As the minority group least likely to have a primary-care doctor and with nearly half living beneath the poverty line, Latinos, especially recent immigrants, have challenged doctors for decades.
But this simple idea - using people from church or the barrio to encourage preventive care - has produced success noted in medical journals over the last five years.
The U.S. Department of Health and Human Services announced in May an initiative to encourage the use of promotoras for outreach and education about health services and insurance.
"Now that they have been recognized, we want to develop a national database of networks for training and certification," said Jose Velasco, a public health adviser at HHS's Office of Minority Health.
Philadelphia saw its first promotoras in action three years ago, when Matthew O'Brien, then a medical resident at the University of Pennsylvania, and Steve Larson, his mentor and an associate dean, decided to establish the Puentes de Salud clinic in South Philadelphia in 2006.
"We would talk to people at health fairs and after religious services. We heard about them over and over again," said O'Brien, who now teaches at Temple medical school.
The constant mention of women who visit homes and provide basic care, but were not nurses, prompted O'Brien to bury himself in the public health literature in what he calls his own "remedial M.P.H." He was surprised at how they were able to increase vaccinations and other preventive health measures in developing countries and border states.
The clinic opened with four promotoras and now has six.
Despite the praise, some academics ask if the promotoras - housekeepers, waitresses, nannies - are adequately trained and qualified to teach and guide their patient-peers. O'Brien said they are.
