Fieldset
What is a health promoter?

What exactly is health promotion? Canadian Nance Cunningham – a flying health promoter – explains the impact of this vital role while on assignment with Médecins Sans Frontières / Doctors Without Borders (MSF), training teams in Pakistan.

Health promotion workshop in Pakistan

“Health Promoter” — usually we just say “HP” — what kind of a job is that?

You can’t tell by just looking at the words. “Promote health” could mean a lot of different things, and the health promoters really do have a lot of different skills and responsibilities.

If you’d never worked with an HP, you might think that midwives, doctors, infection control specialists, pharmacists, nurses, all are health promoters. They do enhance health, but that is not what we mean.

In fact, we have a special team of HPs playing a number of roles in the smooth running of many medical projects.

Community health

The HP teams are a link between our health centres and the community. 

Among other things, they explain the services that MSF can provide, deliver health education, and keep watch for the beginning of epidemics — for the first measles cases, the first dengue cases — so that medical departments can prepare.

The work health promoters do is varied and they always need to think on their feet. So much so that there is no diploma or degree that can fully prepare them for the job. They have to find their own path.

The HPs are also part of our response to epidemics.

In northern Pakistan in 2018, there were some cases of Crimean-Congo haemorrhagic fever, a very dangerous disease spread by ticks.

The HP team based in Timergara jumped into action, starting with the creation of a poster especially for people who work with animals — goat sellers, butchers, etc. — and visited these high-risk people to explain about the disease, and how to handle animals more safely.

crimean-congo_haemorrhagic_fever_poster_from_pakistan.jpg

Crimean-Congo haemorrhagic fever poster from Pakistan
Crimean-Congo haemorrhagic fever poster from Pakistan

In Karachi, HPs I work with have also paved the way for us to go into factories and offer hepatitis C testing to all the workers — providing free treatment to all who test positive, and anyone in their household who needs it as well.

Their own path

The work health promoters do is varied and they always need to think on their feet. So much so that there is no diploma or degree that can fully prepare them for the job. They have to find their own path, learning from each other and from experience.

However, there are principles and concepts behind health promotion, even if they are not always easily seen from the outside.

The Ottawa Charter for Health Promotion of 1986 put many of these together on paper.

Workshopping the “why”

In Pakistan, several MSF health promotion and community engagement teams work in different parts of the country. However, until 2018, they rarely met.

The team members had been hired for their skills and dynamism, then guided into what to do and how to do it. But, recently, we have been organising workshops that bring out the why.

I love seeing the “Aha!” on faces many times each day, as they apply what they have learned to their work.

Twelve HPs attend at a time – from sites in Baluchistan, Khyber Paktunkhwa and Karachi – coming together for a week-long workshop.

The training includes identifying key community members, monitoring and evaluation, needs assessment, health communication, learning theory, and more. This all fits together to help HPs make a project’s medical activities more effective.

The workshop itself uses the same principles of adult learning and communication that the HPs themselves learn.

The presentations are interactive, bring out the knowledge of the participants, are adapted to the needs of the group, and respectful of people’s cultures. For example, some participants ask not to appear in photographs, or only from behind, or veiled.

Big smiles and new friends

The sessions are enlivened by laughter during games which illustrate the principles being presented.

By the end of the week, the HPs have not only learned from each other and from the presenters, but are ready to apply the principles to new activities and new communities, with confidence.

For me, this kind of capacity building is very rewarding. It reveals what people already know, adds some new ideas, then links it all together with professional principles.

I love seeing the “Aha!” on faces many times each day, as they apply what they have learned to their work.

In fact, I learn a lot as well, as I hear about what others are doing. We all go back to our work full of new energy, with big smiles and new friends.

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I would like to thank Khatab Muhy, who started this series of workshops by inviting me and some of my team to join a workshop originally planned just for his teams. Khatab Muhy, Estelle Thomas, and I then developed the ideas further, and Linnéa Näsholm is now the Flying HP carrying the torch.