Expanding Medical Education for Local Health Promoters Among Remote Communities of the Peruvian Amazon: An Exploratory Study of an Innovative Program Model

Abstract

Purpose

Community health workers (CHWs) play integral roles in primary health care provision in low- and middle-income countries (LMICs). This is particularly true in underdeveloped areas where there are acute shortages of health workers. In this study, we evaluated the development and community utilization of a CHW training program in the Loreto province of Peru. Additionally, a community-oriented training model was designed to augment access to basic health information in underserved and isolated areas of the Amazon.

Methods

Health resource utilization was compared in each community by surveying community members before and after implementation of the CHW training program, which utilized a community participatory program development (CPPD) model.

Results

All communities demonstrated significantly increased CHW utilization (p = 0.026) as their initial point of contact for immediate health concerns following CHW training implementation. This increase in CHW utilization was accompanied by trends toward decreased preferences for local shamans or traveling to the closest health post as the initial health resource.

Conclusion

The community-focused, technology-oriented model utilized in this study proved an effective way to promote the use of CHWs in the Amazon region of Loreto, and could prove valuable to CHW capacitation efforts within other Peruvian provinces and in other LMICs around the world.

Keywords:

• community health worker
• promotores
• human resources for health
• mobile health technology
• expanding access to healthcare
• rural health

Abbreviations

HRH, human resources for health; CHW, community health worker; LMIC, low- and middle-income country; NGO, non-governmental organization.

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics and Consent Statement

IRB permission was granted through the ATSU, Arizona IRB Committee; IRB #2105-155.

Acknowledgments

We acknowledge support from the non-governmental organization, 501(c)(3), Project Amazonas, and in particular Dr. Devon Graham, for facilitating this research, community meetings, lodging at Madre Selva, outreach, training facility accommodations, and mobile clinic data. We acknowledge the 501(c)(3) MGY, and in particular David Tseng, Sam Waggoner, and Guadalupe Chavez for their commitment to the development and persistent reassessment of mobile health programs. We also acknowledge A.T. Still University School of Osteopathic Medicine in Arizona, and the University’s Institutional Review Board for working with us. We acknowledge and give tremendous thanks to the community health workers, community leaders, and residents of Comandancia, Nuevo Israel, and Santo Tomas along the Orosa River in Loreto, Peru.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors declare they have no competing interests in this work.

Additional information

Funding

There were no outside sources of funding for the research reported in this manuscript.