By: Martha Moore-Monroy and a panel of promotoras experts
In the United States, as in the rest of the world, Community Health Workers (CHWs) have attracted a great deal of attention lately. In the US this has happened both as a result of ongoing national health care reform and as a general recognition of CHWs’ value and impact on the health of underserved communities in particular. There are some gaps in the US literature on CHWs, particularly related to selection, training and curriculum development for CHWs. Information on these important aspects of CHW programs is especially essential as institutions and individuals that are new to the CHW model consider implementing CHW programs in their service areas and face persistent and increasing resource limitations.
In this conversation, various stakeholders from the Promotoras team in Southwest Arizona will share our experiences. We hope you will share your experiences as well so that we can reflect together on our program and its partners to see how CHW programs in the US and other parts of the world can learn from each other.
In the Southwestern US, CHWs are sometimes also known as Health Advisors, Peer Health Promoters, Promotoras or Patient Navigators. They work to connect individuals and families with appropriate health and human services, while providing outreach, education, referrals and follow-up, case management, screenings, advocacy, and home visiting services. The careful selection of candidates for CHW training is essential, as there are some characteristics of CHWs that cannot be acquired through training. The most effective CHWs are those who are already doing the work in the community. They are the natural, unofficial leaders who are part of the communities they serve and, as such, have a deep understanding of the culture, language, history, and social determinants of health impacting those communities. In addition, these CHWs are able to be the bridge between services and members of the community. This is especially true in communities where health care providers may not speak the same language or come from the same culture as their patients. Often the patient or client is left unclear about the provider’s instructions but feels reluctant to question the provider. In these instances, the CHW is a crucial member of the health care team, explaining the provider’s instructions in a manner the patient can understand.
As you will see from our first set of discussion questions below, we would like to use this conversation in part to discuss different strategies for identifying natural leaders.
Another topic for the discussion is training and building the health-related knowledge-base of CHWs. Some programs offer their own training. One such program is the Health Start pre/post natal program funded by the Arizona (state) Department of Health Services. The Health Start curriculum was developed in the mid 1990’s and is now undergoing a major revision. All CHWs working in Health Start are required to pass a series of 11 pre- and post-exams before they begin home visitation to pre- or post-natal women. The exams allow for health education discussions and peer-training. A second program that provides in-house training is the International Rescue Committee’s (IRC) Well-Being Promotion Program in Tucson, Arizona. This program trains refugee women to visit newly arriving refugee families.
On the positive side, in-house trainings are generally free of charge, but they are sometimes also limited in scope. For this reason, we work with South Mountain Community College in Phoenix, Arizona, which offers entry level classes that teach skills and topics for CHWs. The course includes 30 hours of service-learning experience in the field and fulfills 3 credit hours towards a 16-credit Community Health Worker Certificate of Completion. We have found that training and curricula developed in collaboration with the CHW leadership are more effective and successful, as they are the ones who know the needs of the community and what they need to learn to best serve their clients. This CHW-led ongoing workforce development and training approach has proven essential to the success of our CHW program. We will share more on this throughout the month.
Finally, we will also compare our US model, which continues to evolve, with the Latin American models where CHW programs were initiated. We also hope to share and explore CHW success stories in cervical cancer prevention and along the US–Mexico border, a comparison of the US models to those in developing countries, and various methods for professional development and career advancement.
Questions:
- Is local leadership an important selection criterion in successful CHW programs? If yes, what are the different approaches for identifying and cultivating local leadership?
- What other professional and/or personal skills and qualities are essential for a successful CHW and CHW program?
- Can CHWs be taught to become local leaders? What are some of the workforce development approaches for CHWs that include leadership development?
Martha Moore-Monroy, MA is the Program Director for the REACH Pima County Cervical Cancer Prevention Partnership based at the University of Arizona, National Center of Excellence in Women’s Health. She serves as a Regional Director for the National REACH Coalition Board of Directors, an organization dedicated to the elimination of health disparities. The primary focus of her professional career has been working with promotoras/community health outreach workers and community based coalitions dedicated to the elimination of health disparities facing underserved and minority populations. Martha received her MA at the University of Arizona in Tucson.
Gail Emrick, MPH is as the Executive Director with the South East Arizona Area Health Education Center, SEAHEC in the border town of Nogales, Arizona. Her work focuses on health workforce development for rural and underserved communities and health service agencies in three border counties of Arizona. Gail is an International Health and Development Specialist who has dedicated her professional life to promote the wellbeing of individuals, families and communities in Central America and the U.S.-Mexico border regions. With twenty five years of experience in program management, Gail has served as Executive Director, Principal Investigator, Regional Technical Advisor and senior Program Officer for international and local non-profit organizations including Project Concern International and the United Nations World Food Programme, as well as US-based academic institutions including the University of Arizona’s Center for Rural Health. Ms. Emrick has collaborated with Ministries of Health, Agriculture, Environment, the UN Food and Agriculture Organization, UNICEF, the Nutritional Institute of Central America & Panama (INCAP), and with municipal leaders and local organizations to improve health and nutrition, food security, water and sanitation, and address priority development needs and concerns. At Columbia University, in the city of New York, Gail earned her joint Masters Degree in Public Health and International Affairs, with a focus on Latin America’s economic and political development.
Joyce Latura, BA, is the Maternal and Child Health Manager at Mariposa Community Health Center in Nogales, Arizona. For the past 31 years, Joyce has worked with, supervised and trained Community Health Worker staff in early childhood education, parental involvement and maternal and child health fields. Through her commitment in recognizing the value of Community Health Workers and their skills, Joyce presented a year-long leadership project on CHWs at the 2005 Summer Institute in Maternal and Child Health to the Rocky Mountain Public Health Education Consortium. In her professional work, she currently is working with Promotoras de Salud on cross-training staff to implement case management, health education and screenings for pre and post natal women. In 2009 Joyce began working with and teaching refugees and Well Being Promoters in Tucson, Arizona through the International Rescue Committee (IRC ). In 2010, through an opportunity from Goshen International, Joyce began training 25 CHWs in Bujumbura, Burundi, Africa. She is currently developing training curricula for Goshen International Community Health Worker Academy.
Susan Kunz, MPH, Director of Health Promotion and Disease Prevention, Platicamos Salud. Mariposa Community Health Center in Nogales. She has provided public health leadership in Arizona’s U.S.-México border region for 30 years. Her work has been in partnership with community-based organizations to create, advance and replicate evidence-based practice that address social determinants of health. Susan began her public health career as a Peace Corps Volunteer in Colombia, South America. Susan worked for the Tohono O’odham Nation as a health planner to build its tribal health department and complete the first tribal health assessment including tribal members in México. She directed the Border Health Foundation, coordinating projects in the four U.S. border states and the six Mexican border states. She recently completed a four-year term as Co-Chair of the Community Action Board (CAB) for the Arizona Prevention Research Center at the University of Arizona. Susan is Chair Elect of the National Community Committee (NCC) that advises the CDC Prevention Research Center Program nationwide. Susan received her Master’s in Public Health Degree from the University of California at Berkeley and received the Commitment to Underserved People Award from the Arizona Public Health Association.
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