will primarily form relationships with Peace Corps, U.S. health care training institutions,
and global communities through the local board of health. In addition, Peace Care will necessarily
be forming alliances with other organizations that may be well positioned to provide specific
services. These Alliances with complementary organizations will be continuous and will add to the
effectiveness of Peace Care overall.

Partnered Peace Corps Posts

• Jordan
• Senegal
• Uganda
• Discussions are under way with several other Peace Corps posts: Ethiopia, Malawi,
Nicaragua, Peru, and Zambia

Proposed Partnered Intervention Models (Training Programs)

• Integrated Management of Childhood Illness - World Health Organization - NO CURRENT

PARTNERSHIP FORMED
◦ IMCI is an integrated approach to child health that focuses on the well-being of the
whole child. IMCI aims to reduce death, illness and disability, and to promote
improved growth and development among children under five years of age. IMCI
includes both preventive and curative elements that are implemented by families and
communities as well as by health facilities.
• Diabetes Self Management Program - Stanford University - PARTNERSHIP FORMED
◦ This program was created through the Division of Family and Community Medicine
in the School of Medicine at Stanford University by a RPCV as a community-based
self-management program that assists people with chronic illness. The program is
designed to help people gain self-confidence in their ability to control their
symptoms and how their health problems affect their lives. The small-group
workshops are generally 6 weeks long, and this format fits nicely with goals that
Peace Care intends to accomplish. Health leaders in the focus communities will be
certified, qualifying them to implement our program in their own communities and
surrounding communities. Thus, expanding the reach of the Peace Care model, and
impacting, greatly, the skillset of the local health care workforce. This will allow
them to very favorably affect outcomes associated with diabetes through a low-cost,
effective, and sustainable method.
• Advanced Life Support for Obstetrics (ALSO) International - American Association of
Family Physicians - NO CURRENT PARTNERSHIP FORMED
◦ Advanced Life Support in Obstetrics (ALSO) helps physicians and other health care
providers such as midwives develop and maintain the knowledge and skills they
need to effectively manage potential emergencies during the perinatal period,
averting surgical intervention and avoiding maternal and infant outcomes in areas
where no surgical intervention is readily available.
• Operation ASHA - India (Detailed Brochure) - PARTNERSHIP FORMED
◦ Operation ASHA has created a new paradigm in TB treatment. It is taking the
treatment to the doorsteps of the poor. This drastically reduces the effort, time and
money the patients have to invest in taking their medicines. This is the key to

24
 ensuring that the patients complete the entire therapy. This also eliminates default
and drug resistance. Operation ASHA is building a large network of centers so that
the patients can get the medicine at a convenient place, for example, on their way to
work or while returning from work. The goal is that no patient should have to walk
for more than 20 minutes to reach a treatment center. Not only that, these centers
operate from the early hours of morning and till late in the night. This also makes it
convenient for the patient to procure the medicine without default. Simultaneously,
focus is on patient education and counseling. Counseling is changing the mindsets
of the patients and their families. The ill effects of missing a dose are explained in
detail. It is made clear that default may lead to drug resistance, and that a drug
resistant patient not only has no hope for herself, she also infects her loved ones –
family members, neighbors and colleagues with drug-resistant TB, which also
proves fatal. Multiple counseling sessions over the period of therapy ensure
continuous interest of the patient in completing the therapy.

Technology Partner

• EpiSurveyor
◦ EpiSurveyor was developed by DataDyne and provides free mobile phone data
collection and other technologies for international development and global health
worldwide. The increasing ability to leverage mobile phones and web access across
the developing world have made possible this scalable, sustainable application
which is a mobile-phone-and-web-based data collection system that is simple to use
and maintain.

