Education, activism and community empowerment: Examples from El Salvador

From Russian “felshers” to Chinese barefoot doctors, community health promoters (CHP) have long history of providing health promotion and disease prevention in many cultures and countries. Each CHP has unique historical, political and economic context. Questions regarding CHP's role in health care systems abound. Are CHP most effective when they are integrated into or remain outside health system? Should they receive salaries or work as volunteers? Can CHP be effective advocates and have positive influence on people's health? Doctors for Global Health (DGH) has been working in community health care in rural El Salvador since its civil war ended nearly 20 years ago. DGH reinvigorated health promoter programs in two communities: CHP in Estancia, Morazán, and rehabilitation health promoters (RHP) in Santa Marta, Cabañas. Santa Marta RHP interface with ministry of health clinic and provide respiratory treatment, physiotherapy, and massage; conduct home visits; run early child development class, Vamos a Jugar (Let's Play) and elderly exercise and support group, Mayores en Movimiento (Elders in Movement); and train CHP in DGH's partner community Estancia. CHP in Estancia provide preventive and curative care in the community clinic and on home visits; and advocate for their patients who need emergency or subspecialty care referrals in Salvadoran health care system. This is challenging as CHP often perceive lack of respect from Salvadoran health professionals who aren't interested in their observations and dedication. This presentation will describe DGH's role in helping CHP develop strong advocacy skills and successes and challenges of activism and community education.