Date: Monday April 14, 2025
Written by: Cristina Juan Jiménez
Chagas disease (CD) is a complex infectious neglected tropical disease (NTD) caused by the protozoan parasite, Trypanosoma cruzi (T.cruzi). It affects around 6 to 7 million people, mainly in rural areas in 21 endemic countries in Latin America. However, due to human migration, the disease has spread to non-endemic regions, including the United States of America and European countries, where doctors may lack experience and underestimate its severity. Spain ranks as the second leading destination for Latin American migrants with childhood T. cruzi infection who are in search of better job opportunities.
Migrants with CD in Spain face numerous barriers to accessing healthcare, including precarious economic conditions, rigid work schedules, possessing a limited understanding of the healthcare system, and widespread misconceptions about CD – such as the belief that it is a terminal illness. These factors severely delay diagnosis and treatment, with most patients only seeking medical attention once the disease has advanced to its chronic stage. Additionally, health studies on precarious migration emphasize the importance of understanding how these populations perceive health and access care, highlighting the need for health to be views as a broader concept that includes well-being and social relationships. To help overcome these barriers, the role of community health workers (CHWs) have become integral in supporting migrant populations, acting as a bridge between the healthcare system and the needs of vulnerable communities.
The role of community health workers
In contexts with weak health systems—such as remote populations, rural areas, or regions with institutional and political dysfunction—the World Health Organization (WHO) and the Pan American Health Organization (PAHO) have promoted the role of CHWs as essential actors in bridging the gap between healthcare systems and communities, thereby improving access to care. According to PAHO’s 2004 definition, CHWs should promote healthy practices, and must meet the following criteria: being chosen by the community itself, living within it, being recognized and representative, and working on a voluntary basis. In line with this, WHO adopted a similar definition in 2014, emphasizing that CHWs should work in coordination with formal healthcare providers. Over time, this definition has evolved to include the possibility of paid positions, aiming to enhance sustainability and ensure that health systems assume responsibility for integrating CHWs into their structures. Given their critical role, CHWs must receive adequate training to understand both the needs of the community and the functioning of the healthcare system.
The Mundo Sano Foundation´s efforts to fight against CD
The Mundo Sano Foundation is an international organization that has been working in the field of NTDs since 1999. In Spain, the foundation has been carrying out community-based screening for CD since 2014, including a CHW employed by the foundation – one of the first initiatives in the country to formally integrate this role in the healthcare response. The CHW also served as a transcultural mediator, playing a key role in building trust and improving communication between healthcare providers and the affected community. Building on this experience, the foundation’s CHW began collaborating in 2015 with Hospital La Paz-Carlos III in Madrid—a national referral center for imported diseases—to support patients with CD. Their main responsibilities include providing information, guidance, cultural mediation, emotional support, and assistance navigating the healthcare system. This support is essential throughout the patient’s care journey. Given the innovative nature of this initiative, a qualitative study was conducted between 2023 and 2025, to better understand the barriers faced by people living with CD in Madrid and to evaluate the impact of CHW support across different stages: pre-test counseling, diagnosis, treatment adherence (when needed), and follow-up.
Conclusion
CD remains a significant health issue among Latin American populations, even in non-endemic countries like Spain. The main barriers within healthcare systems include administrative challenges (long waiting times, repeated tests etc), geographical limitations (long distances to referral hospitals or to the pharmacy for foreign medicines), work-related constraints (limited work schedules), and financial barriers. Additionally, there is a lack of knowledge about CD transmission, symptoms, and treatment among both patients and primary care providers, highlighting the need for targeted educational interventions to address stigma, misconceptions, and refusal to suffer from the disease. The role of CHW has proven valuable in facilitating access to care, improving adherence, and providing culturally tailored support, though not directly related to treatment adherence. While further studies are needed, managing CD should focus on strengthening primary care awareness, educating healthcare workers, optimizing referral pathways, and expanding CHW involvement in structured health programs.
