Community health workers are front-line public health professionals who share life experience, trust, compassion, values and/or cultural alignment with the communities they serve. Also referred to as health care extenders, clinical supporters and community care workers, community health workers extend the reach of clinical settings into the community to increase access to care. They advocate for and help patients navigate the health care system and connect them to culturally and linguistically relevant health care services.
Community health workers traditionally work where they live and understand the communities they serve. They often work in community health facilities such as hospitals, nursing homes, clinics, faith-based organizations and other settings. Some community health workers may be employed by government agencies and nonprofit groups to assist with community organizing, health education, Medicaid enrollment and preventive care services.
What Services do Community Health Workers Provide?
Community health worker services often include:
- Creating connections between vulnerable populations and health care systems.
- Providing culturally appropriate health literacy.
- Performing health screenings, informal counseling, referrals and other direct services.
- Facilitating health care and social service system navigation.
- Assisting in accessing medical and non-medical services.
- Advocating for individual and community health needs.
- Accommodating for interpretation and translation services.
Community health workers can increase access to health care, especially in rural and underserved areas, improve health outcomes and reduce disparities in a cost-effective way. Several studies have demonstrated that community health worker interventions can improve population health and reduce costs. Community health workers provide services associated with increased appointment-keeping, medication adherence and cancer screening rates. They may also reduce health care costs by addressing chronic conditions, identifying issues early and focusing on preventative care, which tends to be more cost effective than seeking treatment and hospitalization. Their lived experiences and expertise contribute to building trust among patients. These factors may lead to positive health outcomes, cost savings and patient satisfaction in diverse communities.
The Bureau of Labor Statistics estimates that more than 117,000 community health workers and health educators were employed across almost all states in 2022. The Bureau also estimates that the community health worker profession will grow 14% by 2032, with approximately 8,000 openings each year, nationally. States play an important role in integrating community health workers into the health care system through certification, training, continuing education, financing and reimbursement of services, recruitment and retention.
Doulas as Community Health Workers
Doulas are essentially community health workers who provide social support and guidance to expectant mothers during labor, birth and postpartum as part of a maternity care team. They provide holistic perinatal physical, emotional and educational support to pregnant and birthing mothers and their families. They work in the communities where they live, and as community health workers, they provide case management, education and follow-up care.
Doula services often include:
- Functioning as navigators and advocates for expecting families.
- Serving as consistent points of contact and trusted sources of information.
- Providing culturally appropriate support to women at higher risk of poor outcomes.
Research indicates that doula services positively impact maternal and infant health outcomes and experiences, including lower cesarean section rates, fewer obstetric interventions, fewer complications during and after childbirth, decreased use of pain medication, shorter labor hours and many more.
States have passed legislation to include doulas in the definition of community health workers. Tennessee defines doulas as "vital childbirth team members and community health workers." South Carolina offers programs to pair perinatal families with community health workers to help improve birthing outcomes. Oregon enacted legislation to create a Traditional Health Workers Commission and included doulas as one of the types of traditional health workers. This commission oversees the work of traditional health workers and integrates them into the health care system in the state.
States are also pursuing several strategies to improve access to community-based services provided by doulas, including coverage and reimbursement. Louisiana requires private health coverage plans that cover benefits for maternity services to cover doula services. Some doulas are paid through community programs or under the classification of a community health worker. New Jersey began enrolling doulas as Medicaid/NJ FamilyCare providers and allowed doulas to receive Medicaid/NJ FamilyCare reimbursement for services rendered in 2021.