Journal of Community Health

, Volume 35, Issue 2, pp 182–189 | Cite as

A Role for Community Health Promoters in Tuberculosis Control in the State of Chiapas, Mexico

  • Michael E. Herce
  • Jacob A. Chapman
  • Arachu Castro
  • Gabriel García-Salyano
  • Kaveh Khoshnood
Original Paper


We conducted a qualitative study employing structured interviews with 38 community health workers, known as health promoters, from twelve rural municipalities of Chiapas, Mexico in order to characterize their work and identify aspects of their services that would be applicable to community-based tuberculosis (TB) control programs. Health promoters self-identify as being of Mayan Indian ethnicity. Most are bilingual, speaking Spanish and one of four indigenous Mayan languages native to Chiapas. They volunteer 11 h each week to conduct clinical and public health work in their communities. Over half (53%) work with a botiquín, a medicine cabinet stocked with essential medicines. Fifty-three percent identify TB as a major problem affecting the health of their communities, with one-fifth (21%) of promoters reporting experience caring for patients with known or suspected TB and 29% having attended to patients with hemoptysis. One-third of health promoters have access to antibiotics (32%) and one-half have experience with their administration; 55% complement their biomedical treatments with traditional Mayan medicinal plant therapies in caring for their patients. We describe how health promoters employ both traditional and allopathic medicine to treat the symptoms and diseases they encounter most frequently which include fever, diarrhea, and parasitic infections. We contend that given the complex sociopolitical climate in Chiapas and the state’s unwavering TB epidemic and paucity of health care infrastructure in rural areas, efforts to implement comprehensive, community-based TB control would benefit from employing the services of health promoters.


