CHWs

Community health workers (CHWs) are lay members of the community who receive structured training to provide basic health services and link people to the formal health system. Working at the local level, CHWs often share language, culture, and lived experience with the populations they serve. They operate across primary health care, public health, and social support settings and are employed in many countries, from low- and middle-income contexts to urban health initiatives in high-income countries.

Typical duties include health education and counseling; newborn, maternal, and child health support; immunization promotion; screening for common conditions; basic first aid; adherence support for treatment; referral to clinics; and assistance with health system navigation. They may also address social determinants of health, such as housing, nutrition, and access to services, and may use mobile tools for data collection and appointment reminders.

Training and supervision vary widely but generally include several weeks to months of instruction on anatomy and physiology, communication skills, ethics, confidentiality, and safe referral practices. CHWs usually work under the supervision of nurses, midwives, or physicians within a primary care team and are often integrated into health programs through national policies or NGO partnerships. Certification and career pathways exist in some settings.

Evidence from many settings links CHW programs to improved health service access, higher vaccination and screening coverage, better treatment adherence, and, in some cases, reductions in morbidity and mortality. Cost-effectiveness depends on design, scale, and integration with health systems. Digital tools, supervision models, and sustainable financing are critical to success.

Despite benefits, CHW programs face challenges such as inconsistent funding, variable quality of training, supervision gaps, workforce retention, safety, and integration with formal health services. Successful implementation typically requires clear policy frameworks, adequate remuneration, community engagement, and ongoing monitoring and evaluation.