Over the last decades, there has been an increasing interest in the development of “promotores,” or community health worker (CHW), programs to improve public health in underserved communities. But, what exactly are promotores and what is their role in these communities?
Promotoras/es are leaders, predominantly in Hispanic communities, that provide relevant health information and promote healthy behaviors to those with less knowledge and/or access to health care within their communities. Other commonly used terms for promotores are peer leaders, patient navigators, health advocates, and lay and outreach workers. Although their responsibilities may vary from programs to regions, the main role of promotores usually is to raise awareness about health issues, preventive care, disease management, and follow-up care, and to improve communication with health care providers, among other roles. The study Community Health Workers: Who Are They and What They Do, references that 66% of CHWs are women, 77% of these are women of color and 58% has a high school degree or less.
According to the World Health Organization (WHO), CHWs should be:
- members of the communities where they work,
- selected by the communities,
- answerable to the communities for their activities,
- supported by the health system but not necessarily a part of its organization, and
- have shorter training than professional workers.
Health care providers, community clinics and state health departments have acknowledged the value and key role of promotores in promoting community-based health education and prevention. One of the main reasons why promotores have a great impact and are so effective with their outreach efforts is that they are trusted leaders in their communities. They personally know and understand what community members are going through and they can explain certain health issues, instructions and more technical terms in an easy-to-understand way, relieving patients of the burden of having to decipher a doctor’s explanations and recommendations by themselves.
The CHW concept has been used for at least 50 years. If we go back in time, we will find that the first forms of what are now promotores or CHWs took place in the 17th century, in Russia, where farm workers were called “lay people” and they would receive one year of training so that they could care for the individuals in the military. At the same time, there were similar groups in China, Kenya, Liberia and Latin America. In 1987, WHO adopted a definition for health counselors and identified some of their key roles:
- education focused on prevention and the control of health problems,
- promotion of healthy practices,
- prevention and control of local and common health problems,
- treatment of common illnesses, and
- providing essential medicines.
WHO suggests that the first formal CHW programs were implemented in the United States during the 1950s and 1960s. These were developed with the interest of creating health resources that were accessible and appropriate for communities that did not receive services via the traditional medical system.
Many studies have shown that there are many implementation problems when it comes to promotores programs, such as the lack of resources, standardized information on promotores programs, certification issues, and organizational costs. Nonetheless, it has been proven that promotores/CHWs can make a significant and positive difference in the health of their community members. It will be interesting to see how the promotores programs movement evolves in the coming years as an essential part of the health system, as well as a communications strategy for reaching out to particular groups and communities.