In the late 1980s, health and living conditions in the impoverished Mississippi Delta reached a new low. Rising service delivery costs, a lack of coordination of public health programs, insufficient outreach to rural communities, and fragmentation among community groups contributed to the Delta's degenerating living conditions.
The Mississippi State Department of Health, the Mississippi Cooperative Extension Service, and Freedom from Hunger, a private voluntary agency, banded together in 1988 to address the deep-seated public health problems in rural Mississippi. The resulting agency partnership became known as the Partners for Improved Nutrition and Health (PINAH).
"Natural helpers", community-oriented people trusted by their neighbors, are identified by PINAH and offered the opportunity to improve their skills as local problem solvers. After ten weeks of skills-based training, the volunteers become certified Community Health Advisors (CHA). As CHAs, resident volunteers connect with local health service agencies and use their local knowledge for the common end of improving access to health care services while expanding the impact of health education.
Within each community where the CHAN program is introduced, PINAH staff initiates or promotes a series of activities to establish, train, and support the local volunteer network. Principle activities include organizing local advisory councils, partnering with service agencies, and supporting health advisor initiatives.
Evaluation of CHA's progress began almost as soon as PINAH initiated the program. In 1989, an interim evaluation reported that forty-one community residents had completed CHA training and were assisting, on average, 4.4 people per week. By the end of 1991, an average of nine people were being assisted by eighty-four CHA's weekly. A 1990, evaluation reported that 83 percent of beneficiaries received useful assistance from their CHA's. While these statistics point to CHA's direct impact, PINAH cites the enhanced patterns of communication between agencies, within communities, and between agencies and communities as the program result that will have the biggest impact on the health and living conditions in the Mississippi River Delta.