U.S. Health Care Institutional Partners

• The University of Illinois Chicago Department of Family Medicine Residency Program

Global Community Health Track
• The University of Illinois Chicago School of Public Health
• Personnel from the following institutions
◦ Contra Costa Family Medicine Residency
◦ New Mexico State University, Dept. of Health Science
◦ Columbia University Mailman School of Public Health

25
Project Plan

• Establishment of Board of Directors,

Advisory Committee, Working Group
Months 1 through • Business Plan / Budget / Nonprofit Status
Year 1
12 • Pilot Project Planning
• Fundraising
• Grant Application
• Pilot Project Early Planning
• Development of IT Platform
• Fundraising
Months 12
Year 2 • Pilot Project Preparation
through 24
• Seek Secondary Projects / Additional
Alliances
• Grant Applications
• Complete Pilot Project
• Evaluate Project and Program
• Plan Secondary Projects
Months 24
Year 3 • Present Findings of Pilot Project; Promotion;
through 36
Conventions
• Fundraising
• Seek Formal Relationship with Peace Corps
• Many Alliances
• Multiple Projects
• Encourage Collaboration and
Communication between Projects
Months 37 • Compare outcomes in consideration of
Year 4
through 48 diverse variables.
• Assure Reliable and Consistent Source of
Funds
• Obtain Formal Relationship with Peace
Corps
• Integration into the Peace Corps Structure
Months 49 • Partial or Full Funding through Peace Corps
Year 5
through 60 / U.S. Legislature

Location of Operation

The Primary Office for Peace Care will be located in Chicago, Illinois. However, Projects will be
carried out in multiple locations across the globe and partnerships could be feasibly formed with

26
organizations in various locations. This flexibility is afforded through online collaboration and
communication.

Company Structure

Peace Care will be initially established as a 501(c)(3) non-profit organization. A pilot project will be
carried out with a willing Peace Corps Post and the program, after demonstration of success, could
be integrated into Peace Corps, directly, or by means of a collaborative relationship. In the future,
Peace Care could collaborate with the World Health Organization through the Global Health
Workforce Alliance to further impact the training of health care workers around the globe.

Personnel

Board of Directors

President: Andrew Dykens, MD, MPH

Andrew is a Clinical Instructor of Family Medicine in the Department of Family Medicine at the
University of Illinois - Chicago (UIC) and a clinical physician at UIC’s Mile Square Heath Center.
Originating from southwest Missouri, Andrew came to Chicago after receiving his medical degree
from the University of Missouri-Columbia, and he completed his residency at the UIC Department of
Family Medicine Residency Program. Andrew has received his Master of Public Health degree
through the division of Health Policy and Administration. As a Capstone project this degree through
UIC, the idea of Peace Care was conceived.

Andrew has a strong interest in chronic diseases, community medicine, and health disparities and, to
this end, he serves as director of the Healthy Heart Group Visit Program at Mile Square Health
Center. In addition, he holds a passion for global health. With the combined enthusiasm of several
UIC faculty members, he is directing the newly implemented Global Community Health Track
through the UIC Department of Family Medicine Residency Program. This developing program
strives to expose interested resident physicians to a global community health perspective. Read more
at www.globalcommunityhealth.org .

His interest in global health first developed through his experiences as a Peace Corps volunteer from
1997 to 1999 in Mauritania, West Africa. He served as a Health Education/Water Sanitation
volunteer in Selibaby, the capitol of the Guidimakha region. Andrew lived with a Soninke host
family, with whom he has since stayed in good contact. He concentrated primarily on HIV/ AIDS
education and worked with a local youth group to incorporate health themes into their traditional
songs and skits. They performed in small villages all over the Guidimakha region, a region bordering
both Mali and Senegal, and at high risk for HIV transmission due to the degree of transnational
commerce. Upon completion of his Peace Corps service, he acted as the training coordinator for the
community health, water sanitation, and disease control sector for the 1999 Peace Corps Mauritania
volunteer training class. During medical school, Andrew returned to West Africa to shadow the
regional World Health Organization director and study the health system of Senegal, the country
bordering Mauritania to the south. He is active in the Global Health Education Consortium and
contributed to their modules project by co-authoring a module entitled “Planning Your Global Health
Elective’, which is intended to guide medical students and residents through the process of planning
an international experience.

Andrew is married to Lauren and they live together in Chicago, IL with their beautiful daughter,
Sevilla Dabel, and their spirited Husky, Bella Mango.

