Emergency medical training for health promoters in Central and South America.

Underserved regions in the developing world are challenging areas to provide emergency medical care. As populations in these often remote or isolated districts may have minimal access to regular health care, contacts with medical providers are frequently episodic and driven by an acute condition. Health promoters—practitioners who provide basic medical care and promote public health in numerous countries across Central and South America, Asia and Africa—help to fill this void. Typically, health promoters are certified through a formal training program in their country and come from the same population as the clients they serve, which helps them form a link between their community and the dominant health care system in the region (1–2). Access to health and social services in regions served by health promoters is usually minimal, resulting in high morbidity and mortality associated with preventable diseases. Health promoters strive to improve the overall health of these communities by supplementing and improving the curative, preventive, and promotional aspects of the existing health system. Evaluations of the public health impact of health promoters have identified specific benefits for the populations they serve, as well as challenges and limitations. A review of Peruvian health promoters indicated that they had the greatest impact on boosting vaccination coverage and increasing use of available public health services. Sustainability was a problem, however, with only 40% of health promoters originally trained still active 3 years after their training and supervision had ended (3). In Bangladesh, the impact of village health promoters was limited by methods used, time constraints, and extreme poverty and illiteracy in the population served (4). To have a positive impact on public health in indigenous or rural populations, health promoters must: (1) determine the health status of a population , (2) gain acceptance by taking into account community cultural beliefs and practices, (3) improve health care outcomes from both emergent and non-emergent medical conditions using available resources, and (4) ensure the effort is sustainable. Many health systems that use health promoters have no ability or mechanism to assess the impact of health promoters, no means for health promoters to advance their education or skills, and no plan for sustainability. These limitations can hinder the ability of health promoters to bring about lasting gains in patient care and public health.