As someone who has had the pleasure and honor of working with CHWs, both in the US and internationally, for more than 25 years, I am very excited about the new, expanded launch of the CHW Central website! Based on my own experience, CHWs in the US have much to learn from CHWs in the developing world, and vice versa. A website where CHWs can share experiences and organize together across the boundaries of geography and culture can benefit both CHWs and the communities they serve.
In the developing world, CHWs have been recognized as crucial members of the health workforce since at least the 1970s, when the World Health Organization at its Alma Ata Conference declared CHWs to be cornerstones of primary health care. Of course, the roots of the model go back much further, to the Russian feldshers who cared for the health of civilian and military populations in the 17th century, and the Chinese barefoot doctors, peasants who were trained to extend health care to rural areas after the Chinese revolution. Church-based CHW programs like the one in which I worked in the 1980s in El Salvador have flourished in Latin America since the 1960s.
In the US, CHWs have played integral roles in communities and the health care system for more than 50 years. The Indian Health Service’s Community Health Representative Program, the oldest continuously operating CHW program in the US, was founded in the late 1960s. During the same period, the Office of Economic Opportunity founded CHW programs in urban areas around the US. Programs in migrant and seasonal farmworking communities flourished from the late 1980s to the present day.
In the US, recognition for CHWs has been slow in coming. But thanks to tireless efforts by Community Health Workers and their advocates, that recognition has finally come. In just the last few years, Community Health Workers have been recognized as a job class by the US Bureau of Labor. Their potential contributions to the health care system have been highlighted in the Patient Protection and Affordable Care Act. They have been the subject of legislation in at least six states. Those six states include my own state of Oregon, where CHWs were prominently included in our own version of health care transformation. Right now, policies are being debated and created that will affect Community Health Workers for decades – even generations – to come.
At this crucial time of possibility and change, it is essential that US CHWs and their advocates work to maintain the characteristics of the CHW model that have made it so very effective over time and around the world. These characteristics include CHWs’ membership in the communities they serve and their ability to play multiple roles, from providing culturally specific health education and information, to sharing informal counseling and social support, to organizing communities to identify and address their own most pressing health issues. A vital resource in this effort is a mechanism for connecting to and learning from and with CHWs in the developing world. So many of the issues CHWs face are the same, whether they are in Dhaka or Detroit, Tucson or Tanzania. My colleagues and I in Oregon look forward with great anticipation to participating in the global CHW movement this website can help to create.
Noelle Wiggins is the founder and Director of the Community Capacitation Center (CCC) of the Multnomah County Health Department (MCHD) in Portland, Oregon. From 1990-1995, Noelle served as the Director of La Familia Sana (The Healthy Family), a Community Health Worker (CHW) program based in Hood River, Or. From 1986-1990, Noelle trained and supported CHWs in a rural, conflictive area of El Salvador. Noelle served as Assoc. Director of the National Community Health Advisor Study and is a Past President of the Oregon Public Health Association. Noelle holds a BA in History from Yale University, an MS in Health and Social Behavior from the Harvard School of Public Health, and an EdD in Curriculum and Instruction from Portland State University.
Wiggins, N. & Borbón, I.A. (1998). Core roles and competencies of community health workers. In Final report of the National Community Health Advisor Study. Baltimore, MD: Annie E. Casey Foundation, 15-49.