Who Are Community Health Workers (CHWs)?

Community Health Workers come in many titles including Promotores de Salud, Community Health Representatives (CHRs) in tribal nations, Community Health Advisors, and more.

The American Public Health Association's Community Health Worker Section has adopted the following definition for community health workers:

A community health worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community being served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.  A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.

Many CHW programs across the country have either adopted or adapted this language to define this workforce, and many, if not most, of the programs across the U. S. also subscribe to a core set of competencies for CHWs regardless of the many titles under which these workers are prepared to serve.

The following list of core competencies was elucidated in "The National Community Health Advisor Study (1998)," which was well informed by working and seasoned community health workers and employers across the country. The National Community Health Advisor Study was a policy research project of the University of Arizona, directed by E. Lee Rosenthal, MPH, PhD and funded by the Annie E. Casey Foundation.

  1. Communication Skills
  2. Interpersonal Skills
  3. Service Coordination Skills
  4. A Knowledge Base for Service
  5. Capacity Building Skills
  6. Teaching Skills
  7. Advocacy Skills
  8. Organizational Skills

The CHW workforce is now receiving increasing overall recognition and growth, including:

  1. The formation and proliferation of CHW networks and associations across states, regions, and in special population settings, including "Promotores" serving in U.S.-Mexico border neighborhoods and "Community Health Representatives (CHRs)" serving in the tribal communities of many American Indian Nations within the United States;
  2. In addition to community-based training, the consideration for the efficacy of higher education (college responsive programs) preparation of CHWs;
  3. Concern for who is informing the training "standards" and "CHW-character-appropriate educational practices" nationally;
  4. Questions continuing as to what are the nationally accepted CHW "core competencies" and concern for best practice validation of those competencies;
  5. The integration of the CHW in health and human service teams to improve coordination and continuity of care through community health outreach that can reduce health disparities in socioeconomically disadvantaged neighborhoods and which connects people with culturally attuned health care and human services; and
  6. The credentialing of this workforce for employers to receive Medicare, Medicaid, and other third-party reimbursements for the services of CHWs across the many recognized titles of service.


Other Sites about CHWs/CHRs

CDC Online Course


HRSA CHW Toolkit

National Heart, Lung and Blood Disease Institute Community Health Worker Health Disparities Initiative

The Community-Campus Partnerships for Health (CCPH)

University of Texas Health Science Center at Houston


Financing CHWs

CHW Brief

Career Profile

APHA Newsletter Winter 2012

CHWs, Promotores, and the Triple Aim

University of Arizona
Arizona Area Health Education Centers Program
1834 Mabel St. Tucson, AZ 85721
phone:(520) 626-4030
fax:(520) 626-4037


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