Who are Community Health Workers?

A Community Health Worker is a trusted member of the community who empowers their peers through education and connections to health and social resources. They have proven to be successful at increasing health outcomes for their communities because they have a deep understanding of the cultural norms of the people they serve. CHWs are widely known to improve the health of their communities by linking their neighbors to health care and social services, educating their peers about disease and injury prevention, working to make health services more accessible, and by mobilizing their communities to create positive change.

The Role of Community Health Workers

Over the years, CHW’s access and insight into their communities have supported successful health initiatives across the globe. Their understanding of cultural preferences, language, and local resources allow them to be effective at addressing emerging health challenges in any geographic location of any cultural make-up, and across various age groups. This flexibility means that CHW-led programs can look very different yet share the same common goal; to improve health outcomes in communities that are under-served and under-resourced.

In these communities, access to health services is often restricted due to factors such as economic status, language, race/ethnicity, gender, age, or geographic location. Individuals who live within these areas often have trouble obtaining a vehicle, affording or accessing public transportation, and finding culturally appropriate health information. These barriers impact one’s ability to maintain a healthy lifestyle because it prevents them from finding affordable fresh foods, keeping appointments with health professionals, having the knowledge to adopt healthier habits, and applying for health care and services.

What makes CHWs uniquely qualified to provide support in these communities is their ability to build strong relationships, speak the language, and empathize with complex life situations. These qualities allow CHWs to successfully connect individuals to community resources, organizations, and government programs that often provide free or low-cost services. Further, CHW programs are known to be cost-effective for the community at large. Multiple ROI (return on investment) analyses have shown positive returns for every $1 spent on CHW programs. MHP Salud’s own analysis of Casa de Camino’s cancer screening and education program found that it demonstrated an ROI of $3.09 for every $1 spent.9

With the appropriate resources, training, and support, CHWs will provide a variety of social and economic benefits while also improving the health of their communities by:

  • Linking their neighbors to health care and social services

  • Educating their peers about disease and injury prevention

  • Working to make community resources more accessible

  • Mobilizing their communities to create positive change through targeted outreach and customized programming

  • Linking their neighbors to health care and social services

  • Educating their peers about disease and injury prevention

A Community Health Worker’s unique insight allows them to tailor their activities to address issues specific to the communities they serve; however, essential CHW responsibilities include:

CHW with program participant

Conduct informal counseling and provide support

CHWs sitting at a table holding up pamphlets

They focus on serving the specific needs of ethnic and racial groups, vulnerable populations and communities with prominent health problems

A CHW talking with a farm worker in a field.

They advocate for communities that are often overlooked because of economic or cultural differences

A woman making a fruit cup.

They show individuals and families how to adopt healthier eating habits and encourage them to stay active

A woman filling out forms.

They help individuals navigate and enroll in public assistance and health insurance programs

Two CHWs holding up a poster board

They find and research new services and resources for community members

The CHW Profession

The Community Health Worker profession has seen substantial growth in recent years because of CHWs ability to address the unique health and social issues within their communities. The Bureau of Labor Statistics reports that the profession is expected to grow at a rate much faster than the national average of all other occupations from 2018-2028.7

Where do CHWs work?

Community Health Workers programs are typically implemented in areas that are hard to reach because of geographic location, like the rural farms and colonias along the borders of Texas and California. These areas are sometimes known as food deserts because there are very few grocery stores that sell fresh and healthy foods. Further public services like hospitals and clinics are hard to get to due to personal and public transportation challenges. CHWs can also work within sections of the inner city that house small communities of individuals from the same cultural and economic backgrounds like New York City, Chicago, and Detroit, Michigan. In these cities, CHWs may work to address several challenges such as sexual assault and domestic violence, and health care application assistance for English language learners.

How many CHWs are employed in the United States?

The HRSA Community Health Worker National Workforce Study, published in 2007, estimated that as of 2005, there were approximately 121,000 Community Health Workers in the United States. At that time, the number was growing at over 7 percent annually (C.H Rush, personal communication, May 15, 2009).

A CHW filling out a form for a women in the community

Community Health Workers can also be referred to as….

