What are community health workers?
When Jamie Collins, a 54-year-old transgender woman from Shreveport, Louisiana, used drugs and engaged in sexual activity with multiple partners, she knew she was taking risks for her health. Hence, she was not surprised when she was diagnosed as HIV positive. She had moved to Dallas, Texas in 2011 and received the news after being admitted to Parkland Hospital to be treated for injuries sustained during a physical assault.
Before Collins could fully process the news, a community health worker (CHW) who was also HIV positive was dispatched to Collins’ bedside from the Parkland HIV Health Clinic.
Collins already knew CHW. One of them visited her during her time in prison and convinced her to seek treatment for her drug addiction. Parkland CHW has also been a valuable source of support.
“That gentleman sat with me, talked to me, came with me to get my lab work done, and even attended my doctor visits to make sure everything was okay,” Collins said. The CHW also helped Collins find affordable housing and good public transit and connected her to other health and social services.
More than a decade after receiving his HIV diagnosis, Collins still feels his CHW even though he no longer works at the clinic. She considers him a lifelong friend and he is one of the reasons she currently volunteers as a community health advocate.
“They were so compassionate,” Collins said of her CHWs. “Even though I’m a strong person, I’ve had my moments of doubt and fear about my situation. Without their help, I know my health would not be as good as it is.
What are community health workers?
CHWs have been called public health ambassadors and they play important roles in the lives of people in need of medical assistance. Indeed the World Health Organization praised them as among the most important public health care providers globally.
Much of the influence of CHWs comes from their close connection with urban and rural communities and the ability to connect medical systems to vulnerable and historically marginalized populations in need of health care. CHWs work as volunteers or paid staff, and their titles vary according to their affiliations with health and social services. They are also known as peer counselors, promoters, community health aides, health coaches and outreach workers, a growing number of CHWs hold formal degrees and certifications in practice. Many others count strong ties and the ability to maintain culturally appropriate relationships with their communities as valid credentials.
CHWs provide a variety of health and education services, including drug abuse interventions, nutrition, immunizations, infectious disease counseling, child and reproductive health care, and follow-up support.
Having a trusted CHW as an advocate often helps ensure that patients needing medical assistance have an easier and less intimidating experience. Their advocacy often makes the difference between whether a patient continues to receive the care she needs or leaves the system altogether, said Helen Limbani, a public health practitioner of 30 years.
“Caregivers become like family,” said Limbani, who is currently a case manager for The Afiya Center, which provides reproductive services for black and brown women in the Dallas area. Limbani entered the field as a volunteer at hospitals and clinics before being hired to do the same job. “We’re not doctors, so we’re less of a threat to people,” Limbani said. “A degree is fine, but in this job it is still important to be a person with passion”.
Historical origins of community health workers
The concept of using non-physicians to provide health care dates back to the 1650s, when some German servicemen were trained to be medical assistants or feldsher and were later introduced by Peter the Great to treat the Russian army. Since that time, the concept has expanded and evolved and inspired community health programs around the world. In particular, CHWs have played a vital role during the outbreak of the Covid-19 which has overwhelmed the healthcare system. They served as a pipeline that provided access to services that would help mitigate the damaging impact caused by the pandemic. Recognizing their importance, the Centers for Disease Control and Prevention (CDC) established Community Health Workers for COVID Response and Resilient Communities, a initiative which has provided financial support and technical assistance to strengthen their service efforts.
Their growing number responds to growing needs
The need for CHW in the US appears to show no signs of slowing down. The Federal Bureau of Labor Statistics reports a estimated 61,010 workers nationwide are employed as CHWs and that doesn’t include the countless others who are unpaid volunteers.
Alex Fajardo is a CHW who has been in the field for decades. To the Educational center of the El Sol neighborhood, which serves populations in the inland and coastal communities of San Bernardino and Southern California, there were only three CHW volunteers or promoters on the team when asked to join them 20 years ago. They wanted him to continue what he was already doing: serving as an interpreter, assisting the elderly with transportation, and working to prevent youth violence in his neighborhood. Now, as executive director of that same agency, Fajardo oversees a staff of 150 mostly bilingual laypeople who are trained to serve more than 50,000 community residents in their area.
Promoters are community health workers who provide services in Spanish-speaking communities.
Fajardo appreciates that there are more opportunities for CHWs to provide services, but is concerned about how their core identities will be affected by the increased involvement of medical and government institutions seeking to hire them. Traditional CHWs must now compete for jobs with those with formal certifications and college degrees, but may have limited real-world experience understanding the needs of the people they will serve.
Fajardo recommends having candid and ongoing discussions between community health workers and medical system representatives about how CHW programs can be improved without detracting from the essence of their roles and placing them in positions of enforcers for the institutions they work for instead of advocates for the people that I am trained to serve.
“It’s about relationships,” Fajardo said. “We cannot lose our identity as loyal to the people or as the voice of the community. This is extremely important because communities are where we belong.