27
Lauren Nicole Dykens, M.M.S., PA-C

Lauren Dykens is a compassionate Physician Assistant working at Northwest Community Hospital’s

Emergency Department in Arlington Heights Illinois. She graduated from Rosalind Franklin
University of Health Sciences with her masters degree in medical science in 2005. Prior to that she
received her bachelors of arts degree from University of Missouri in biology. Lauren has worked in
the Emergency room since 2005 and specializes in treating patients with acute illnesses and injuries.
She loves being able to make a difference in individuals' lives. Lauren has a passion for helping the
under-served population and a desire to reach out globally. She is very much looking forward to
traveling and contributing to the Zambia project in 2010. She currently lives in Chicago with her
husband Andrew, her new baby girl, Sevilla Dabel, and dog, Bella Mango. She enjoys being active
outdoors, cooking, and spending time with her friends and family.

Karen E. Peters, DrPH

Karen E. Peters, DrPH is an Assistant Professor at the University of Illinois at Chicago School of
Public Health in the Division of Health Policy and Administration and Adjunct Assistant Professor
of Family and Community Medicine at the UIC College of Medicine in Rockford. She received her
MPH and DrPH at the UIC School of Public Health in the Division of Health Policy and
Administration. Her dissertation focused on an examination of length of stay among a national
sample of home health agency clients with an emphasis on organizational behavior and health
services delivery. Following graduate studies, Dr. Peters was Director of Medicine and Public Health
at the American Medical Association (AMA) where she served as the AMA’s representative to the
National Medicine and Public Health Initiative, a joint collaborative project between the AMA and
the American Public Health Association. She returned to UIC to assist in the development of the
National Center for Rural Health Professions at the College of Medicine in Rockford where she is
Assistant Director for Research and Evaluation and Co-Director of the Public Health Program on the
Rockford campus. She also serves as one of the Core faculty in the SPH’s new DrPH Program in
Public Health Leadership. She has produced over 25 peer reviewed publications and 50 meeting
abstracts and presentations. Dr. Peters research foci have included aging and public health, rural
health care, public health workforce, community based participatory action research (CBPAR) with a
focus on addressing health equity, and numerous evaluation studies at the national, state and local
level related to chronic disease (arthritis, cardiovascular disease, oral health). She has co-developed
and co-teaches a training course on evidence based public health for local public health workforce
practitioners. Her current research is conducted under the auspices of the UIC Institute for Health
Research and Policy, where she has had funding by the CDC and NIH. Her activities in the IHRP
have included community based evaluation, evaluation of statewide oral health and arthritis
statewide partnership activities and she is currently Principal Investigator on a five state
cardiovascular research network focusing on perceptions of cardiovascular health and on a mental
health study focusing on rural Latino immigrants in IL. In addition, she serves as interim Director of
the Northern IL Area Health Education Center in Rockford and is Director of Dissemination for the
Center for Research on Health and Aging at IHRP. Her service activities include participation on the
American Public Health Association’s Action Board and editorial work for the Journal of Family and
Community Health. In 2007 she was inducted as a Fellow of the Institute of Medicine of Chicago.
Her international work is more recent and has focused in two major areas of research. The first uses
the Community Based Participatory Action Research (CBPAR) approach to addressing health
disparities in both the Colombian Amazon and, in the Dominican Republic. The second area focuses
on health competencies, orientation to rural and interdisciplinary practice and professional values
among health professions students and practicing providers in a series of comparative studies in
India, Colombia and the US.

Laura Sadowski, MD, MPH

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Laura is a physician researcher at Stroger Hospital of Cook County (formerly Cook County Hospital)
where she serves as the Co-Director of the Collaborative Research Unit. She is an Associate
Professor in the Department of Internal Medicine at Rush Medical University. Laura is an action
researcher (or program evaluator); trained during her graduate school years in public health at the
University of Michigan, as well as completing a Robert Wood Johnson's Clinical Scholar Fellowship
at the University of North Carolina at Chapel Hill. Upon completing the Clinical Scholars
fellowship, Laura became a leader in the International Clinical Epidemiology Research and Training
Network, focused on capacity building in multi-disciplinary units within medical institutions of Low
and Middle Income Countries (LMIC). Laura was the PI on the USAID funded University Linkages
5 year program during the 1990s which developed a bi-directional exchange program between
faculty of the Universidad de Javeriana in Bogota, Colombia and the University of North Carolina at
Chapel Hill Schools of Public Health and Medicine. She also served as the Steering Committee
leader, investigator and trainer for the WorldSAFE studies of Family Violence in Brazil, Chile,
Egypt, India, and the Philippines.

