Nicaragua

 

Program Overview

The Teach for Health community health promoter program in San Ramon, Nicaragua seeks to empower rural communities to identify and seek solutions to health problems with the help of an elected health promoter who receives specialty training. Community health promoter competency is improved through monthly training modules and annual continuing education workshops, with long term support and advising relationships while health promoters develop their own solutions on a day to day basis working in their communities. Graduate students in medicine, nursing and public health join with local organizations to provide the necessary training for community driven sustainable responses.

Projects initiated by health promoters have included health outreach and education workshops at schools, family planning informational talks, anti-malarial household fumigation, checkups and family support for sick community members, community cleanup days and more. Health promoters serve as a contact point for their community’s questions and needs- returning to monthly program meetings for brainstorming and feedback with their peers and Teach for Health program staff. The fundamental basis for all projects is that they must originate from identified community needs, while seeking solutions that rely on existing community resources.

Why It’s Needed

The small communities surrounding San Ramon have little access to healthcare, with the central health clinic providing basic primary care located up to 6 hours away. Additionally, with limited access to acute care and minimal resources, preventive medicine is especially important to maximize health outcomes and quality of life. Finally, in Nicaragua and in most developing countries we feel as though there is a lack of community empowerment, with government and NGO projects “stepping in” to provide scattered basic services with little underlying support and maintenance. This program’s basis stems from education and community involvement, creating a sustainable infrastructure of empowered and motivated individuals who with provide committed, incremental improvements for their communities.

Location

San Ramon is a region of Nicaragua with approximately 37,000 inhabitants. This rural, coffee farming group of communities is located about 2 hours north of the capital city of Managua. Individual communities ranging from around 20 to 3,000 people are scattered throughout this mountainous region and are connected by dirt roads of varying quality. The central town of San Ramon, with around 15,000 inhabitants, is the meeting point for selling agricultural products and buying goods, and is a 15 minute to 2 hour bus ride from the small communities, with additional walking time of up to 2 hours to get to the bus stop from isolated houses. Irregular bus service connects some communities along main dirt roads, with other transportation often including walking and horseback riding.

Cost Effectiveness

In public health and development projects, lack of funding is always a concern. Our program is based on the idea of community volunteerism and empowerment, uniting motivated individuals for high yield and low cost projects. Example: antimalarial campaigns are relatively low cost, but require a substantial infrastructure to implement at a community level. Transporting “experts” to a region, bringing materials, paying wages, transporting staff and materials to a rural community, asking permission of each house, etc can cost thousands (if not tens of thousands) of dollars. Through the community health promoter model, an existing promoter recruited 8 friends and family members who were willing to help spray household walls (the WHO recommended method to prevent malaria). The group also removed standing water sources like tires or buckets, which are the major source of dengue. The group got a spray can and pesticide donated for a week from the health clinic and went door to door to 160 households to give mosquito eradication advice while treating the area. Total cost: (~10 dollars in transportation, with improved community empowerment and more effective communication). Using a centralized meeting point with health promoters who live in target high risk communities our program can have a permanent and effective presence at very low cost.

Our Accomplishments

• Training 3 cohorts of health promoters, 86 total over the course of 2 years
• 69 health promoters are currently active, an 80% retention rate
• Health promoter representation from 21 villages, concentrated in high risk and vulnerable communities as identified by local government
• 4 one year intensive training programs for Teach for Health “Program Assistants” chosen from within the health promoter program to specialize in locally based program support, grant writing, and linking local resources
• 18 self-funded graduate students from the USA trained in Nicaragua with significant UCSF/UC Berkeley involvement, 4 completed research projects, 3 conference presentations
• 1 Nicaraguan MPH students sent to Guatemala for training
• Increasing shift of management and decision making to the promoters themselves
• Leadership workshops for 100+ Nicaraguan ministry of health workers
• 20 Nicaraguan firefighters trained and certified to First Responder level, 3 trained as trainers
• Patient care reports integrated into ambulance, clinic and fire first responder protocols to improve continuity of care in emergency situations
• Numerous community programs implemented by our promoters: community cleanups, sanitation/trash disposal systems, moving kitchens away from sleeping areas with improved smoke ventilation, insecticide spraying for malaria and dengue control, health education campaigns, starting daycare/education for children of rural coffee farmers, hand hygiene materials and education for rural schools.

In Pictures:
Watch the video below for a visual overview of the place where we work, our partners, and just a few of the wonderful health promoters who make up our team.

Program funding has been generously provided by:

Blum Center for Developing Economies

UCSF Global Health Sciences

And many individual donors. If you are interested in helping support our project, please visit the donations page of this website.