Who are Promotoras and Community Health Workers?
“The cornerstone of [Community Health Worker] programs is the recruitment of community members who possess an intimate understanding of the community’s social networks as well as its strengths and its special health needs.”
“A community health worker is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.
A community health worker also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.”
With the appropriate resources, training and support, Community Health Workers improve the health of their communities by linking their neighbors to health care and social services, by educating their peers about disease and injury prevention, by working to make available services more accessible and by mobilizing their communities to create positive change.
MHP Salud refers to Spanish-speaking CHWs working with Latino(a) populations as Promotores(as). There are many additional terms, including:
- Camp Health Aides
- Colonia Health Workers
- Lay Health Advisors
- Outreach Workers
- Community Health Representatives
- Indigenous or Village Health Workers
- Non-traditional Health Workers
The HRSA Community Health Worker National Workforce Study, published in 2007, estimated that as of 2005, there were approximately 121,000 Community Health Workers in the United States. At that time, the number was growing at over 7 percent annually (C.H Rush, personal communication, May 15, 2009).
What do Community Health Workers do?
“I feel proud of being a Promotora. You feel special because you aren’t only going to learn for yourself, but also to help and inform more people.”
The nature of the training, roles, responsibilities and duties of Community Health Workers varies considerably from program to program. Paid and volunteer* Community Health Workers may work part- or full-time with clinics, nonprofit organizations, public health departments or other organizations. Community Health Workers conduct outreach and health education in clients’ homes, community centers, clinics, hospitals, schools, worksites, shelters and farmworker labor camps. Many Community Health Workers programs focus on serving the needs of specific ethnic or racial groups, while others focus on vulnerable segments of the population or prominent health problems. Although Community Health Workers engage in a broad range of activities, they share a number of common roles.
Community Health Workers provide:
- A link between communities and health and human service agencies
- Informal counseling and support
- Culturally-competent health education
- Capacity building on individual and community levels
- First aid and emergency assistance (1)
* All CHWs who participate in MHP Salud programs receive a wage, stipend, or incentive.
Qualities of Community Health Workers
“People who are Promotores(as) have a gift for service and a noble and kind heart. We think about things and take care of people. We identify with the people and the needs of the community.”
Community Health Workers are typically empathetic, resourceful and willing to help others. Such qualities are personal characteristics that can be enhanced, but not necessarily taught.(2) The Community Health Worker qualities most commonly cited in the National Community Health Advisor Study are:
- Relationship with community being served
- Desire to help the community
- Creativity and resourcefulness
- Personal strength and courage
- Respectfulness (1)
MHP Salud seeks these qualities when recruiting community members to be CHWs.
Skills of Community Health Workers
“A Promotor is a leader and does everything possible so that his or her community will succeed. As leaders, they need to be counselors, defenders, spokespeople and visionaries. They need to have the ability to organize the community – to discover the talents that exist in the members of the community in order to take them and work with them. But without the spirit of service, these skills are nothing.”
Skills are abilities that can be gained through study and practice.2 In order to do their complex work, Community Health Workers must possess or build multiple skills. According to the National Community Health Advisor Study, Community Health Workers are more effective in their work when they have the following skills:
- Communication skills
- Interpersonal skills
- Teaching skills
- Service coordination skills
- Advocacy skills
- Capacity-building skills
- Knowledge base1
In MHP Salud’s programs, CHWs develop these skills through training and practice designed to support personal and community empowerment.
Contributions of Community Health Workers
“Sometimes you don’t get results instantly, but you plant a seed.”
Community Health Workers effectively address many barriers to better health for underserved populations. Some of their accomplishments include:
- Improving access to services
- Helping people understand the health and social service system
- Enhancing client and health provider communication
- Increasing appropriate rates of service utilization
- Decreasing costs for organizations and government programs
- Improving adherence to health recommendations
- Reducing the need for emergency and specialty services
- Improving overall community health status
CHWs accomplish these and other outcomes by providing education and advocacy and building capacity in their communities.(3) (4) (5) View specific outcomes of CHWs’ work with MHP Salud in the Real Life Results section.
(1) Rosenthal, E.L., Wiggins, N., Brownstein, J. N., Rael, R., Johnson, S., & Koch, E. et.al. (1998). The final report of the National Community Health Advisor Study: Weaving the future. Tucson, Arizona: University of Arizona, Health Sciences Center.
(2) Wiggins, N. (2004, January). Qualities of effective community health workers. Paper presented at the 13th Annual West Coast Migrant Stream Forum, Seattle, WA.
(3) Richter, R. W., Bengen, B., Alsup, P. A., Bruun, B., Kilcoyne, M., & Challenor, B. D. (1974). The community health worker: A resource for improved health care delivery. American Journal of Public Health, 64 (11), 1056-1061.
(4) National Rural Health Association. (2000, November). Community health advisor programs. Retrieved June 28, 2004, from www.nrharural.org/dc/issuepapers/ipaper17.html
(5) Pew Health Professions Commission. (1994). Community health workers: Integral yet often overlooked members of the health care workforce. San Francisco, CA: University of California at San Francisco, Center for Health Professions.