Laura can offer PeaceCare assistance in developing and evaluating programs, designing and
implementing studies in community and clinical settings in LMIC, strategies for dissemination of
findings and information to (hopefully) lead to policy and practice change, develop and implement
strategies to retain trainees and study participants. Laura is a native Midwesterner, from Detroit. She
left Detroit after completing her Chief Medical Residency at Henry Ford Hospital, venturing south to
her fellowship in Chapel Hill. She enjoys theatre and music, lives a low-tech lifestyle, and is an avid
hiker (a challenge for someone living in Chicago).

Stephen S Stabile, MD

Stephen is a family doctor and is the Associated Chief Medical Officer of the Ambulatory and
Community Health Network, Cook County Health and Hospitals System. Stephen began his career
teaching developmentally disabled adults. After receiving his Master in Health Care Administration,
he worked as the director of hospital administrative services for the University of Texas M.D.
Anderson Cancer Center. It was there that he realized that caring for patients was more fun than
attending meetings and he received his M.D. from Baylor College of Medicine in Houston. His
commitment to working with under-served and marginalized communities led him to Chicago where
he completed his residency in Family Medicine at Cook County Hospital. Since then, he has
practiced in and served as the medical director of a local community health center before returning to
the Cook County system in 2001. He practices at the Logan Square Health Center of Cook County.

Stephen has lived in South Africa and Australia. He has volunteered as a physician in Belize,
Guatemala, Honduras, The Domnican Republic, Zambia, Brazil and Mexico. He organized the local
global health interest group, Global Health in Chicago. He serves on the Board of two community
health centers and of the state high risk group insurance program. He is actively involved in the
Illinois Academy of Family Physicians and a variety of progressive causes. He lives on the north
side of Chicago with his partner, Andy, who is a family physician at the Cook County jail.

Research Team

Principle Investigators
• Contact PI: Laura Sadowski, MD, MPH, Co-Director and Associate Professor
of Medicine, Collaborative Research Unit of Stroger Hospital of Cook County and Rush
Medical University. Senior Scientific Investigator, Heartland Alliance International.
• Co-PI: Karen Peters, DrPH, Clinical Assistant Professor, Division of Health Policy and
Administration, School of Public Health, University of Illinois – Chicago. Senior Scientific
Investigator, Heartland Alliance International.

29
Names of other key personnel
• Co-Investigator, Project Manager: Andrew Dykens, MD, MPH, Clinical Instructor of
Family Medicine, University of Illinois - Chicago. Director, Global Community Health
Track, University of Illinois - Chicago Dept. of Family Medicine. Scientific Investigator,
Heartland Alliance International.
• Co-Investigator: John Booker, PhD, Associate Professor and Academic Coordinator,
Online Master of Public Health Program, New Mexico State
University. Senior Epidemiologist, Department of Pediatrics, University of New Mexico.
• Co-Investigator: Shrikant Bangdiwala, PhD. Professor of Biostatistics, University of North
Carolina at Chapel Hill (UNC), Chapel Hill, NC
• Co-Investigator: Nestor Esparza, Program Officer, Heartland Alliance for Human Needs &
Human Rights.
• Co-Investigator: Sue Forster-Cox, PhD, MPH, CHES, Associate Professor, New Mexico
State University, Dept. of Health Science.
• Co-Investigator: Karen Levin, RN, BSN, MPH, CHES, Director of The Center for Public
Health Preparedness. Associate Director of the Division of Planning and Response, National
Center for Disaster Preparedness, Columbia University Mailman School of Public Health.
• Co-Investigator: Scott Loeliger, MD, MS, Faculty, Contra Costa Family Medicine
Residency. Director, Mark Stinson Fellowship in Underserved & Global Health. Program
Director, Global Health through Education, Training and Service (GHETS). Program
Director of Health Workforce Development. Faculty Physician, Director, Mark Stinson
Fellowship in Underserved/Global Health, Contra Costa Regional Medical Center, Martinez,
California.
• Co-Investigator: Edward Mensah, PhD, Associate Professor of Health Economics and
Informatics. Director, Public Health Informatics Program, Division of Health Policy and
Administration, School of Public Health, University of Illinois - Chicago.
• Co-Investigator: Scott Portman, Director, International Programs, Heartland Alliance
International.

