What does health activism mean in Venezuela's Barrio Adentro program? Understanding community health work in political and cultural context

Abstract

Launched in 2003 by the leftist government of Hugo Chávez, Venezuela's Barrio Adentro (Inside the Poor Neighborhood) health care program is deeply dependent on local community health workers to implement and administer clinics and various health initiatives. Based on ethnographic research conducted between 2006 and 2009, this article analyzes the experiences of Barrio Adentro community health workers (promotores) in a working‐class neighborhood in Caracas, the capital city of Venezuela. My research reveals that community health workers understood their relationship to the state as fraught, but fundamentally collaborative. In contrast, they viewed local residents as the main threat to achieving their community health goals, based on perceptions that some residents were apathetic or politically opposed to the government's programs to promote social change. In situating this analysis in the broader social and historical context, I show how community health workers represent one of the most significant forms of state‐supported activism in a country that has radically expanded social and political participation for historically marginalized groups in the name of “21st century socialism.” I argue that the state's antineoliberal discourse, substantial investment in public health care, and employment of Cuban doctors distinguish community health work in Barrio Adentro from the experiences of community health work in other areas of Latin America, where community participation has also been framed as a form of empowerment but often serves as a mechanism to devolve state responsibilities for health care onto local communities. In focusing on the broader social, political, and economic context that gives meaning to Barrio Adentro activists, this analysis offers insights that may be applied to community health initiatives in other settings.