Study highlights opportunities for building a resilient CHW workforce
Published: April 14, 2025
By Wes Gibson
A recently published study highlights strategies to build a resilient Community Health Worker (CHWs) workforce to aid public health practices and outreach. CHWs are deeply involved in connecting community members to health care, resources, and services they may need. Globally, CHWs have proven to be valuable assets within the health care ecosystem, with improved return on investments in both financial and health outcomes.1
The recent publication in BMC Public Health on February 15, 2025 presents a framework based off an initiative with Health Equity Collective, a systems-based coalition housed under UTHealth Houston School of Public Health’s Center for Health Equity, and the City of Houston’s Health Department, to support CHWs in the Greater Houston region.
Since 2022, the collective has developed partnerships with over 325 member organizations to address non-medical drivers of health (NMDOH) to improve care coordination.
The project focused on three primary activities including key-informant interviews with CHW employers, a landscape scan survey completed by CHWs, and a journey-mapping exercise. Findings highlighted significant gaps in career planning and counseling services; limited funding, job insecurity, lack of pay parity, and minimal career pathways hindering CHWs’ ability to deliver high quality care and sustain these connections and efforts long-term.
Rosalia Guerrero, MBA, CHWI, director of vulnerable populations and senior project manager, adds, “This published paper provides clear, data-driven insights that create a call to action for CHW employers and allies who wish to build a stronger, more sustainable workforce - one that is empowered, well-supported and equipped to improve health in our communities.”
The interviews with CHW employers and leaders in Texas outlined the challenges faced by CHWs, including landscape needs assessment revelated diverse organizational affiliations, roles, and demographics, with a majority reported being grant funded. The journey mapping exercise shares CHW lived experience in their own words and has resulted in the development of a personal story shared on YouTube, Amira’s video, which is now widely disseminated for use in CHW advocacy efforts.
The study’s findings highlight the challenges faced by CHWs in being underpaid, experiencing burnout, inconsistent job descriptions, and a lack of pathways and support for career development within the organizations and systems they’re hired within. The consistency of these themes across the three data-gathering activities highlights clear opportunities for investing in policy, systems, and environmental changes that will strengthen the CHW workforce and its capacity to contribute to regional health equity improvements.
Based on CHW’s feedback, organizations can take the following steps to more effectively include and empower the CHW workforce:
- Invest in CHWs through robust Human Resources strategies and offer full-time positions with competitive pay and benefits
- Involve CHWs in strategic decisions
- Ensure clarity on CHW roles within teams
- Build community-centered areas for CHWs to serve
- Provide professional development and training opportunities in leadership, advocacy, and career planning
While policymakers and health care leaders have called for a rapid scaling up of CHWs to address longstanding health needs, more attention needs to be given to strengthening the CHW workforce concerning job parity, career growth, and equity within systems that hire and train CHWs.2 A stronger and more resilient CHW workforce will have direct impacts on better health outcomes for our communities.
As we move forward it is imperative that stakeholders at all levels prioritize the well-being and advancement of CHWs, recognizing their indispensable role in our public health ecosystem.
Investigators on this study include Shreela Sharma, PhD, RDN, LD; Heidi Hagen McPherson, MPH; Jemima John, PhD, MPH; Rosalia Guerrero, MBA, CHWI; Sisan Tennyson, MPH, Deborah Banerjee, PhD; Nadia Siddiqui, MPH; Sheila Savannah, MA; Peter Durand; Amanda Gao; Sean Haley, PhD; Elisa Garcia BSN, RN; Jennifer Cofer, DrPH, MPH, CHES; and Adrick Harris, MPH, LSSWB.
- McGinn E, Kureshy N, Alilio M, Kavanagh M. Investing in Community Health Workers to Accelerate Primary Health Care: Advancing Rights, Protections, and Health Systems Integration. 2024.
- Smithwick J, Nance J, Covington-Kolb S, Rodriguez A, Young M. “Community health workers bring value and deserve to be valued too:” Key considerations in improving CHW career advancement opportunities. Front Public Health. 2023;11:1036481.