Strengthening primary healthcare in LAC requires both people‑centred service delivery and strong public health functions. Community health workers (CHWs) extend prevention, follow-up and navigation to underserved communities, while environmental and occupational health personnel support regulatory and surveillance functions (e.g. workplace risk control, sanitation and broader environmental health protection). Recent evidence synthesises that CHW interventions can be cost-effective in primary healthcare, but performance depends on programme design, including supervision, remuneration and integration with services (Van Iseghem et al., 2026[1]). More broadly, efforts to deliver essential public health functions require multidisciplinary workforce capacity across health and non-health sectors (WHO, 2022[2]). Cross-country differences in reported densities for CHWs and environmental and occupational health personnel should be interpreted with caution, as these functions are often regulated, employed and recorded by different ministries or agencies.
CHW availability varies sharply across reporting countries. Brazil reports 19.1 CHWs per 10 000 population, reflecting the scale of the Family Health Strategy and its community health agent cadre, while Honduras (7.6) and Guyana (6.6) also report higher densities (Figure 8.10). The LAC13 average is 4.7, but some countries report very low values, including Paraguay (1.6) and Panama (1.2), and Guatemala reports 0.1 per 10 000. Differences partly reflect the scope of CHW programmes (paid vs. volunteer, full-time vs. part-time) and whether CHWs are counted as a distinct cadre within health workforce statistics or absorbed into broader technical workforce categories.
Indicators for environmental and occupational health inspectors and associates suggest large differences in regulatory capacity (Figure 8.11). Brazil reports 81.4 inspectors per 100 000 population and Uruguay 51.2, well above the LAC12 average of 21.4, while several countries report fewer than 6 per 100 000 (e.g. El Salvador 5.8; Panama 4.0; Peru 4.0; Guatemala 2.3). Because these functions can be delivered by staff in different ministries and agencies, cross-country comparability is sensitive to institutional arrangements and occupational classification and the distinction between licensed and professionally active workers.
Reported densities of environmental and occupational health and hygiene professionals also vary widely (Figure 8.12). Nicaragua reports 67.5 professionals per 100 000 population, an extreme value compared with the LAC9 average of 11.5, while El Salvador reports 21.4 and Brazil 5.5 (around 2021). Several countries report fewer than 1 professional per 100 000 (e.g. Peru 0.7; Uruguay 0.5; Panama 0.4). Such dispersion likely reflects both real differences in workforce capacity and major differences in how countries define and record these occupations; it may also reflect variation in whether countries report licensed, professionally active or mixed categories of workers. Values should therefore be interpreted with caution.
These indicators point to a “dual capacity” challenge for LAC: (1) community-facing outreach (CHWs) and (2) public health protection functions (environmental/occupational health professionals) are both highly variable across countries. In Health at a Glance: Latin America and the Caribbean terms, this matters for the credibility of PHC-oriented reforms: CHWs can strengthen continuity and self-management support, with systematic review evidence showing measurable improvements in chronic disease outcomes in some settings (Evans, White and Ha, 2023[3]). In parallel, adequate inspection and environmental health capacity underpins safe food, water, workplaces and public environments – areas where cross-country analyses continue to emphasise the centrality (and complexity) of inspection practice (Barnes et al., 2024[4]).
