Community Health Workers: Initial Thoughts

This post is the first in a series on community health workers that I hope will lead to a discussion about expanding this model in U.S. communities. I will provide some limited background to the concept here and suggest some ways to use community health workers. In later posts, I will review evidence of their efficacy elsewhere in the world and the flesh out ways we might use them in Davis, California, and Yolo County, California.

Community health workers (CHW) is a general term that encompasses a variety of functions and activities. In some places, they are called health promoters, peer educators, community health representatives, or health educators.

In general, community health workers are volunteers. That is, they may or may not be part of some formal health delivery system, but they are generally not salaried staff. In some cases, they may receive various incentives or reimbursement for expenditures on behalf of the program (transportation costs, for example).

They are typically members of the community in which they serve. Ideally, they are well known and trusted, speak the local language, and understand local cultural practices related to health-promoting behaviors and healthcare-seeking practices. Because of their position in the communities they serve, they function as a critical link between formal healthcare provides or health departments and community members.

The WHO guideline on health policy and system support to optimize community health worker programs to which I will return in a later post, suggests three possible roles for CHWs:

• Promotive
• Preventive
• Curative

A single CHW may play more than one role: they may provide education on smoking cessation program options (promotive); provide information and access to insecticide-treated bednets (preventive); or provide directly observed treatment of HIV antiretrovirals to those with the virus (curative).

Like all volunteer programs, and especially given the importance of CHWs providing appropriate advice or treatment, CHW programs must pay close attention to recruitment, selection, and training–including some form of certification. They must also provide supportive supervision and continued professional development. Finally, they must assure that CHWs are adequately linked to the formal services they support.

Each of these represent challenges and are a function not only of the characteristics of available CHWs (education level, availability), but also of the complexity and variety of tasks assigned to them.

With this brief background, a future post will provide further examples of how CHWs have been used around the world and the evidence of their effectiveness.