Organizational Challenges

The initial limitation of the development of Peace Care is funding, though modest funding could
have an enormous impact, due to the well established nature and efficiency of Peace Corps and
professional educational programs. In the case of physician training programs, funding would be
necessary to fill the gap of Medicare payment for resident salaries while they are away from their
home institution. Funding would, as well, be necessary for travel and the organization of educational
seminars, community interventions, and clinical activities.

Other challenges would include the establishment of administrative collaboration that would
effectively preserve the mission of each collaborating institution, the preservation of U.S. institutions
as consulting organizations and avoidance of paternalistic or one-sided program and intervention
development. In achieving sustainability, the development of reliable information technology to
assist in intra-organizational communication could, as well, present certain challenges.

30
Social Return on Investment
Summary of Social Impact

• Improve Health in Communities Worldwide

• Increase the Global Health Care Workforce
• Increase Primary Care Proficiency in LMICs
• Increase Community Health Research in LMICs
• Improve Global Health Education
• Expand Peace Corps
• Increase the U.S. Active Role in Global Health Initiatives

Metric to Evaluate Return on Investment

In order to reliably evaluate the success of the program and the impact of the interventions, Peace
Care would adhere to the SMART principles (specific, measurable, attainable, relevant, and time
bound) for data collection. The strategic objectives for each collaborative body would be integrated
into the overall evaluation process and the community and clinical research, integral to Peace Care,
through collaboration with Peace Corps Volunteers will encourage development of successful
interventions, and the program’s impact will be readily tracked. The monitoring of the impact on a
larger scale could be tracked through the established indicators and benchmarks through the World
Health Organization and the Global Health Workforce Alliance.

The program will evaluate multiple components of its activities including the following: medical/
public health interventions, community health outcomes, and impact of clinical work. Impact will
also be measured on the participating health care professionals, trainees, LMIC workforce, U.S.
health care training institutions, Peace Corps, and the Peace Corps Volunteer.

In terms of evaluating the impact of interventions and the direct impact on the communities, Peace
Care will utilize a model known as Community Based Participatory Research. Community Based
Participatory Research (CBPR) is a methodology of research that establishes an equitable partnership
between the community and researchers. There are multiple phases of this model including
partnership formation, assessment, implementation, evaluation, and dissemination. Within each
phase, the community is empowered to ensure full participation and emphasis on priorities as
perceived within the community. CBPR fosters sustainability through health system change at the
local level.

Evaluation, in this manner, is critical not only for the successful implementation of projects and the
growth of Peace Care, but will contribute significantly to the public health and primary care research
in LMICs, thus, having a much broader effect.

Long Term Impact

Peace Care will significantly impact...

• Global Health Disparities
◦ the global burden of disease
◦ the global shortage of health care workers
◦ the deficiency of primary care in low-income countries
◦ the deficiency of global health research

31
• the U.S. understanding of Global Health
◦ the need for global health training for health care professionals
◦ the U.S. active role in global health initiatives

32
Conclusion
Low and Middle Income Countries continue to be gravely affected by unabated epidemics
of malaria, tuberculosis, diarrhea-related illnesses, and, of course, the ravages of HIV. Moreover,
chronic diseases are the leading cause of death in the world, causing an estimated 35 million deaths
worldwide in 2005, approximately 67% of all-cause mortality. (1) (2) As an example, the global
prevalence of diabetes is expected to increase from 171 million to 366 million between 2000 and
2030. (3) Furthermore, while the impact of chronic diseases is growing substantially around the
globe, the greatest increase is located in LMICs. However, LMICs are not able to adequately
address these growing health concerns. The World Health Organization estimates that there is a
shortage of about 4.3 million health care workers globally. (4) Africa has only about 10% of the
world’s population and is affected by about 24% of the global disease burden but has only 3% of the
global health workforce. (4) Sub-Saharan Africa is deficient the 1.5 million workers that would be
necessary to provide adequate health care. In addition, countries with better developed primary
health care systems have been found to have better health indicators. (5) (6)

Thus, we have a significant challenge before us, to build a healthier world. For this purpose, some
have proposed a Global Health Corps as a possible solution that, while the eventual impact may be
substantial, would not be feasible without the creation of a large, costly structure. However, the
Peace Corps is currently uniquely positioned to have an enormous impact in the field of global health
if an expanded approach is pursued. We would offer a solution such as "Peace Care." With this
global consideration, the vision of “Peace Care” is to utilize the idealism of the Peace Corps, the
effectiveness of primary care, and the foresight of public health to positively impact global health
disparities by specifically addressing the global burden of disease, the global shortage of health care
workers, the deficiency of primary care in low-income countries, and the deficiency of global health
research while improving the role of the United States of America in global health by improving
global health training for health care professionals and increasing U.S. capacity for active
commitment in global health initiatives.

