Breaking New Ground in Diabetes Prevention, Detection, and Treatment Access in the Dominican Republic

CHW trainingHHI has been breaking new ground in the training of Community Health Workers (Promotores de Salud) on diabetes prevention, case detection and referral.

According to the International Diabetes Federation, 50% of all diabetes cases around the world go undiagnosed.

For people living in poverty, this often results in a long list of complications that can eventually end in death if left unchecked:

  • heart disease
  • stroke
  • renal failure
  • vision loss and blindness
  • amputations due to diabetic neuropathy

The case for “why” diabetes prevention, case detection and referral need to be tackled is very straightforward: to save lives.

The greater question was, “how?”

The answer to that comes through the vital link between Individuals and those who can help them get diagnosed and get treatment.

That person is the local Community Health Worker or Promotor de Salud.

This is why we have been so excited to be able to create the first-ever training manual on diabetes for Community Health Workers in the Dominican Republic!

For the first time, the Community Health Workers of the province of Puerto Plata are receiving training on diabetes. HHI, in close collaboration with the Ministry of Public Health, has trained over 90 Community Health Workers on diabetes prevention, case detection and referral.

  • At the municipal level in Montellano, where the HHI office is located, we are working with and training over 30 Community Health Workers.
  • At the provincial level of Puerto Plata, we have now trained 60 Community Health Workers using the new manual.

training manualsOur manual serves as a guide for Community Health Workers to help people in theircommunities be able to get the help they may desperately need to manage a disease many are unaware they have. CHW’s have learned how to evaluate risk factors and give referrals.

All of this is done at the community level, within a context that people feel comfortable in as they learn how they can get help and treatment.

Since we have started training CHW’s, the numbers have spoken for themselves:

 Trained Community Health Workers have successfully carried out risk

factor detection in their communities, using a tool developed by the

project, and are referring patients when appropriate (1,378 people

assessed for risk factors so far)

CHW team trainingThe CHW’s we have trained are excited to learn and feel empowered to take this knowledge back to their communities. Their training is a combination of fun exercises, team building and knowledge and skill building.

The Community Health Workers believe in their communities and they want to be a resource to help people achieve health through the power of knowledge and understanding. Because of this, they commit themselves to the training wholeheartedly and it shows in their response.

The training manual has been a labor of love and we are proud of the product we have produced together with our partners. We are motivated by the dedication these Community Health Workers have demonstrate to us, and can’t wait to share more results!

The manual and trainings have been made possible through our  two year joint partnership grant  with the World Diabetes Foundation, Population Services International (PSI) and the Ministry of Public Health.

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Our Team is Growing in Size and Diversity – Learn How This Contributes to the Sustainability of HHI’s Programs

HHI Team Gathering

HHI Team Gathering

Here at Health Horizons International, sustainability is reflected in the partnerships we build within the healthcare system, collaboration with local community leaders and in how we build our own team of staff members.
As we build our team of HHI staff to meet the needs of our work at every level, we have been intentional with the search to hire and engage local Dominican staff. Our persistence is paying off!
Our team has grown from 5 staff members to 12 in the past year and we are growing in a way that helps improve the quality and sustainability of our work!

For every open position, HHI seeks out local Dominican staff first.

Currently, 10 of our 12 staff members are local Dominican staff. One of the non-Dominican staff is HHI’s Administrative Director based in the United States and the other is our Executive Director.
There is a wide range of diversity among them representing different parts of the Dominican Republic, different ethnic backgrounds and different socio-economic backgrounds.

The team has benefitted from bringing on experienced and highly qualified local staff who understand both the realities being experienced by ordinary people in the communities where we work and the local health system.
In the past year, our team has grown from 5 to 12 staff members — 10 of whom are local individuals. They represent different areas of the Dominican Republic, different ethnic backgrounds, and different socio-economic and educational backgrounds. The team has benefitted from welcoming these experienced and highly qualified ndividuals, who understand the local health system and the realities experienced by ordinary people in the communities where we work.

  • Our Director of Programs, Dr. Luis Manuel Rosa, completed medical school in Santo Domingo before earning Masters degrees in Epidemiology and Public Health, and worked for several years leading international health programs in Afghanistan, Jordan, and the Philippines.
  • Our Coordinator for the World Diabetes Foundation Project, Sheila Calderón, is an expert program manager and relationship builder with years of experience implementing complex health programs with other NGOs across the north coast.
  • Our Clinical Program Coordinator, Dr. Maria Teresa Pou, is a talented and dedicated physician who completed her residency in Family Medicine in Santiago.
  • Our Administrative and Logistics Coordinator, Marinelly Gutierrez, is a diligent and detail oriented office manager from the nearby town of Sosua.
  • All of our field-based staff – Carlos Castillo, Catherine Balbuena, Elisa Ruben, Marc Nicoleau, and Willy Destin — hail from the communities where we implement our programs.

Our team is strong because of our diversity, bringing knowledge and experience to every level of HHI’s work. Very soon we will begin searching for three new local positions to be based in the capital city of Santo Domingo.

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What Does it take to be a Community Health Worker in the Dominican Republic? “LOVE.”


health workers

Community Health Workers, Grace, Lourdis and Candy Above: Attending an HHI training; below: serving at their primary health center

Community Health Workers, or  Promotores de Salud as they are known here, are the link between the health system and the communities where they live.
That link is what makes all the difference between a child with or without life saving vaccines, a mother understanding the importance of breastfeeding, a person being referred in time to receive treatment for their diabetes before losing their eyesight or a limb.
Community Health Workers in the Dominican Republic are an important part of the public health system and they receive a small stipend each month to cover their costs, but their time and commitment is voluntary.
The country’s Community Health Worker network is in need of improvement.  Many Primary Health Centers lack the number of Community Health Workers necessary and the ones that do exist do not receive regular training or supportive supervision at the community level. This means that very little formal monitoring of their work is taking place.

What motivates these Community Health Workers to keep going?

HHI sat down with three Community Health Workers who recently took part in an HHI training about diabetes prevention to learn what keeps them motivated.

Grace, Lourdis and Candy are from the El Javillar community and all three of them work with  the Primary Health Center of CPN El Javillar.

The Dominican Ministry of Public Health has the goal of putting in place one Community Health Worker for every 100 households in urban communities and one Community Health Worker for every 90 households in rural settings.
There is a long way to go in many places to reach this goal. Across the province of Puerto Plata there are primary health centers below the goal, but these three Community Health Workers do not let that get them down.
Grace, Lourdis and Candy told us that their motivation, “comes from the heart” when they are working together with fellow community members.
The connection that they feel with the people in their communities who are neighbors, friends and family to them is what gives them motivation to help improve health.  Their dedication is an inspiration to us all!
HHI is in a unique position to help the Ministry of Public Health continue to improve the Community Health Worker system in the Dominican Republic.  We have successfully trained and worked with Community Health Workers in the DR since our founding in 2009.  We are currently training and providing supportive supervision to 92 Community Health Workers across the Province of Puerto Plata.
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