In nearly all of our posts, we write about our promotoras (community health workers) that live and work in the mountain communities surrounding Ollantaytambo. We discuss their trainings, the health interventions they’ve led, and what it’s like to spend time in their homes. In this post, I’d like to backtrack a bit and explain why community health worker training is a sustainable, capacity-building approach to health promotion in isolated communities.
When Sacred Valley Health/Ayni Wasi was founded over three years ago, its primary activity was the mobile clinic, which operated under the auspices of local partner Awamaki. Co-founders Keri Baker R.N. and Marc Willcox M.D. and a staff of health volunteers traveled to underserved communities that lacked health care options in order to provide onsite primary care. Limited to nonexistent road access meant that they often backpacked or rode mules up to these communities. Gradually, however, it became apparent that importing medical expertise and resources on a monthly basis wasn’t a sustainable model for promoting health in the isolated mountain villages. Given their resource and time constraints, visiting medical professionals are rarely able to address the root causes of diseases they treat. And when they leave, communities are often in the same position as before, lacking the knowledge required to cope with the health issues they face.
We sought a solution that would complement rather than compete with government clinics, and which would fill the gaps in services by training local people. A community health worker program facilitates the transfer of health knowledge from accredited medical professionals to local people through training in basic diagnosis and services. It seeks to empower local people to become health advocates and activists in their communities.
In February 2012, the group of SVH cofounders visited Socios en Salud, the Peruvian branch of Partners in Health, which runs a promotora program in poor neighborhoods in Lima, Peru’s largest city. The Socios team generously shared their time and knowledge, explaining what approaches had been effective. The SVH cofounders asked a lot of questions and received training materials and advice on what community health worker training could look like in the rural Andean context. Members of the SVH team also met with nurse supervisors from Caritas to learn about their promotora programs in and around Cuzco. Little by little, SVH/ Ayni Wasi’s promotora program began to take shape.
SVH/ Ayni Wasi’s promotoras attend monthly trainings, which we hold at government clinics in the district. They then share their knowledge at community assemblies and on a more informal basis through household visits and small group presentations. The goal of this information sharing is that their knowledge will ultimately permeate the whole community, allowing all residents to make informed healthcare decisions for themselves and their families.
The community empowerment model functions on multiple levels. At its core, the program empowers the locally-elected promotoras to take charge of community health. Throughout their training, promotoras gain health-focused knowledge and skills, and also the confidence to mobilize their neighbors. As part of their duties, promotoras frequently check in with fellow community members, sharing information about healthy behaviors. They educate about topics such as good nutrition and disease prevention, and they also identify cases where referral to a clinic is required. Their sustained engagement and frequent dialogue with neighbors creates a space to identify and independently pursue community goals.
Becoming a promotora is a rare leadership opportunity for women in a culture where most rural communities’ governing councils consist primarily of men. The promotoras brainstorm and make decisions about health-related matters in partnership with their neighbors, local leaders, and government clinic personnel. By taking on this elected role, our promotoras are stepping into the leadership arena. They strengthen fellow community members’ ability not only to live healthy lives, but also to advocate for themselves and adapt to changing circumstances. In development terms, this is capacity building, a term defined by Unesco as “the process by which individuals, groups, organizations, institutions and societies increase their abilities to: perform core functions, solve problems, define and achieve objectives; and understand and deal with their development needs in a broad context and in a sustainable manner.”
As SVH/ Ayni Wasi’s Promotora Program embarks on its third year of community health worker training, we look forward to participating in the ongoing process of education and empowerment in the rural communities of the Sacred Valley.