Promotor@s help their communities heal.
Promotoras have been an essential part of the healthcare system in South America since the 1950s. The term “promotora” comes from the Spanish word “promover,” which means “to promote,” and refers to Community Health Workers (CHWs), individuals who promote health and wellness in their communities.
Modern Community Health Workers (the way we understand them today) have been an integral part of healthcare systems for many years. The earliest knowledge of the Promotora system comes from observations in Latin America, Africa, Asia, and the Middle East as early as the 1920s. The origins of the modern CHW can be traced back to the late 1920s in South Africa, where malaria assistants were trained by senior health officers. Similarly, in China during the 1930s, “Farmer Scholars” were trained to address health concerns in their communities. These early efforts paved the way for the emergence of Barefoot Doctors, who were Chinese agricultural laborers engaging their fellow community members in taking responsibility for their health.
The emergence and proliferation of the Promotora system in Latin America can be traced back to the 1950s. During the same time, from the 1950s to the 1970s, the number of active Barefoot Doctors in China surpassed one million, highlighting the need to address the health needs of rural and underserved populations in developing countries. Inspired by the Barefoot Doctor approach, many countries, including Honduras, India, Indonesia, Tanzania, and Venezuela, implemented CHW programs to improve access to healthcare. The United States government also recognized the potential of CHWs and supported their programs as a means to expand healthcare access in underserved communities, leading to the development of community health centers.
In 1973, in Ciudad Juárez, Mexico, a group called Salud y Desarrollo Comunitario de Cd. Juárez, A.C. (Health and Community Development of Juárez City), which was run by the Federación Mexicana de Asociaciones Privadas (Mexican Federation of Private Associations [FEMAP]), created the very first promotora model. This model was all about providing medical care and education to communities in Juárez that were often overlooked and marginalized. It was a huge success and soon, the promotora model spread to other parts of Mexico, as well as to other Latin American countries, and eventually even to the United States.
In the 1970s and 1980s, CHW programs gained even more momentum all over the world, particularly in Latin America and Africa. Governments in countries such as Indonesia, India, Nepal, Tanzania, Zimbabwe, Malawi, Mozambique, Nicaragua, and Honduras launched national CHW programs. Non-governmental organizations (NGOs) also played a significant role in establishing smaller CHW programs in developed nations worldwide. These initiatives focused on promoting literacy, family planning, immunizations, and other economic development activities.
By that point in time, this promotora model had been around in Latin American countries for almost 20 years, but it didn’t really catch on in the United States until then. In the early 80s, the US government realized the importance of reaching out to rural, marginalized, and hard-to-reach communities to improve access to healthcare. Because of this new insight, the US started supporting campaigns to make this happen. In the 1990s, the Centers for Disease Control and Health Resources and Services Administration also played a big role in bringing attention back to the promotora model.
Unfortunately, economic and political instability in the late 1980s and 1990s led to the decline of many government-backed CHW initiatives. Nevertheless, over the past two decades, there has been a resurgence of successful CHW programs worldwide. Research findings have demonstrated the effectiveness of community-based programs in improving child health, leading to renewed support for CHWs.
As of 2007, it was estimated that over 120,000 CHWs were serving throughout the United States, with an expected annual growth rate of 7%. In recent years, CHWs have gained national recognition for their ability to effectively address health and social issues within their communities. Several states, including the District of Columbia, have enacted laws to support CHW infrastructure, professional identity, workforce development, and financing. Additionally, some states have enacted laws that define Promotora model infrastructure, established Community Health Worker Advisory Boards and define an official scope of practice.
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The National Institute of Health
A Brief History of Community Health Worker Programs (Henry Perry, September 2013.)
Community Health Network of NY
The New York Health Foundation