Bridging the gap: the village health worker as the cornerstone of the primary health care model.

The Alma-Ata Conference in 1978 reiterated the goal of 'Health for All by the Year 2000' and declared primary health care (PHC) the vehicle through which this lofty goal was to be achieved. National governments were recognized as responsible agents for developing and implementing PHC plans. The emphasis on community-oriented delivery of care places great importance on the village health worker (VHW), the individual who serves as the 'interface' between the formal health care system and the community. Despite the acknowledged importance of the VHW role, the question of whether the PHC model, with the VHW as the cornerstone can be effectively implemented without a "fundamental shift of wealth and power" (Sidel) continues to be asked. This paper examines the evolution and current status of the VHW role in Costa Rica, Nicaragua and Columbia, three Latin American nations which have adopted the PHC model. The authors discuss the evolution of the PHC model in each country with particular reference to the occurrence or non-occurrence of fundamental changes in the society. The conclude that the primary determiner of successful implementation of PHC is a national commitment to PHC including recognition of the importance of community participation which is best achieved through reliance on the village health worker.