Concern America

Concern America seeks to build local capacity in health care, community leadership, clean water, income generation, and education in order for community members to address their most pressing needs themselves.

At the core of its work, Concern America is focused on building local capacity in health in remote communities, rather than simply the providing of health services. This emphasis allows community members with very little access to formal education opportunities to develop lasting knowledge and skills that are comparable to nurse practitioners and physician assistants. They live and work in their own communities and have the cultural context and language to best understand and communicate with their patients. Additionally, Concern America ensures that there is a network of support for further learning and growth through advanced courses and continuous training opportunities with more advanced -practitioners and field personnel.

Concern America's strategies include:
1. Increased Availability of Care: Practitioners and midwives continue to provide care to their communities in the teaching clinics and in their homes and communities. The clinic sites have been reconfigured to ensure safety for all, as well as established specific instructions and processes for those with COVID symptoms.
2. Training and Increasing Public Health: While most in-person courses are postponed, the programs have expanded virtual training through informational videos and increased telemedicine support, particularly to keep practitioners and patients updated on COVID information. Short videos, made by advanced practitioners and field team members, can easily be shared by way of mobile phones. Likewise, practitioners are able to then inform their communities on the best public health practices, helping to provide guidelines and a reliable source to answer questions and local needs around safety, transmission, and vaccines.
3. Essential Medicines and Equipment: Previously, most families had been able to pay for the affordable care they receive and the practitioners’ supply is maintained as a rotating fund.
4. Build Local Leadership: Practitioners and midwives continue to expand their responsibilities in leading program activities, managing the clinic, accounting, budgets, and reporting, further extending the work of the program through local leadership. They continue to be instrumental in identifying and responding to the needs in their communities.
5. Integrated Development: By using popular education materials and activities that train community members, Concern America strengthens community-based development and empowers local leaders to addressing environmental health concerns. Concern America works with teams of environmental health practitioners to develop community water systems, install family water filters, and construct healthier and fuel-efficient stoves.

Since its establishment in 1972, Concern America has worked in fifteen countries on four continents, making a difference in the lives of more than two million people. It has sent over 300 field volunteers to support refugee aid programs, health care training, education, appropriate technology training and development, cooperative and fair trade income-generation. Concern America currently works with 4,000 health care providers, midwives, dental promoters, teachers, water system builders, and artisan cooperative members in more than 1,000 communities.

With a reputation for preserving organizational integrity in all aspects of its work, Concern America has succeeded quietly, for nearly five decades, while continuing to grow to serve more of those in need. Despite economic downturns and shifting trends in international development, Concern America has maintained and expanded its programs by attracting and keeping loyal donors and maintaining a dedicated team of field personnel and home office staff.

Becoming the primary health care providers in their villages, practitioners participate in a standardized three-year course of study. This includes diagnosis, treatment, and an emphasis on preventive care and is done through coursework and extensive hands-on training and practice in the programs’ clinics and community visits. Practitioners and midwives further their education through courses on advanced topics such as minor surgeries (like tendon repair and cyst removal), palliative care, complicated deliveries, orthopedics, trauma management, diabetes control and treatment, and managing psychiatric conditions. During the pandemic, the program has created and shared videos and flyers by cell phone of updated procedures, treatments, and public health information for practitioners and their communities.

In order to make the model accessible to other programs around the world, Concern America has developed a 24-book training series for practitioners. Using “popular education” pedagogy, the dynamic How To Teach Health manuals are comprehensive and facilitate a hands-on, community-centered learning experience, including teacher guides and student workbooks. Concern America has partnered with Hesperian Health Guides, the publisher of the seminal Where There Is No Doctor, to promote and distribute the innovative How To Teach Health series. Publication of the series significantly expands and deepens the catalog of resources to build community-led health programs and has the potential to expand and improve care to hundreds of thousands of people worldwide.

The impact of Concern America’s health promoter practitioner model becomes apparent by looking at the numbers. They demonstrate increased accessibility of high-quality health care in isolated regions. Consider Petén, Guatemala, where Concern America operates its largest health program. The doctor/patient ratio had been estimated to be 1:5,000, before Concern America began its trainings, and a typical health consult would cost more than US$20 including travel and medications. For context, most families’ income amounts to a meager US$2/day.

As a result of Concern America’s work, the ratio of health care provider to patient has improved by a full order of magnitude: 1:500. A typical consult with a practitioner costs about US$3. That includes lab tests, medicines, and patient education — and it all takes place in one’s own village.

Last year alone, practitioners in Guatemala provided 150,000 high-quality medical consults, saving families US$2.55 million, needless hardship, and untold deaths. The complexity of diagnosis and treatments recently registered at one of the teaching clinics in a single day of consults included strep throat, malaria, high blood pressure, fungal infections, intestinal parasites, pneumonia, wound care, eczema, diabetes, muscular pain, epilepsy, and anemia.

To train and accompany the practitioners and other community members, Concern America engages long-term field personnel who work for a minimum of two years, though most stay for an average of five years, and some stay for decades, because of their commitment to this transformational work. They are nurses, doctors, engineers, and related professionals who live in the communities where they work. They share housing and food, as well as the hopes and challenges of life in that region.

Now, local leaders are responsible for most of the training courses, community visits, community organizing, and program coordination. In the Guatemalan health program mentioned above, in 1997 Concern America supported eight field personnel who worked in 40 villages. Today there are five field volunteers, yet the program serves more than 300 communities. This is possible because of the strong local team of advanced practitioners, midwives, and environmental health promoters. In fact, a number of the Guatemalan practitioners and midwives now travel to Colombia and Mexico in place of Concern America field personnel to staff and support the organization’s health programs in those countries. In all, a population of 255,000 currently receives its health care from Concern America-trained practitioners.