Community health workers Tuberculosis Chiapas Mexico 


  1. 1.
    World Health Organization. (2009). Global tuberculosis control—epidemiology, strategy, financing (pp. 1–5). Geneva: WHO.Google Scholar
  2. 2.
    Corbett, E. L., Watt, C. J., Walker, N., Maher, D., Williams, B. G., Raviglione, M. C., et al. (2003). The growing burden of tuberculosis: Global trends and interactions with the HIV epidemic. Archives of Internal Medicine, 163(9), 1009–1021.CrossRefPubMedGoogle Scholar
  3. 3.
    World Health Organization. (2009). Global tuberculosis control—epidemiology, strategy, financing (pp. 219–236). Geneva: WHO.Google Scholar
  4. 4.
    Dye, C., Garnett, G. P., Sleeman, K., & Williams, B. G. (1998). Prospects for worldwide tuberculosis control under the WHO DOTS strategy. Lancet, 352, 1886–1891.CrossRefPubMedGoogle Scholar
  5. 5.
    Secretaría de Hacienda del Estado de Chiapas (2000). Agenda Estadística de Chiapas 1999. Tuxtla Gutiérrez, Chiapas: Secretaría de Hacienda del Estado de Chiapas, p. 194.Google Scholar
  6. 6.
    Sánchez-Pérez, H. J., Garcia, G. M., & Halperin, D. (1998). Pulmonary tuberculosis in the border region of Chiapas, Mexico. International Journal of Tuberculosis and Lung Disease, 2(1), 37–43.PubMedGoogle Scholar
  7. 7.
    Sánchez-Pérez, H. J., Flores-Hernández, J. A., Jansá, J. M., Caylá, J. A., & Martín-Mateo, M. (2001). Pulmonary tuberculosis and associated factors in areas of high levels of poverty in Chiapas, Mexico. International Journal of Epidemiology, 30, 386–393.CrossRefPubMedGoogle Scholar
  8. 8.
    Instituto Nacional de Salud Pública, INSP (2005). Atlas de Salud. Cuidad de México, DF: INSP, Last Accessed 5/10/09 at:
  9. 9.
    Secretaría de Salud/Instituto Nacional de Estadística, Geografía e Informática, Dirección General de Información en Salud, México (2005). Estadísticas de mortalidad en México: Muertes registradas en el año 2003. Salud Pública de México, 46, 171–187.Google Scholar
  10. 10.
    Sánchez-Pérez, H. J., Hernán, M. A., Hernández-Díaz, S., Jansá, J. M., Halperin, D., & Ascherio, A. (2002). Detection of pulmonary tuberculosis in Chiapas, Mexico. Annals of Epidemiology, 12, 166–172.CrossRefPubMedGoogle Scholar
  11. 11.
    Yamin, A. E., Crane, T., Penchaszadeh, V., & Grunder, A. (1999). Health care held hostage: human rights violations and violations of medical neutrality in Chiapas, Mexico (pp. 1–52). Boston: Physicians for Human Rights.Google Scholar
  12. 12.
    Nájera-Ortiz, J. C., Sánchez-Pérez, H. J., Ochoa-Díaz, H., Arana-Cedeño, M., Salazar Lezama, M. A., & Mateo Martín, M. (2008). Demographic, health services and socioeconomic factors associated with pulmonary tuberculosis mortality in Los Altos Region of Chiapas, Mexico. International Journal of Epidemiology, 37, 786–795.PubMedGoogle Scholar
  13. 13.
    Solórzano-Moguel, J. J., & Álvarez-Cuevas, M. E. (1991). Atención del enfermo tuberculosis a nivel comunitario en el estado de Chiapas, México. Boletín de la Oficina Sanitaria Panamericana, 111(5), 432–438.PubMedGoogle Scholar
  14. 14.
    Physicians for Human Rights, El Colegio de la Frontera Sur, & Centro de Capacitación en Ecología y Salud para Campesinos-Defensoría del Derecho a la Salud (2006). Excluded People, Eroded Communities: Realizing the Right to Health in Chiapas, Mexico. Boston: Physicians for Human Rights, pp. 1–63.Google Scholar
  15. 15.
    Menegoni, L. (1996). Conceptions of tuberculosis and therapeutic choices in highland Chiapas, Mexico. Medical Anthropology Quarterly, 10(3), 381–401.CrossRefPubMedGoogle Scholar
  16. 16.
    Instituto Nacional de Estadística, Geografía e Informática, INEGI (2000). Anuario Estadístico del Estado de Chiapas. Cuidad de, México, D.F.: INEGI.Google Scholar
  17. 17.
    Álvarez-Gordillo, G. C., Álvarez-Gordillo, J. F., Dorantes-Jiménez, J. E., & Halperin-Frisch, D. (2000). Percepciones y prácticas relacionadas con la tuberculosis y la adherencia al tratamiento en Chiapas, México. Salud Pública de México, 42(6), 520–528.CrossRefPubMedGoogle Scholar
  18. 18.
    Instituto Nacional de Estadística, Geografía e Informática, INEGI (2000). XII Censo General de Población y Vivienda. Aguascalientes, Ags.: INEGI.Google Scholar
  19. 19.
    Farmer, P. E., Robin, S., Ramilus, S. L., & Kim, J. Y. (1991). Tuberculosis, poverty, and “compliance”: Lessons from rural Haiti. Seminars in Respiratory Infections, 6(4), 254–260.PubMedGoogle Scholar
  20. 20.
    Mitnick, C., Bayona, J., Palacios, E., Shin, S., Furin, J., Alcántara, F., et al. (2003). Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. New England Journal of Medicine, 348(2), 119–128.CrossRefPubMedGoogle Scholar
  21. 21.
    Chowdhury, A. M., Chowdhury, S., Nazrul Islam, M. D., Islam, A., & Vaughan, J. P. (1997). Control of tuberculosis by community health workers in Bangladesh. Lancet, 350, 169–172.CrossRefPubMedGoogle Scholar
  22. 22.
    Vasan, R. S. (1997). Selected summaries: Community health workers and tuberculosis control. The National Medical Journal of India, 10(6), 283–284.PubMedGoogle Scholar
  23. 23.
    Simonnet, F., & Prazuck, T. (1988). Do health workers recognise tuberculosis in Burkina Faso? Lancet, 8614, 792.CrossRefGoogle Scholar
  24. 24.
    Barker, R. D., Millard, J. C., & Nthangeni, M. E. (2002). Unpaid community volunteers—effective providers of directly observed (DOT) in rural South Africa. South African Medical Journal, 92(4), 291–294.PubMedGoogle Scholar
  25. 25.
    Kironde, S., & Klaasen, S. (2002). What motivates lay volunteers in high burden but resource-limited control programmes? Perceptions from the Northern Cape province, South Africa. International Journal of Tuberculosis and Lung Disease, 6(2), 104–110.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Michael E. Herce
    • 1
  • Jacob A. Chapman
    • 2
  • Arachu Castro
    • 1
    • 3
    • 4
  • Gabriel García-Salyano
    • 5
  • Kaveh Khoshnood
    • 6
  1. 1.Division of Global Health Equity, Department of MedicineBrigham & Women’s HospitalBostonUSA
  2. 2.Division of Global Health & Human RightsMassachusetts General HospitalBostonUSA
  3. 3.Department of Global Health and Social MedicineHarvard Medical SchoolBostonUSA
  4. 4.Partners in HealthBostonUSA
  5. 5.Equipo de Apoyo en Salud y Educación Comunitaria, Calle Francisco LeónEAPSECChiapasMexico
  6. 6.Division of Epidemiology of Microbial DiseasesYale University School of Public HealthNew HavenUSA

Personalised recommendations