“For women who want to plan their families and their husbands won’t let them, I tell them to come with their kids to my house in the afternoon and we take advantage to talk about family planning.”

Lichita, a health promoter in rural El Salvador, reaches out to women with advice on family planning as part of her commitment to provide basic health services and referrals. The people she visits are those with the fewest resources and most limited access to physicians and hospitals in the country. One of 1,755 promoters working for El Salvador’s Ministry of Health, Lichita is responsible for 2,500 residents of the canton of Borbollon, El Taurito in the department of San Miguel.

Along with a focus on family planning counseling and methods, promoters provide immunizations and offer advice on maternal health, prevention and management of acute respiratory infections and diarrhea, and water and waste management. They also coordinate the work of parteras, traditional birth attendants whose services are vital in a country where 57.3% of rural births occur in the home. The frontline role of promoters and parteras is more critical than ever as El Salvador rebuilds its infrastructure and health care system in the aftermath of devastating earthquakes that struck early in 2001.

Supported by USAID’s mission in El Salvador, the PRIME Project has been collaborating with the Ministry of Health since 1997 on a multi-faceted initiative to improve and streamline the ability of promoters to provide family planning education, services and referrals. PRIME has advised in the development of a National Reproductive Health/Family Planning Plan, conducted a national survey of promoters that showed the effectiveness of their work, and helped coordinate a strategy to improve systems for contraceptive storage and distribution.

Around the country, PRIME has assisted the Ministry of Health in training more than 4,000 Salvadoran primary-care providers in family planning and reproductive health service delivery, including all 1,755 Ministry of Health promoters, 2,275 parteras, and 983 physicians, nurses and administrators. By working through the Ministry’s existing structure, PRIME is building capacity within El Salvador’s health care system for the continuing education, training, and supervision of promoters and parteras. As a result, promoters like Lichita will have the knowledge, skills and support they need as they travel from house to house checking on the health needs of their communities.

The PRIME II Project works around the world to strengthen the performance of primary-care providers as they strive to improve family planning and reproductive health services in their communities.