Publication date: Feb 01, 2025

Most people in low- and middle-income countries work in the informal sector and lack social protection. In Bolivia, the unified family, community, and intercultural health model established universal health coverage for informal workers and their families in 2019. The COVID-19 pandemic, which occurred soon after, exposed both the vulnerabilities and the strengths of this health policy. To describe the community-based design of a health promotion strategy based on people-centered and participatory research within a vulnerable community of informal market vendors during the COVID-19 pandemic. As part of participatory action research during the COVID-19 pandemic, market vendors collaborated with a multidisciplinary research team, local authorities, and the health network to promote health and safety in their markets. Market vendors developed a health promotion strategy facilitated by a highly structured mixed qualitative-quantitative concept mapping approach and reached a consensus on an operational health strategy with measurable goals, actions, timelines, and actors. A community health diagnosis together with health education and individualized clinical care, created a common understanding of health and built trust between the community and the research/health team. Market vendors identified health needs related to care access, self-care, market organization, and the social determinants of health, including strategies to prevent infections, reduce cardiometabolic risk, and improve mental health. Effective strategies to promote health or to manage health crises such as a pandemic can be developed by organized communities in primary care supported by individual and collective health data, health education, and the integration of social scientists, epidemiologists, and health professionals.

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