By: Diego Otero-Oyague
Lee la versión en español aquí | Read spanish version here
Community-based mental health care can benefit not only the people receiving care, but also the community health workers who deliver it. My name is Diego Otero-Oyague and I’m a Clinical and Community Psychologist working and doing research with Community Health Workers (CHWs) in Lima, Peru. I would like to share with you how pleased and thankful I am for choosing to work with CHWs in Villa el Salvador, a south-Lima district. In the lines below I will share my experience as a coordinator and supervisor with an amazing CHW group. I will also share some of the learnings and experiences CHWs took away from working with older adults in their communities experiencing depression.
Here in Peru, CHWs are known as Agentes Comunitarios de Salud. Always volunteers, CHWs usually start as recognized members in their communities. Later, they are recruited and formally registered by health authorities to help extend access to healthcare services for community members. They often contribute to health campaigns on vaccination, infection disease prevention, maternal and child health. Through the “VIDACTIVA” program, implemented by St. Martin de Porres University in collaboration with the University of Washington, we trained CHWs to implement an evidence-based intervention for older adults with depressive symptoms.
Not so different from other Latin American countries, an estimated 10% and 15% of older adults in Peru experience depression. Rates reach up to 30% among older adults with low income who experience poverty, unsafe housing, and limited health infrastructure, exacerbating depression. In addition to structural barriers that contribute to depression, older adults face barriers in accessing mental health services in Peru. These barriers include stigma, ageism, and mistrust of public health services, among others. These conditions demand innovative and community-driven solutions, such as task-sharing interventions involving CHWs that address such barriers by providing psychosocial support, reducing stigma, and enhancing access to care.
That is why we developed VIDACTIVA for older adults experiencing depression. Services are delivered by CHW trained in Problem Solving Therapy, Behavioral Activation, active listening and psychoeducation. In the VIDACTIVA program, CHWs provide up to 9 visits to older adults in their homes on a 14-week timeline. During the visits, CHWs and their clients in a familiar way, talk about life, their day-to-day problems, potential solutions and daily activities for cognitive and behavior activation while they build strong bonds, trust and friendship.
Between 2022 and 2025, we implemented VIDACTIVA by working hand in hand with a group of 16 CHWs. The group was composed of 15 women and one man, all between 41 and 74 years old, with significant years of experience in community leadership. Both the CHWs’ knowledge of the communities and their experience were key attributes that made the intervention both acceptable and feasible.
My experience coordinating and being part of the support and supervision group with the 16 CHWs of VIDACTIVA was enlightening, and we believe that was also the case for the CHWs. For the intervention, we paired CHWs in groups of two, with each group supporting 5 older adults. All CHWs attended a weekly three-hour meeting where they discussed the most recent sessions with their older clients. CHWs were encouraged to freely share how they felt, their achievements and difficulties, and their perspectives on the needs and challenges of the older adults they supported. This allowed them to give and to collect feedback and validation from fellow CHWs and from us as coordinators.
The weekly meetings were very important to organize CHWs as a collaborative group where they could find support, build significant bonds and share important insights, learning about themselves, their personal lives, their family and community. The groups discussed program management issues as well as mental health and community support for older adults. Through this process, both program managers and CHWs learned. Alejandrino is a 74-year-old CHW with 20 years of experience serving the community, he noted:
“I have learned to value life and get to know many friends; for me, it is a joy. The training sessions we had have strengthened me, helping me get to know and value myself and supporting me in finding solutions to my own problems.”
As older adults themselves, some CHWs found that the program’s training helped them with their own lives. Mariluz, a 63-year-old CHW enthusiastically expressed:
“Personal growth. I found myself. I also strengthened my assertiveness. Enjoyable and social activities are important and I incorporated sport into my daily life. I put what I learned into practice in my own life.”
She recognizes a “reconstruction” in her daily habits and activities, putting increased value on physical activity and expressing that she has overcome feelings of monotony or boredom. Another CHW, Gloria, who is 67 years old, noted about the program:
“It (VIDACTIVA) has helped me quite a lot. I have become much more aware of how I have been falling short as a person, and that has helped me. Even now, as I prepare to go out, my husband’s support has helped me a lot with practicing and rehearsing the questions. The many times I have rehearsed them, he himself has become aware of the problems that have been troubling him, and that is truly valuable.”
As the above example shows, CHWs’ families also had an impact on them (CHWs) and their work; others found that the work helped their families as well. Sixty-six-year-old CHW Aurea told us how the program helped her strengthen her own family and how she also feels more prepared to turn that learning to the community:
“I have also been able to apply the teachings within my family and my surroundings, and I feel prepared to go out into the world.”
Looking back, the biggest lesson from this journey is how much a community program can transform both the participants and the CHWs delivering it. When CHWs come together as a team to share experiences, collaborative learning flourishes.
Mental health from a community perspective shouldn’t always come from outside experts dropping in; it should grow from the community’s own strengths and collective wellbeing. Working side-by-side with CHWs and building on their real-world wisdom gives us an amazing opportunity to create richer, more effective care for everyone.
Bio: Diego Otero-Oyague has been a Licensed Clinical Psychologist, Researcher and Psychotherapist for 12 years, with an MA in Psychoanalysis and Culture Theory. My clinical and academic interest is oriented towards mental health, community-based interventions with older adults, psychotherapy, attachment theory, mentalization studies, and suicide prevention. I have experience in conducting qualitative and quantitative research and am currently an active member of the Aging Research Center (CIEN) Universidad San Martin de Porres USMP and The Community Psychology Research Group Pontificia Universidad Católica del Perú PUCP.
This is the fourth feature in CHW Central’s 2026 series on CHWs Supporting Older Adults, which brings together perspectives from different regions of the world on the growing role of Community Health Workers in supporting older adults. As the series continues through 2026, we invite you to explore the different perspectives being shared from research, policy, and practice. If you missed our earlier features, you can also read What Community Health Workers Make Possible in Supporting Older Adults by Prof. Arkers Wong, which examines the role of CHWs in Hong Kong, China, How CHWs Can Help Close Social Care Gaps for Older Adults by Amanda Keddington, which explores opportunities to strengthen care for older adults in the United States and Beyond Care Delivery: CHWs as the Connectors of Healthy Ageing and Longevity by the International Federation on Ageing (IFA).
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