NEXT >

Village Health Promoter Practitioners as the "Doctors" of Their Communities

Critical Need Being Addressed

In materially poor countries with few resources to dedicate to health care, combined with factors that increase barriers to care such as isolation, war, and language/cultural differences, there is little hope that fully-staffed clinics and hospitals will be built in the near future, or that existing services will be improved and expanded to meet daily health care needs.

Description of Initiative

Too often in our world, individuals have to travel long distances, through conflict zones, spending money they do not have, on the chance that an existing hospital or clinic would treat them with respect, in their native language, and actually meet their health needs. The fact that the members of many of these communities may lack formal education does not, however, mean that they cannot be empowered to learn the skills necessary to become the health care providers for their communities.

Concern America has developed a successful “Health Promoter Practitioner” model in which community members are trained to be the primary health care providers in their own communities and the regions where they live. Once trained, these Health Promoter Practitioners can competently diagnose and treat patients, administer a wide range of medicines, and perform surgeries (e.g. tendon repairs), all within a local system that comes from and responds to the needs of the community members. Concern America's four-year Practitioner training program, a model developed by the organization over the past 20 years and unparalleled in its quality of instruction and accessibility to individuals with little formal education, trains lay practitioners whose resulting depth of knowledge, skills, and ability to provide health care are comparable to the work of physician assistants and nurse practitioners in the U.S. As a result, in villages located hours away from health care centers and whose residents earn less than $2.00/day, high-quality, low-cost health care is a reality, saving and sustaining innumerable lives, using few resources.

Concern America’s Health Promoter Practitioner model has proven extremely successful in various countries in Latin America. In an effort to bring the model to many more communities/regions, organizations, and governments throughout the world, Concern America and its field team members who implement the Health Promoter Practitioner model on the ground (all medical professionals with many years of experience in the field) are writing a “Manual” that can help western-trained medical professionals understand this primary health care model and replicate it around the world. The writing of the Manual has already begun, is estimated to take three more years, and will be a major contribution to the field of primary health care worldwide.

BFI Assessment Summary

This initiative is a project of Concern America, a non-profit based in Santa Ana, California , The project trains local people in very poor, mostly rural, often war-torn regions (so far in Mexico, Guatemala, Colombia and soon Mozambique and perhaps Rwanda) to serve as the primary healthcare providers in their communities, which would otherwise have no health infrastructure. Unlike medical aid organizations that bring emergency or infrequent care from the outside, the goal is to empower local people to have control over and be able to provide 90% of their healthcare needs.

This approach is not unique to this initiative. Jamkhed in India, to cite only one example, has operated a Comprehensive Rural Health Project that has trained village health workers for nearly 40 years, but the features that distinguish Concern America’s program are many. They include the depth and rigor of their training (developed and refined over a 20-year period), which features a four-year program for the most advanced practitioners, who become capable of performing even some complex operations, such as tendon surgeries. They say their training is “unparalleled in its quality of instruction and accessibility to individuals with little formal education.” There is a profound respect for local cultures and their capacity to run their own affairs, i.e. a democratic approach to expertise that offers a deep, systemic challenge to current hierarchical models. There is a strong self-replicability built in the model whereby trained practitioners in turn teach others in their and neighboring communities, so expertise spreads virally.

Village Health Promoters has a holistic approach that sees healthcare as only one component of communities’ empowerment, and that stresses human health’s links to healthy ecosystems, farming practices and socio-political contexts. They have a goal to create state-of-the-art manuals to help mainstream Western medical professionals understand this primary health care model so it can be replicated around the world, there would also be field manuals for use by on-the-ground local practitioners, in many languages.

Concern America, which began in 1972 and has won many prestigious awards, is a highly credible and well-run organization that gets excellent results with relatively small budgets. The team on this project has decades of experience in the field (including in some very dangerous conflict zones) but is still remarkably passionate and dedicated. Given how little access to affordable health care billions of people on our planet have, this model offers a very credible, replicable, cost-effective way to build healthcare infrastructure while simultaneously helping communities self-organize to begin to address the deep roots of their poverty and disenfranchisement. It might have the potential to be a paradigm-shaking initiative.

PEOPLE: Village Health Promoters

Curt Wands, PA, is the principal author of the Training Manual for Village Health Promoter Practitioners (TM). Curt began with Concern America (C/A) in 1989 in Guatemalan refugee camps in Mexico. He initiated C/A's health project in Colombia and led that project from 2004-2009. Curt has worked in community-based health since 1979 as a practitioner, community organizer, and administrator. Dr. John Emrich, based in Mexico, has been a trainer of Health Promoter Practitioners (HPP) and midwives in Latin America for decades. Together with his wife, Susan Emrich, he has been an invaluable part of developing and implementing the HPP model in Mexico, Guatemala, and Colombia. Susan Emrich, based in Guatemala, is a community health specialist who has lived and worked in community health in Mexico and Central America for more than 25 years. She has been key to the development and implementation of the HPP model. Marianne Loewe, C/A Executive Director, has served in that position since 1979. Marianne has provided the impetus for the writing of the TM, knowing well that the HPP model can and will be replicated around the world, bringing health care to those most in need, once the TM is available.

ABOUT CONCERN AMERICA

Concern America is a unique nonprofit, nongovernmental development and refugee aid organization - unique in that our philosophy emphasizes the transference of skills and thus the creation of opportunity (seen as a more permanent solution), in impoverished regions. Concern America does this by training community members, who live in economically poor situations, in health, potable water, education, and income-generation. These villagers then become the health care-givers, the educators, the cooperative members, the well-diggers, etc.

When Concern America doctors come to live in a village and, rather than just doing medical consults and providing services, show that villagers have the capacity to learn the skills needed to bring quality health care to their communities, it has a ripple effect of trust-building. When Concern America water engineers live in a village and show that people can learn the complicated engineering skills necessary to bring in potable water, this empowers everyone.

Back to the 2011 Semi Finalists