Helping Health Workers Learn: A Book of Methods, Aids, and Ideas for Instructors at the Village Level

David Werner & Bill Bower (1982)

This book teaches people how to become community health care workers, and how to use and apply the information contained in Where There Is No Doctor. But it goes beyond mere medical training, and focuses on developing the health worker as an agent of political change so so that the true primary determinants of unhealth–disparities of land, wealth, and power–can be addressed.

One of the biggest obstacles to ‘health by the people’ has been the unwillingness of experts, professionals, and health authorities to let go of their control. As a result, community health workers are made to feel that their first responsibility is to the health system rather than to the poor. Usually they are taught only a very limited range of skills. They become the servants or ‘auxilliaries’ to visiting doctors and nurses, rather than spirited leaders for change. They learn to follow orders and fill out forms, instead of to take initiative or to help people solve their own problems on their own terms. Such health workers win little respect and have almost no influence on overall community health. Many of them get discouraged, grow careless, become corrupt, or quit. Results have been so disappointing that some experts, even within WHO, have begun to feel that the goal of ‘health of all through community involvement’ is like the pot of gold at the end of the rainbow–a dream that has been tried, but failed.

In spite of the failure of most large, centrally controlled programs to acheive effective community participation, in many countries there are outstanding examples of enthusiastic community involvement in health. This is especially true in small, non-government programs that take what we call a people-centered or community-strengthening approach to health care.

You cannot love human beings who are marked by unjust laws, and not work for other laws.

Within these community-based programs, there is a wealth of variety in terms of innovation and adaptation to local conditions. But at the same time, there is a striking similarity in their social and political objectives in many parts of the world–Pakistan, India, Mozambique, the Philippines, Mexico, Nicaragua, Honduras, El Salvador, and Guatemala.

In these community-based programs, a new kind of health worker has begun to play a leading role. These health workers speak out for the ‘voiceless’ poor. Their goal is health for all–but health that is founded on human dignity, loving care, and fairer distribution of land, wealth, and power.

To us, one of the most exciting aspects of this new world-wide community-based movement, decentralized and uncoordinated as it may be, is that it goes far beyond any rigid religious or political doctrine. Most of the leaders in these programs recognize the dangers to ordinary people in any large, centrally controlled system, be it capitalist or communist. They have far greater faith in small, self-directed groups of working people. They welcome criticism, and encourage others to observe for themselves and form their own conclusions. They believe in helping the powerless to gain strength through a greater understanding of the factors that shape their health and their lives.

Around this practical human vision has gradually grown a whole new approach to the training, role, and responsibilities of community health workers. Ideas and methods are being shared and further developed through a series of informal networks around the world.

Helping Health Workers Learn (PDF)


The health workers of the title are not doctors and nurses, but village health workers - laypeople with a special interest in and calling for working with health problems, laypeople who are natural helpers. But there is much in this volume for professional health workers to learn. Helping Health Workers Learn is one of the few books on health education that face up to this major problem: Many health education programs increase layfolks’ dependence on all-powerful professionals and undermine people’s sense of their own abilities to take care of them selves. The authors clearly recognize that one of the biggest obstacles to self responsibility in health is the unwillingness of professionals to let go of control.
—Tom Ferguson, MD Self Care Archives

Hesperian materials are invaluable, particularly when working at the community level. Though Helen Keller Worldwide uses a number of Hesperian publications, I feel Helping Health Workers Learn and Where There Is No Doctor are absolutely essential for public health organizations working in countries with limited infrastructure. We at Helen Keller Worldwide feel a strong connection with the Hesperian approach of designing health education and intervention from the point of view of the recipient, thereby guaranteeing community involvement and program efficiency.
—Chad MacArthur, MPH, MEd, Director of Training and Community Education Helen Keller Worldwide

Excerpt taken from the introduction.

David Remembers How Bill Bower Got Involved in Co-Authoring Helping Health Workers Learn

Editor’s Note: In 2021, I asked David about his collaboration with Bill Bower, co-author of Helping Health Workers Learn. Here is an excerpt of our conversation.

David Werner

Bill Bower had attended a talk that I gave at Stanford University on the programs in Mexico, and he got interested. He contacted me after he graduated and was interested in volunteering. And Bill grew up in Venezuela. His father was actually a big oil company leader in Venezuela. But he spoke excellent Spanish and that was very helpful. He volunteered off and on for a couple of years in Mexico [from around 1974].

And then we took this trip with Bill—I, Martin Reyes, Lynne Coen, Goerge Kent and a couple of other people from the Mexico program—to visit different community-based health programs in Mexico and Central America and into the northern part of South America. The trip lasted a couple of months, visiting the different programs. And the reason we did that is that Where There Is No Doctor particularly [was by then] distributed all over the Americas, and we got all kinds of correspondence from people about different programs they were involved in, training health workers, and so on. Our original intent was to write a paper on that, on the different programs, and how they were responding. We divided the programs into community-supportive and community-oppressive programs. Community oppressive ones were often organized by governemnts, and the basic idea was to bring people in line … to follow instructions and this kind of thing. In our eyes, non-government programs were often involving health with social justice and human rights issues, and [the struggle] of people for equality and and their rights.

But as we got into writing this booklet on it, we decided that we’d turn it into a whole training manual for village health workers. Although we didn’t like the word ’training’ because that was sort of … the whole ideas was getting people to discuss things together and discover the right way to do things, and so on. It’s called discovery-based learning, which became a focus of Helping Health Workers Learn.

Bill worked on sections of it. I did most of it. But Bill was an enormous help in typing the whole thing out, and getting the thing coordinated. He put an enormous amount of work into it. And Bill and I remain friends ever since. He left because of COVID-19, but he’s been visiting me in New Hampshire every summer. He’s a professor at Columbia University.