Por, Para y Con la Comunidad: A Comparative Analysis of Community Health Worker Interventions in Latin America and the United States
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Community health workers (CHWs) represent an invaluable link between individuals and health care in diverse regions around the world. They have been employed on varied scales since the 1800s to connect people with resources ranging from water sanitation to primary health care. A wide body of literature supports that CHW programs positively impact health outcomes. Many of the world’s most pressing health issues including infectious disease, chronic illness, and access to primary care have been approached at the community level through the use of lay health workers. Studies from regions across the globe support the view that community-based approaches to these challenges are effective, and that CHWs are imperative to the success of such programs. During the summers of 2012 and 2013, I worked closely with CHWs as an intern and fellow for the Peruvian branch of the non-profit public health organization Partners in Health (Socios en Salud) in Lima, Peru. This project stems from my experiences facilitating workshops for CHWs in urban Lima, where I observed community-based accompaniment in action. Through critical analysis of my work and that of others researching community health and development, I identify key features of CHW involvement that help explain the successes and setbacks of community health provision in Latin America and the United States. I ultimately conclude that CHWs are uniquely suited to bridge the gap between existing public health strategies and vulnerable communities. CHWs improve health status and care delivery and are cost effective. Countless studies with rigorous methods have demonstrated the measurable advantage that CHWs provide towards addressing today’s greatest health concerns. The main question I am left with is, why not here? The U.S. boasts an enormous network of tertiary care facilities working alongside clinics, but lacks support from within communities to connect the neediest patients with available services. In this project, I explore the potential of CHWs to improve the lives of those who are medically underserved by current strategies in the U.S. In the current era of health care reform, there has never been a more opportune time to integrate the proven CHW advantage into existing health infrastructure.