title: 'It's the sense of responsibility that keeps you going': stories and experiences of participation from rural community health workers in Guatemala.
abstract: BACKGROUND
  In 1978, the Alma-Ata declaration on primary health care (PHC) recognized that the world's health issues required more than just hospital-based and physician-centered policies. The declaration called for a paradigm change that would allow governments to provide essential care to their population in a universally acceptable manner. The figure of the community health worker (CHW) remains a central feature of participation within the PHC approach, and being a CHW is still considered to be an important way of participation within the health system.
  
  
  METHODS
  This study explores how the values and personal motivation of community health workers influences their experience with this primary health care strategy in in the municipality of Palencia, Guatemala. To do this, we used an ethnographic approach and collected data in January-March of 2009 and 2010 by using participant observation and in-depth interviews.
  
  
  RESULTS
  We found that the CHWs in the municipality had a close working relationship with the mobile health team and with the community, and that their positions allowed them to develop leadership and teamwork skills that may prove useful in other community participation processes. The CHWs are motivated in their work and volunteerism is a key value in Palencia, but there is a lack of infrastructure and growth opportunities.
  
  
  CONCLUSIONS
  Attention should be paid to keeping the high levels of commitment and integration within the health team as well as keeping up supervision and economic funds for the program.
authors.affiliation: Division of Epidemiology and Global Health, Umeå University, SE-901 85, Umeå, Sweden. ana.lorena.ruano@epiph.umu.se.
authors.forename: Ana Lorena
authors.initials: AL
authors.lastname: Ruano
authors.forename: Alison
authors.initials: A
authors.lastname: Hernández
authors.forename: Kjerstin
authors.initials: K
authors.lastname: Dahlblom
authors.forename: Anna Karin
authors.initials: AK
authors.lastname: Hurtig
authors.forename: Miguel San
authors.initials: MS
authors.lastname: Sebastián