Where There Is No Doctor There Are Health Promoter Practitioners

Where There Is No Doctor There Are Health Promoter Practitioners

Organization type: 
nonprofit/ngo/citizen sector
$250,000 - $500,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

Concern America has developed and is successfully implementing an integrated health care model that trains community members in impoverished regions to be the primary health care providers in their own villages, known as "Health Promoter Practitioners.” As a result, in villages located hours away from health care centers and whose residents earn less than $2.00/day, high-quality, low-cost health care is a reality, saving and sustaining innumerable lives, using few resources.

About Project

Solution: What is the proposed solution? Please be specific!

Concern America’s Health Promoter Practitioner model is a breakthrough in the provision of primary health care in economically impoverished communities located in remote and, at times, war-torn regions: (1) The model does not rely primarily on doctors or nurses for direct care, or the construction/staffing/equipping of new and expensive clinics and hospitals, recognizing that even without the most advanced machines and technology, 90% of primary health care needs can be successfully met in one’s village, all with a low-cost set of “essential” medicines (World Health Organization designated) and simple, basic medical equipment; (2) The model draws upon the wisdom, creativity, and deep-rooted commitment of the local community members themselves to help their own communities and the Practitioners come from the very people they serve, respecting their culture’s health care beliefs and cultural norms, while providing care in their own native language(s); (3) The Health Promoter Practitioners emerge as local leaders who are at the center of creating local health infrastructure and systems and who actively work to change the root causes of the lack of health care in their regions by working with governments to improve health policies and the quality of care given in area health centers/hospitals.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

Concern America is successfully implementing Health Promoter Practitioner training programs in three countries in Latin America. Once trained, the Health Promoter Practitioners can competently diagnose and treat patients, administer a wide range of medicines, and perform surgeries (e.g. tendon repairs). The four-year Practitioner training program, a model developed by Concern America over the past 20 years, includes bi-monthly training courses combined with regular accompaniment as the Practitioners learn skills and gain experiences. The level of skills and knowledge of Health Promoter Practitioners is comparable to physician assistants and nurse practitioners in the U.S. In an effort to bring the model to many more communities/regions, organizations, and governments throughout the world, Concern America, and its field team members who implement the Health Promoter Practitioner model on the ground (all medical professionals with many years of experience in the field), are writing a Health Promoter Practitioner Training Manual that can help western-trained medical professionals understand this primary health care model and replicate it around the world. The writing of the Manual is estimated to be completed by the end of 2012 and will be a major contribution to the field of primary health care worldwide.
About You
Concern America
About You
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About Your Organization
Organization Name

Concern America

Organization Phone


Organization Address

2015 N. Broadway

Organization Country
Country where this project is creating social impact

, PE

How long has your organization been operating?

More than 5 years

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What stage is your project in?

Operating for more than 5 years

Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.

Concern America works in “developing” countries among impoverished communities with (1) few resources to dedicate to health care, (2) rural isolation, (3) language/cultural differences, and (4) often living in regions of war. Within these contexts, the Health Promoter Practitioners, as well as the population served by their work, are mostly campesinos (peasants) and include representatives of several indigenous, ethnic groups. Furthermore, one of the best ways to convey the realities of the community engaged by Concern America is through the stories written by the organization’s field personnel. From Colombia:

"So, in the midst of this [violence], the Health Promoter Practitioners are life-savers and spirit-savers. They can diagnose and treat the vast majority of the infectious, chronic or endemic diseases of their villages and can initiate and motivate programs to prevent them. In the best of cases they can fight the system and get a patient with a serious injury or illness into the hospital. They are a hope for their village and for our world. Because of that very reason Promoter Practitioners can be targets of those who want to see society controlled by those whose interests in health are not at the forefront. And, of course, this is why we support them and defend them.”

Share the story of the founder and what inspired the founder to start this project

Concern America’s Health Promoter Practitioner model came into existence through years of accompanying communities in Latin America that lacked access to quality health care. How does one develop a functioning, primary health care system in an area where neither government nor private solutions exist? How can local people, even those with only a few years of formal education, be engaged in the provision of their own primary health care and the creation of a local health system that meets their needs? These were the questions faced by Concern America and its field personnel in the early 1980s as it accompanied Guatemalan refugees living in camps in Mexico and Salvadoran refugees in camps in Honduras.

