Shifting Power in Public Health: How Promotoras Are Transforming the System
For decades, Promotoras de Salud—Latina immigrant health workers—have been the backbone of public health outreach in underserved communities. These women, deeply connected to their communities, provide culturally relevant health education, build trust with families, and bridge gaps between institutions and those most in need. Yet, despite their critical role, Promotoras have been systematically undervalued and underpaid. Most are paid stipends of less than $600 per year, a reality shaped not by a lack of will on the part of the organizations supporting them, but by legal and systemic barriers that have historically prevented those organizations from compensating Promotoras fairly.
At Bienestar Collective, we are working to change this. By supporting the development of independent Promotora-led worker cooperatives, we are creating a pathway toward fair pay and professional recognition. This model allows Promotoras to contract with health centers, nonprofits, and other agencies, finally making it possible for these organizations to pay them for their expertise and leadership.
The Problem with Stipends
The stipend system is a symptom of a larger issue: the systemic undervaluing of immigrant women’s labor. While health centers, nonprofits, and public health agencies often want to pay Promotoras more, they have been restricted by tax and employment laws that make it difficult to compensate them as independent professionals. As a result, many Promotoras have been stuck in a system that limits their earnings, keeps them in poverty, and denies them the recognition they deserve for their essential work.The stipend system also reinforces a lack of autonomy, as large, disconnected organizations often dictate the work Promotoras must do, creating programs that may not align with what communities truly need. This approach fragments care and limits the potential of Promotoras to make the greatest impact.
A New Model: Worker-Owned Cooperatives
At Bienestar Collective, we believe in a different approach—one that centers Promotoras as leaders, decision-makers, and professionals. Through our Cooperative Development program, we mentor and support Promotoras in forming independent worker-owned cooperatives. These cooperatives allow Promotoras to:
Earn fair pay for their work, breaking free from the exploitative stipend system.
Design and direct their own work, ensuring it stays connected, relevant, and meaningful to their communities.
Build community wealth and create sustainable economic opportunities.
Using Popular Education, we meet Promotoras where they are—whether in living rooms, parks, or libraries—and guide them through the process of cooperative formation. Together, we explore the inequities of the current system and develop solutions rooted in their lived experiences. Once a cooperative is formed, we provide ongoing mentorship, technical support, and non-extractive fiscal sponsorship to ensure their success, while maintaining their full independence.
Transforming Public Health Systems
Ending the stipend system isn’t just about fair pay—it’s about transforming how public health systems operate. Promotora cooperatives represent a new model of collaboration, where Promotoras contract directly with health centers and nonprofits as equal partners. This shift benefits everyone:
Promotoras gain respect, fair compensation, and the power to direct their own work.
Institutions build trust with immigrant communities and improve health outcomes by working with trusted, culturally connected leaders.
Communities receive better care through programs designed by and for the people they serve.
Dinastía del Río Ruso, one of the cooperatives we’ve supported, is already leading the way. Based in rural Sonoma County, Dinastía’s Promotoras are conducting outreach forRecursos de Bienestar, a project that connects immigrant families to vital health, legal, and safety resources. Through this work, they are demonstrating how Promotora-led cooperatives can set a precedent for equitable partnerships with local agencies.
A Movement for Systemic Change
This work is about more than just one cooperative or one project—it’s about building a movement. By supporting Promotoras in forming independent cooperatives, we are challenging the traditional nonprofit model and creating a new system rooted in equity, collaboration, and community power. We envision a future where Promotoras are no longer seen as volunteers or charity workers but as respected professionals and leaders. A future where public health systems are shaped by the voices of those most impacted. And a future where immigrant women have the power to transform their communities and their lives. Bienestar Collective, we are proud to stand with Promotoras as they lead this movement—not as directors of their work, but as mentors supporting their independence. Together, we are shifting the balance of power in public health and building a more just and equitable system for all.