"'I'm a Health Worker' - Abduaraman Gidi" made by IntraHealth International.
April 17, 2019 This week CHWCentral had the privilege of attending the 20th annual Unity Conference held in Las Vegas, Nevada, United States. For our global audience, the Unity Conference is the US national CHW conference. Attended by more than 800 people, many of them CHWs from across the United States, the conference highlighted some of the major issues and advancements in US CHW programs, many of which will resonate with CHWCentral’s global audience.
A major event during this year’s Unity Conference was the launch of the newly formed National Association of Community Health Workers (NACHW). NACHW’s mission is “To unify the voices of community health workers and strengthen the profession’s capacity to promote healthy communities.”
Though in its early stages, NACHW sets a pioneering example of a national-level CHW association that is poised to support CHW workforce organizing and represent CHW voices in policy discussions and health systems development. Considerable thought was given to the foundation of NACHW; the NACHW board was intentionally formed to represent the demographics of the US CHW community in terms of gender division (it’s more than 60% female), geographic representation, and CHW participation. The composition of the board ensures CHWs remain in the driver’s seat of CHW policy development and workforce development.
Other key themes we picked up from the conference this week include the importance of data, struggles with funding, and the critical role CHWs play in addressing the social determinants of health.
Multiple presentations and sessions focused on how to collect and synthesize data, both for program design and management and for providing information on patient outcomes to lure and satisfy donors.
CHW programs have clearly been documented to save costs. Take for example a recently released meta-analysis of health systems interventions that found: “Of six types of innovation components that we evaluated (i.e., used health IT, used community health workers, medical home intervention, focus on behavioral health, used telemedicine, workflow/process redesign intervention), only innovations using community health workers (CHWs) were found to lower total costs (by $138 per beneficiary per quarter).” Yet funding for CHW programs remains a continuous challenge across programs in the US and is frequently tied to short-term projects rather than long-term health systems investments. Better data may help motivate private health institutions and funders to invest more in CHW programs.
One of the most compelling elements of the conference was the continued emphasis on the role CHWs play in addressing the social determinants of health. Physicians wondering why patients miss appointments frequently don’t have insight into the other challenges their patients face – housing, employment, domestic abuse, access to food – in addressing these issues. CHWs mentioned over and over that in order to even begin to work with patients to address their health issues, they first need to address other immediate issues such as where to sleep for the night.
Participants at the Unity Conference embodied the full diversity of the community health workforce in the US as well as the diversity of the clients they serve: Hawaiian CHWs serving remote island communities, inner-city CHWs serving the homeless in Baltimore and Detroit, CHWs assisting pregnant women with opioid addiction in the northeast, Promotores helping women and men with chronic conditions in the southwest, immigrant CHWs from Congo aiding fellow immigrants in their transition to life in the US, and the 1,600+ community health representatives serving 250 tribal nation communities in the US. What unified this heterogeneous cadre serving the full tapestry of the American population was the unwavering commitment of CHWs to addressing client needs, no matter how broad or varied, with culturally relevant, skilled care delivered with love.
Working in difficult environments with limited resources, the CHWs at the Unity Conference showed deep engagement and dedication to the work they do, actively seeking resources to do it better. They exuded a strong confidence, knowing that the work they do on the frontlines is of critical importance to the clients they serve. Their perspective, pride and passion were evident in their willingness to combine hard-core public health discussions with sessions on self-care and intermissions of song and dance. One client at a time, they are bringing the world closer to the goal of achieving health for all.
Bir et. al. 2018. Health Care Innovation Awards (HCIA) Meta-Analysis and Evaluators Collaborative. RTI. https://downloads.cms.gov/files/cmmi/hcia-metaanalysisthirdannualrpt.pdf