It is during this period that Concern America began training community members to provide primary health care in the refugee camps. Then, as the Guatemalans and Salvadorans returned to their home countries when peace accords were being signed in each country in the 1990s, Concern America continued health trainings in the new communities that they were creating and/or to which they were returning. By the mid 1990s, the Concern America Health Promoter Practitioner model had taken shape.

Social Impact
Please describe how your project has been successful and how that success is measured

The success of Concern America’s Health Promoter Practitioner model is multilayered and evidenced by the following: (1) Currently 250,000+ people in more than 800 remote, economically impoverished and often war-torn villages have access to quality, affordable health care in which they themselves, as Health Promoter Practitioners, are providing their own care; (2) the Health Promoter Practitioners, in addition to their work as volunteer health practitioners, are all community leaders whose work transforms their villages and regions in numerous ways beyond providing health care services; (3) the advanced Practitioners have become leaders in their training programs who “multiply” their knowledge and skills by training and accompanying the newer trainees, reducing the need for outside trainers.

Since 2007, Concern America and its Health Promoter Practitioner model have received much recognition: (a) Twice a finalist for the $1.5 million Conrad N. Hilton Humanitarian Prize; (b) The Albert Schweitzer Award of Excellence from the Albert Schweitzer Institute of Chapman University (Orange, CA, 2010); (c) Semifinalist for the 2011, $100,00 Buckminster Fuller Challenge; and, (d) Pan American Health and Education Foundation’s Clarence H. Moore Award for Voluntary Service, 2007 (out of 600 groups nominated, for the organization’s work in Colombia).

How many people have been impacted by your project?

More than 10,000

How many people could be impacted by your project in the next three years?

More than 10,000

Winning entries present a strong plan for how they will achieve growth. Identify your six-month milestone for growing your impact

Advance the writing of the Health Promoter Practitioner Training Manual, expand the model into Africa (Mozambique), and engage new trainers for the field.

Task 1

Continue the writing of the Health Promoter Practitioner Training Manual by the team of Concern America medical professionals, approximately one chapter/month.

Task 2

Lay groundwork for initiation of new Health Promoter Practitioner training project in Niassa Province, Mozambique (project planning, secure funding, identify trainers/staff).

Task 3

Ongoing outreach to health care professionals to identify and engage new field personnel to learn the model and train new Health Promoter Practitioners.

Identify your 12-month impact milestone

Nearly complete the writing of the Health Promoter Practitioner Training Manual, and launch the Mozambique training project.

Task 1

Continue the writing of the writing of the Health Promoter Practitioner Training Manual, with a target completion date at the end of 2012.

Task 2

Develop a plan for publication of the Health Promoter Practitioner Training Manual, with elements in place for a wide distribution worldwide once the Manual is completed.

Task 3

Initiate the Health Promoter Practitioner training project in Mozambique, while continuing the successful training programs in Mexico, Guatemala, and Colombia.

How will your project evolve over the next three years?

A significant evolution of the Health Promoter Practitioner model is the writing of the Training Manual that is currently in process (which includes a both a “Teacher Guide” for program leaders/trainers and a “Health Promoter Practitioner Handbook” for the village Practitioners). Concern America’s Manual will be made available to institutions worldwide working in the training and delivery of primary health care services (NGOs, schools, governments, funders, grassroots organizations, etc.), filling a serious gap in resources which support the creation of comprehensive primary health care systems. Another important evolution is the expansion of the model from Latin America to Africa.

What barriers might hinder the success of your project and how do you plan to overcome them?

Since 1972, Concern America has worked successfully in fifteen countries on four continents. Through training and accompaniment provided by experts (“volunteers,” totaling over 250 during the life of the organization) from a variety of disciplines, Concern America has made measurable differences in the lives of more than two million people living as refugees/internally displaced peoples, amidst civil conflicts, and with materially poor communities in extremely challenging regions.

This is shared to highlight the experience of Concern America working in difficult situations. Certainly, there are a number of local factors that could prevent the success of the Health Promoter Practitioner model in a given area, but the organization has proved its success over the last two decades in a variety of contexts. In terms of the Manual that is being written, the biggest challenge will be getting it published and widely distributed, though Concern America already has experience in this field (it recently published the 440-page “Indigenous Q’eqchi’ Health Manual,” written in the indigenous Mayan language of Q’eqchi’, a health guide comparable to the invaluable “Where There Is No Doctor” by David Werner).

