Door to Door for Health: Volunteer Health Educators Improve Services in Bolivia

In the city of El Alto, Bolivia, volunteer health promoters known as manzaneras are teaching residents the basics of prevention and self-care while bridging the gap between health services and those who need them.

"For the last year, Ballivián, a volunteer manzanera, has been a soldier in an army of neighborhood health promoters known as las manzaneras in the city of El Alto, in the department of La Paz, Bolivia. Each of the 800 mostly female volunteers is responsible for monitoring the health of the inhabitants of a given manzana (about 1.5 acres) of the city's residential area. In door-to-door visits, the manzaneras encourage residents to use community health services and, when appropriate, refer potential patients— particularly pregnant women and children under 5—to nearby hospitals and health centers. Their task is not only to offer practical health information but also to boost awareness of and demand for health services, somewhat like "health vendors," says Fernando Amado, a Pan American Health Organization (PAHO) consultant in La Paz.

The project started officially in early 2001 as part of El Alto's Social Network Program, a health promotion effort sponsored by the Ministry of Health. From the outset being a manzanera has been strictly a voluntary undertaking. More recently, a new and important element has been added: Each manzanera (or manzanero— about 10 percent of the volunteers are male) is now elected by a neighborhood council, making the experience not only voluntary but also democratic and representative."

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