Working Conditions

Community health workers (CHWs) often live in the community they serve or have an unusually close understanding with those communities through shared life experiences.  They spend much of their time traveling within the community, visiting homes and civic organizations where residents congregate, generally connecting with local people.  CHWs work along a continuum ranging from strictly developmental functions such as community organizing to more service delivery functions such as supporting healthcare services.

Some CHWs work in health facilities and social service organizations providing case management, care coordination, outreach and community mobilizing, health promotion/coaching, home-based support, and system navigation.  Others are employed by government agencies and non-profit groups to provide community organizing, health promotion, and preventive care services "in the field."  These CHWs may staff tables at community events, provide health screenings, make referrals, share information, and help people complete applications to access benefits. They may also visit homes to check on individuals with specific health conditions, prepare and accompany clients to medical appointments, or deliver health promotion sessions to school age children, their parents, and teachers.  Still others are employed in academic institutions to provide participatory research.

CHWs hired by health care agencies often have a disease or population-based focus, such as promoting the health of pregnant women or children, improving nutrition, promoting immunization, or providing education around a specific health issue, such as diabetes or HIV/AIDS.

CHWs are defined by the trust they receive from the communities they work in.  To be effective, CHWs must secure, preserve, and develop that trust.  This can put the CHW in a difficult position, particularly when there is disconnect between program goals and community priorities.  For example, communities that rely on their own traditional medical practitioners (such as native healers) may resist efforts by a CHW to refer patients to "Western" health care resources.  The CHW must be able to balance their responsibilities to the community along with their employer's agenda.