About Community Health Workers
Who are they?
A community health worker is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A community health worker also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy (APHA, 2009).
What is their role?
Community health workers work under many different job titles and perform a variety of duties to address upstream factors in health care. A CHW working in a local health department may educate patients with chronic diseases about the importance of nutrition and lifestyle, monitor their vitals, and strive to reduce emergency room visits. They might also advocate for local policies to address health issues such as smoking in public areas or wearing masks when inside buildings to prevent the spread of Covid. In a community action agency, a CHW may link clients with complex interconnected health and social risks with resources such as housing, transportation, and medical insurance. A CHW working in behavioral health may serve as a supportive listener and implement motivational interviewing skills to support behavior change, coordinate a needle exchange program, and accompany clients to the gym to practice healthy living.
How are they funded?
CHWs can be integrated within a local health department, health care systems, academic-community partnerships, community-based nonprofit organizations, and management organizations. Funding sources include grants, a Pathways Community Based Care Coordination HUB, or employment at a Managed Care Organization. HUBs bill Medicaid managed care plans and other funding partners for successfully completing Pathways. (i.e. Education, Employment, Housing, Medical Home, Pregnancy, and Tobacco Cessation.) HUBs distribute payments to the organizations that employ CHWs and keep a small administrative fee.
Making a Difference
Community health workers are making a difference around the world, in high- and low-income countries. In addition to making significant positive impacts on health behaviors and outcomes, they also have economic consequences including savings in health care costs due to more efficient use of the health system and increased labor productivity of healthier patients. A Social Return on Investment (SROI) analysis completed by Wilder Research for the American Cancer Society concluded that investing $41,184 per year in CHWs for ten years generates net economic benefits of $481,920. With an estimated 62% of CHWs in the Midwest working in cancer outreach, these CHWs will generate more than 5.8 billion dollars in net benefits in the next 20 years through reduced years of life lost, benefits for taxpayers, and increased healthcare efficiency. Another study of pregnant women participating in the CHAPS Pathways model indicated that “structured community-based care coordination coupled with standardized and accountable tracking tools and payment for outcomes may reduce LBW delivery among high-risk pregnant women.” Finally, an SROI measuring equity, women’s empowerment, health employment, and productivity of a Health Extension Program employing CHWs in a program in Ethiopia found an SROI between $1.54 and $3.26 for every dollar invested as well as at least 7,000 children’s lives saved every year.
American Public Health Association. (2021). Community health workers. https://www.apha.org/apha-communities/member-sections/community-health-workers
Diaz, J. (2021). Social return on investment: Community health workers in cancer outreach. Wilder Research. https://www.wilder.org/sites/default/files/imports/ACS_ROI_in_CHWs-6-12.pdf
Robert Wood Johnson Foundation. (2016). Community health workers and population health: Lessons from US and global models. https://www.rwjf.org/en/library/research/2016/08/community-health-workers-and-a-culture-of-health--lessons-from-u.html
Redding, S., Conrey, E., Porter, K., Paulson, J., Hughes, K., & Redding, M. (2015). Pathways community care coordination in low birth weight prevention. Maternal and Child Health Journal, 19(3), 643–650. https://doi-org.proxy.library.ohio.edu/10.1007/s10995-014-1554-4