Tell us about your partnerships

Concern America always enters a new project through the invitation of a locally respected entity, and is intentional about creating strong relationships with a variety of institutions in order to bring numerous ideas and resources to the problems being addressed. Specifically, Concern America currently maintains important relationships with InterAction, an alliance of more than 160 US-based international development organizations (Concern America is both a founding and active member); the Fair-Trade Association; faith-based organizations (including health systems) of the Catholic, Episcopalian, and Presbyterian Churches; the Guatemalan Association of Community-Based Health Services, a leader in community health efforts in that country; the “Good Government Councils” of the indigenous communities of Chiapas, Mexico; the Committee of Associated Inter-ethnic Health Promoters in the Lower Atrato, Colombia, the community-based organization created through Concern America’s work in that country; the sister organization Concern Universal (of England); the Hesperian Foundation (for health materials); the IDA Foundation (for medicines), among others.

Explain your selections

Concern America funds all of its work, including the training and accompaniment of Health Promoter Practitioners and the writing of the Practitioner Manual, through a diverse combination of income streams, helping to maintain consistent levels of project support as necessary. The organization’s average annual income breaks down as follows: foundation grants (30%) and individual donors/special events (70%). The majority of the work with Health Promoter Practitioners is funded through designated grants, ranging from $5,000-$30,000 each, awarded by foundations located in the U.S., England, Italy, and Spain.

How do you plan to strengthen your project in the next three years?

(1) TELLING THE STORY OF THE AMAZING WORK OF THE HEALTH PROMOTER PRACTITIONERS: Concern America and its Practitioner model have received some important recognition in recent years (see the Measuring Success section of this submission) that is helping spread the word of this life-saving and life-sustaining model of local primary health care providers and systems.

(2) WRITING THE HEALTH PROMOTER PRACTITIONER TRAINING MANUAL: The four-year effort to write a Training Manual that brings together all of the curricula, training materials, and methodology of Concern America’s Practitioner model will have the potential to share this effective model with institutions around the world who are looking for innovative solutions to the serious need for patient empowerment.

(3) BRINGING THE HEALTH PROMOTER PRACTITIONER MODEL TO MOZAMBIQUE: Concern America is in the initial stages of expanding its Practitioner program to include communities in Mozambique, an important step of testing the model in a new context.

Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.


Lack of physical access to care/lack of facilities


Limited human capital (trained physicians, nurses, etc.)


Lack of affordable care

Please describe how your innovation specifically tackles the barriers listed above.

Concern America’s Health Promoter Practitioner training model engages local communities and community members in the provision of their own health services. As a result, in isolated villages located hours away from health care centers and/or in war-torn regions, and whose residents live in material poverty, the presence of trained Health Promoter Practitioners who can diagnose, treat, and educate their fellow community members in their own home or a village clinic, in their own indigenous language, creates access to affordable, quality care. As Health Promoter Practitioners proclaim: “Where There Is No Doctor There Is a Promoter Practitioner.”

How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.


Grown geographic reach: Global


Influenced other organizations and institutions through the spread of best practices


Grown geographic reach: Multi-country

Please describe which of your growth activities are current or planned for the immediate future.

Currently, Concern America is laying the groundwork to expand the Health Promoter Practitioner model beyond the three core countries where the organization runs health training and accompaniment projects (Mexico, Guatemala, and Colombia) to Mozambique in early 2012. In addition, the writing of the Health Promoter Practitioner Training Manual will expand the model throughout the world. The Manual is scheduled to be completed by the end of 2012.

Do you collaborate with any of the following: (Check all that apply)

Technology providers, NGOs/Nonprofits, Academia/universities.

If yes, how have these collaborations helped your innovation to succeed?

Every Concern America project is carried out in collaboration with local entities including NGOs, community groups, and churches. In addition, each of its health projects is approached in an integrated manner in which the Health Promoter Practitioners address a variety of health-related issues through “appropriate technologies” (such as building potable water systems, or installing solar lighting in Practitioner-run clinics in villages without electricity). Lastly, the organization is creating a medical resident program, in collaboration with a few universities, to enable medical student-rotations in Guatemala where they can work with and learn from the Health Promoter Practitioners in that country.