Community health workers: The foot soldiers of the health care industry

Could hiring the recently-unemployed as CHWs prepare us for next health crisis?

Community health workers (CHWs) are the unsung foot soldiers of the health care industry. And one advocate for CHWs says hiring Americans left jobless by COVID-19 shutdowns as community health workers could have both short-term, and lasting, effects on the country’s economy and health.

“A U.S. community health corps could provide economic salvation and form the backbone of a future health system that is always ready to fight the next epidemic. And we wouldn’t have to look far for help—we’d only have to look next door.” says Raj Panjabi, the Co-founder and CEO of Last Mile Health and a professor at Harvard Medical School in a recent op-ed in Fortune.

Dr. Panjabi and his co-author Mitchell Weiss of Harvard Business School argue that the unemployed without a medical or nursing degree could be quickly trained as CHWs and hired to help prevent, detect and respond to COVID-19’s transmission.

“In many countries, including the U.S., community health workers—local residents without professional medical degrees, hired and trained to support patients—have been a first and last line of defense for epidemics,” they explain.

CHWs were used in Liberia and West Africa’s fight against Ebola, going door-to-door to educate people about transmission prevention. They also learned the symptoms of Ebola to help detect patients, encouraging them to seek treatment at hospitals. Dr. Panjabi says the same community-based strategy is critical in the global response to COVID-19.

The Role of a Community Health Worker

As lay members of the community, CHWs serve as a connection between patients and health care providers and work in an advisory capacity—providing education, social support, and informal medical counseling. They may be known as community health advisors, promotoras, outreach educators, and peer health promoters.

Because CHWs typically live in the communities they serve and share ethnicity, language, socioeconomic status, and life experiences, they often develop interpersonal relationships and increased levels of trust that may not exist with the larger medical profession. That trust can lead to greater adherence to health recommendations.

Use of CHWs also leads to improved access to health care services, increased health screening, and a better understanding between community members and the health and social service system.

Studies have found that CHWs are beneficial both to the patients they serve and the medical facilities for which they work. A 2014 study found that CHWs “contribute substantially to improvements in care team productivity and outcomes” for patients while reducing medical costs.

After adding CHWs to a patient-centered medical home in the South Bronx, New York, emergency room visits fell five percent, and hospitalizations of patients with chronic health problems dropped 12.6 percent. In addition, the hospital saved $2.30 for every dollar it spent on CHWs.

Another study found CHWs improved the outcomes and lowered costs of diabetes patients in rural Appalachia, decreasing emergency room visits by 22 percent and hospitalizations by 30 percent.

With the COVID-19 pandemic, CHWs may play a key role in educating communities and promoting best practices. In addition, the ability to monitor those who are self-isolating can help determine what medical and social services might be needed and contribute to the management of long-term conditions.

Prevent, Detect, Respond

The job description for a COVID-19 CHW in the United States could be divided into three categories: prevent, detect, and respond.

Prevention could include carrying out social media campaigns to promote social distancing, online promoting of mental and physical health, encouraging strategies in neighborhoods, delivering food and medication to vulnerable residents, and making homemade masks and donating them to local hospitals.

Detection could include staffing hotlines run by hospitals and public health agencies to answer questions from the public, referring COVID-19 patients to testing centers, and organizing transportation.

Responding might involve calling people with COVID-19 who show mild symptoms and are self-isolating to monitor them for worsening symptoms. It also could involve working with nurse supervision to get rapid referral of people requiring hospitalization or working with public health officers to support the tracking and monitoring of COVID-19 patient contacts.

According to Dr. Panjabi, training could be completed via online programs developed by the U.S. Centers for Disease Control and Prevention (CDC) along with state health departments and universities. The funds to hire new CHWs could come from federal economic relief packages and philanthropies.

A Career as a Community Health Worker

The national average CHW salary is $39,540, according to the Bureau of Labor Statistics (BLS). Those who work in hospitals make slightly more while those who work in outpatient care centers or individual and family services earn slightly less.

Qualifications vary since there are no uniform training standards, but components of CHW training materials address cultural competence, patient intake and assessment, protocol delivery, risk factors, insurance eligibility and enrollment, health promotion, and disease prevention and management. Trainings tend to be local and sometimes employer-driven.

Some employers require only a high school diploma, while others demand a college degree. There are roughly 100 hours of on-the-job training. CHWs aren’t licensed but several states have begun developing credentialing programs that may also require legal, ethical, and liability training.

According to the BLS, the job outlook for CHWs was strong even before the COVID-19 pandemic with the BLS predicting 13 percent growth between 2018-2028.

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