Despite enormous advances in technology and improvements in human welfare at the global level, there are still vulnerable populations today that have little or no access to basic health care, even in developed countries such as the United States. One factor contributing to the problem is the major crisis involving human resources in health – resources that are vital to the success of health systems. The problem is particularly acute in developing countries. As the shortage of these human resources has worsened, one of the strategies to alleviate the problem has been through the use of health promoters, also known as Community Health Workers (CHWs).
Community Health Workers to the Rescue
The role of CHWs in providing certain basic health services in local communities began in the mid-1950s with the Barefoot Doctors Program in China, which involved using volunteer health workers in local villages. The success of the program resulted in a national implementation plan, which was replicated in many countries because their conventional services were unable to provide basic health services.
In Latin America and the Caribbean, the Pan American Health Organization launched the Regional Initiative for Schools for Health Promoters in 1995 with the aim of providing training to give future generations the knowledge and skills necessary to promote and maintain healthy environments and communities. This model in most cases has been very successful in developing countries and among vulnerable populations, particularly in rural, remote, or immigrant communities.
Who Exactly Are CHWs and What Do They Do?
The profile and function of community health workers vary widely across the world. The models depend on the specific needs of each community, including its social determinants, objectives, and the health services available in the area. Betsy Rodriguez, an expert on CHWs, considers the definition of the American Public Health Association (APHA) to be the most complete. It states that the main role of these health workers is “to serve as a link between the community and the social and health services offered by the local and state government.” According to the APHA, promoters:
– Constitute front-line public health workers
– Are respected members of the community
– Serve as intermediaries or facilitators between social and health services and the community
– Facilitate access to services and improve the quality of services and the cultural context in which services are provided
– Build individual and community capacity, increasing self-sufficiency and knowledge about health topics
– Educate and carry out work with the community, offering informal advice, social support, and advocacy
According to Rodriguez, community health workers are increasingly involved in care for chronic illnesses, and their intervention has enabled patients to better manage risk factors and prevent cardiovascular diseases, such as diabetes, and has also reduced disparities in medical care.
The Example of Campesinos Sin Fronteras
I have had the opportunity to work with various groups and organizations of community health workers in the United States, including Campesinos Sin Fronteras. This pioneering organization started in 1999 with the aim of educating people in communities – mostly the poor, immigrants, and farmworkers – about chronic diseases and injuries associated with work in the fields, as well as substance abuse and domestic violence. The work is carried out in a way that integrates the various factors involved, taking into account social determinants and the specific context. CHWs in this program are members of the same community where they work and are mostly volunteers. Once empowered, they succeed in empowering others.
As stated by Emma Torres, the Executive Director of Campesinos Sin Fronteras: “I might go to someone’s home to talk about diabetes, but when I get there I see they have nothing to eat, they have a child in jail, or there is a situation of domestic violence and/or extreme poverty. All of these things need to be taken into account, so the promoter needs to have very good people skills in order to understand all this and help people in all of these possible ways. You can’t come in to solve one problem and just leave all the others unsolved.”
Challenges and Opportunities
There is a large amount of research at the global level that highlights the good work of community health workers and the direct impact they have on vulnerable populations. But the research also points to the need over the long term for governments and institutions to continue to provide training, formalization, better supervision, and support. In many cases these governments and institutions need and depend on the good work of these health workers. In the United States, certain states require that promoters be certified in order to work and be paid. Campesinos Sin Fronteras, for example, recently partnered with Arizona Western College to implement an Academic Certification Program for Promoters in order to (1) give health workers the opportunity to have their work formally recognized, and (2) motivate them to continue on with their studies. Health workers believe in and advocate on behalf of their communities in order to empower people to be self-sufficient. We continue therefore to advocate on behalf of them for better financial support and training over the long term.
Is there a community health worker program in your country? Do you think such a program could support efforts in your community? Tell us what you think in the Comments section or at @BIDgente on Twitter.
Mariana Eberle-Blaylock is a health communications specialist who works in the Social Marketing Division of ICF, a global consulting firm.