  • Community Health Representative
  • Indigenous or Village Health Workers
  • Non-traditional Health Workers

Qualities of Community Health Workers

In order to do their complex work, CHWs need to be empathetic, resourceful and willing to help others. Such qualities are personal characteristics that can be enhanced, but not necessarily taught. When organizations want to find Community Health Workers they look for the following qualities:

• Relationship with the community being served
• Desire to help the community
• Empathy
• Persistence
• Creativity and resourcefulness
• Personal strength and courage
• Respectfulness

A CHW stands with a group of women stretching an exercise band
A CHW posing for a picture as a group session ends.

According to the National Community Health Advisor Study, Community Health Workers are more effective in their work when they have the following skills:

  • Communication skills
  • Interpersonal skills
  • Teaching skills
  • Service coordination skills
  • Advocacy skills
  • Capacity-building skills
  • Knowledge base

Currently, 47 states have either enacted CHW legislation, started CHW associations or work with CHWs. They can work with non-profits, community-based organizations, public health departments and other organizations to help improve their community’s overall health.

Integrating CHWs into Health Care Center Teams

CHWs can be integrated into health care center teams to diversify the way health organizations reach individuals and improve their quality of services. In this setting CHWs are successful at:

  • Improving access to services
  • Helping people understand the health and social service system
  • Enhancing client and health provider communication
  • Increasing appropriate rates of service utilization
  • Decreasing costs for organizations and government programs
  • Improving adherence to health recommendations
  • Reducing the need for emergency and specialty services
  • Improving overall community health status

As the profession gains more national attention, programs are beginning to set salaries, stipends or provide incentives to CHWs. This is proof of the value of their work to improve community health.

* All CHWs who participate in MHP Salud programs receive a wage, stipend, or incentive.

CHWs and Clinical Care Teams

How to Become a CHW

In recent years, states have begun to develop training and credentialing requirements to become a CHW. The requirements vary across cities and states, employers and employment sectors. Some things to consider before becoming a CHW are:

  • Some states have developed certification requirements to become a CHW. Check with your local health departments to see if they exist where you live.
  • CHWs are not licensed, but some employers may set additional educational and training requirements.
  • Some employers require just a high school diploma while others can require a college degree.
  • CHWs need to be knowledgeable on community norms and should be able to speak the language of the population they serve.

How to Start or Maintain a Community Health Worker Program

Over the years, MHP Salud has developed multiple Community Health Worker (CHW) programs that address a variety of chronic diseases. MHP Salud’s programs have impacted many health behaviors that influence chronic disease outcomes, like healthy eating, physical activity, and timely disease screening. The programs also yield financial benefits, finding a positive return-on-investment (ROI) of $1.09-3.16 for every $1 invested.

We’ve taken the information from our innovative outcomes-driven programming to develop training and consulting to help organizations start or maintain Community Health Worker Programs. To learn more about our products and support please visit CHW Training and Consulting.

How We Can Help You

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1. Rosenthal, E.L., Wiggins, N., Brownstein, J. N., Rael, R., Johnson, S., & Koch, E. et.al. (1998). The final report of the National Community Health Advisor Study: Weaving the future. Tucson, Arizona: University of Arizona, Health Sciences Center.

2. Wiggins, N. (2004, January). Qualities of effective community health workers. Paper presented at the 13th Annual West Coast Migrant Stream Forum, Seattle, WA.

3. Richter, R. W., Bengen, B., Alsup, P. A., Bruun, B., Kilcoyne, M., & Challenor, B. D. (1974). The community health worker: A resource for improved health care delivery. American Journal of Public Health, 64 (11), 1056-1061.

4. National Rural Health Association. (2000, November). Community health advisor programs. Retrieved June 28, 2004, from www.nrharural.org/dc/issuepapers/ipaper17.html

5. Pew Health Professions Commission. (1994). Community health workers: Integral yet often overlooked members of the health care workforce. San Francisco, CA: University of California at San Francisco, Center for Health Professions.

6. https://www.apha.org/apha-communities/member-sections/community-health-workers

7. https://www.bls.gov/ooh/community-and-social-service/health-educators.htm

8. https://nashp.org/state-community-health-worker-models/

9. https://mhpsalud.org/programs/community-health-workers-roi/