Community Health Workers (Promotoras)
The use of community members to render certain basic health services to their communities in New Mexico is a concept that has existed for at least 50 years. There have been innumerable experiences throughout the world with programs ranging from large-scale national programs, to small-scale community-based initiatives.
We now know that CHWs can play a crucial role in broadening access and coverage of health services in remote rural areas and for disadvantaged sub-population groups, and can undertake actions that lead to improved health outcomes in such areas as maternal and child health, continuity of care for chronic disease patients, and general health education to families and youths. To be successful on a large scale, CHW programs need careful planning, secure funding and active government leadership and community support. To carry out their tasks successfully, CHWs need regular training and reliable logistical support. CHWs represent an important health resource with the potential for providing and extending basic health education and care to underserved populations. The World Health Report 2006: Working Together for Health recognizes shortages of professional health workers as one of the key factors in the burgeoning human resource crisis, particularly in low-income countries and rural and low-income areas in the U.S.
Community health workers are known by many different names in different countries. The umbrella term “community health worker” (CHW) embraces a variety of community health aides selected, trained and working in the communities from which they come. A widely accepted definition was proposed by the World Health Organization:Community health workers should be members of the communities where they work, should be selected by the communities, should be answerable to the communities for their activities, should be supported by the health system but not necessarily a part of its organization, and have shorter training than professional workers.
CHWs are trained to carry out one or more functions related to health care, and may receive training that is recognized by the health services and national certification authority, but this training does not form part of a tertiary education certificate. Early programs emphasized the role of CHWs as not only (and possibly not even primarily) health care providers, but also as advocates for liaisons with the communities they serve and as agents of social change. Today’s programs emphasize their technical and community management function. CHWs do not include formally trained nurse aides, medical assistants, physician assistants, paramedical workers in emergency and fire services and others who are auxiliaries, mid-level workers and self-defined health professionals or health paraprofessionals.
The profile of community health workers internationally is very diverse. In almost all cases they come from the communities they serve. Most importantly, there is broad agreement that who and what CHWs are must respond to local societal and cultural norms and customs to ensure community acceptance and ownership.
CHWs perform a wide range of tasks: home visits that include information about environmental sanitation, contamination of the water supply, health education, nutrition and surveillance, maternal and child health and family planning activities, TB and HIV/AIDS care (i.e. counseling, peer and treatment support and palliative care), healthy homes and pest control.