Primary health care for remote village communities in Honduras: a model for training and support of community health workers.

BACKGROUND AND OBJECTIVES We present a model for the development of sustainable primary health care in village communities in Honduras through the training and support of community health workers. The model follows a "bottom-up" approach using community-centered data generation, problem-specific curriculum development, and ongoing knowledge maintenance and support for community-based care givers. Health worker training, evaluation, and support are provided by US-based primary care professionals. METHODS The intervention is designed in five stages: (1) background needs assessment based on patient chart reviews to identify prevalent health problems, (2) selection of target communities, (3) obtaining community involvement and prospective health worker commitment, (4) development and implementation of a needs-specific curriculum for health worker training and community health education, and (5) maintenance, evaluation, and expansion of training and support for community health workers. RESULTS Chart review of 725 children identified respiratory tract disease, gastrointestinal infections, and skin infections as predominant health problems. A curriculum for health workers was designed to address these and was implemented in a 1-week training program in two target communities. After 15 months of practice, health workers had attended 2,347 patients. Three monthly review and refresher sessions improved case management accuracy significantly. CONCLUSIONS The establishment of sustainable primary health care in remote, underserved communities using community health workers is possible and feasible, even in countries that do not have a national health worker network. Primary care professionals can play an instrumental role in project design, management, and supervision.