Where does primary care begin? The health facilitator as a central figure in primary care

The role of lay advisors (health facilitators) in primary care is described. Health facilitators are people to whom others naturally turn for advice, counsel and support. The majority of illnesses reported by patients are never presented to a doctor. Because primary care is center in the family or other close social support system within the community social structure, all professional care is in fact external to that natural structure and may be considered secondary in function. In the United States, the recent trend toward self-care shows that professional care does not meet the needs of even the middle class and that people actively seek and receive support from peer groups. A pilot program in North Carolina is described, in which 39 health facilitators were identified and given training in the recognition of common illnesses, disease prevention, health promotion, and community resources. The implications of such programs and their effects on primary health care are discussed.