Peace Care, in essence, is a proposed collaboration between Peace Corps, U.S. Health Care
Training Institutions, U.S. Schools of Public Health, and Global Communities to improve the health
of these Global Communities. As the shortage of health care workers is due primarily to a lack of
training capacity in LMICs, The potential for great impact comes from the ability to transfer the
training capacity of the U.S. institution, in collaboration with local physicians and existing health
care workers, to the building of health care capacity within the LMIC community. Community
Health workers could be trained to participate within and support the local health system and detailed
community health education programs could be developed and implemented.

“Peace Care” believes strongly that in order to sustainably address global health and adequately
reduce disparity, solutions should originate and be developed primarily through community
involvement, through (or with the amelioration of) existing health systems, and with the use of
appropriate technology. All solutions should, as well, prioritize capacity building within the local
health care structure through the utilization and implementation of the principles of primary care and
public health. The potential for sustainability of having health care training institutions collaborate
through a Peace Corps Volunteer is excellent for several reasons. “Peace Care” would directly
connect a community with a U.S. institution for a long-term collaborative relationship that can easily
continue even while the institution is not visiting. The fact that Peace Corps remains in country
continuously, the Peace Corps Volunteer is well trained in cultural competence, and that the
Volunteer completes a two year service working closely with a community counterpart who can
continue the work after the Volunteer leaves--all ensures greater sustainability for the collaborative

33
relationship. In addition, the program can very easily be "individualized" for each collaborative
relationship and can grow and mold to fit the needs of the community and the U.S. institution.

The future direction of Peace Care would be limited only by creativity. There are many potential
projects that could connect enthusiastic physicians with community health workers, worldwide.
Beyond addressing the health of individuals within LMICs, Peace Care may creatively impact health
systems through the development of patient-centered medical homes, group visits, and home visits.
Through expansion of the program, other departments at U.S. institutions may also be able to
collaborate in the spirit of improving community health. Fine Arts Departments could collaborate on
the successful presentation of health themes, and Engineering Departments could help improve built
environments, as examples.

Central to the successful and widespread implementation of this valuable project is an online
platform for reliable and efficient communication to conduct project development, tracking, and
follow-up. This platform functionality will include online guides and instructional manuals, wiki
capability for collaboration on documents, spreadsheets, reports, and presentations, research tools,
evaluation tools, communications resources (texting, messaging, email, VOIP ability), project
management tools, and blogging, advocacy, and fundraising capabilities. In addition, the web
functionality would include access, ability to input, and ability to query multiple relational databases
that would contain project information, project successes, resource lists (personnel, equipment, and
methodology), community needs and resources, institutional needs and resources, and affiliate
organizations. This functionality will empower the local community, encourage a standardized
approach and assure sustainability. Minimal bandwidth will be required to utilize these "cloud
computing" resources. Even in remote locations, internet access is becoming more and more
feasible.

Concerning project implementation, after thorough planning is in place, the U.S. institution will
travel to the community of intervention for a short term visit, during which time a primary project
focusing on health care capacity building, multiple secondary projects such as health education
interventions, and, possibly, clinical work will occur. This is when the transfer of skills and
knowledge will primarily occur. However, the effectiveness of Peace Care will be assured through
the ongoing communication and collaboration via the online platform, after the U.S. institution
returns home.

We would like to propose to you “Peace Care” to improve the health of global communities in order
to make a World of a Difference.

We are currently moving forward with a “Peace Care” pilot project in Senegal. Please visit our web
site at www.peacecare.org to read more about the proposal and sign our guestbook to stay informed,
or send an email to peacecareworld@gmail.com if you have questions or comments.

Andrew Dykens MD, MPH

President, Peace Care
RPCV Mauritania, West Africa (97-99)

34
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