community health worker

The untapped workforce that can tackle COVID-19—and America’s healthcare gap

By: and

Apr 23, 2020

Like no other moment in recent history, COVID-19 has exposed how quickly our healthcare system can become overwhelmed. Frontline healthcare workers are working around the clock as healthcare systems adopt drastic measures, such as building emergency hospitals in parks and parking lots. 

Meanwhile, millions of individuals and families are struggling to get the care and resources they need, trying their best to help “flatten the curve,” weathering COVID-19 cases that don’t require hospitalization, and grappling with unstable financial situations. 

America needs a solution that not only helps people in their communities, but also relieves the burden on our frontline healthcare providers. Community health workers (CHWs) may be one such solution.

Community health workers have played important roles in mitigating the effects of epidemics around the world and in improving healthcare delivery at the community level, especially among low-income and elderly populations. With at least 26 million individuals filing for unemployment, healthcare systems have a real opportunity to attract and train hundreds of thousands of people who otherwise may not have considered joining the industry. Employing these individuals as CHWs can help mitigate resource shortages during COVID-19 and serve communities long after the crisis subsides.

A community-based solution to a nationwide crisis

Community health workers are a “boots-on-the-ground” corps of people trained in improving the health of their local communities. They assist health advocacy and intervention efforts, and act as a liaison between community members and health services. CHWs need very limited medical training and do not need a medical license; their benefit comes from a deep knowledge of where they live and work and of the problems their neighbors face. Especially in resource-poor communities where access to healthcare is limited, these vital trainees are often the first point of access into the healthcare system. 

The work of CHWs can take many forms to provide relief to the community both during and outside of health emergencies. On the logistics side, they deliver meals and supplies, organize and provide transport to appointments, and connect community members to social services. On the intervention side, activities can range from monitoring illness symptoms to contact tracing. These tasks can play a crucial role in controlling the spread of COVID-19, as dedicated community advocates help their neighbors follow social distancing protocols and reduce the burden on the healthcare system by cutting off disease spread at its source. This is not an unprecedented solution to a global pandemic—the same coordinated CHW response aided in curbing the 2014 Ebola crisis.

Relative to what doctors and nurses can provide, these lower-end services and interventions are rather rudimentary—and that’s exactly the point. CHWs can provide education, guidance, and assistance for non-emergency medical issues, especially in areas where medical care is hard to access or navigate. By addressing less intensive, but nonetheless crucial healthcare services that don’t require “top of the line” medical care, especially in low-resource areas, CHWs serve those in need and free up the few doctors and nurses available to focus on care requiring their specific expertise.

In the long term, CHWs can have a tremendous impact well beyond this current outbreak. The healthcare system was already stretched thin before COVID-19, and underserved communities regularly fall through the cracks. Between the nationwide primary care provider shortage and continuously rising healthcare costs, many people cannot access healthcare until it’s an emergency. Community-based efforts to prevent disease and improve health can go a long way towards keeping people out of hospitals—where care is astronomically expensive. 

What will it take to train a corps of CHWs?

Training enough CHWs to serve the nation’s needs will be no small task—one task force recommends adding up to 500,000 CHWs to the current tally of 56,000. To put the challenge in context, coding bootcamps’ breathlessly rapid expansion to meet workforce demand has produced 150,000 graduates in the seven years since they’ve been in existence.  

To help expedite CHW training in the short term, federal and state governments should direct waves of funding to existing health departments and CHW training programs, such as Community Health Academy, to both ramp up their efforts and cover the salaries of the growing CHW workforce pulled from the ranks of the recently unemployed.

Looking ahead, there is an opportunity to simultaneously establish a more durable CHW training pipeline. To create seamless learning pathways for prospective CHWs, the federal government could appoint a national third-party credentialer that defines what skills learners must master, regardless of where they learn. Leveraging best practices from current state efforts, this entity would also be in charge of assessing prospective CHWs and certifying their progress.

With this infrastructure in place, CHW training providers can proliferate across the country with a clear understanding of the skills their learners will need to master, and how their learners must demonstrate that mastery. The coding bootcamp business model may offer valuable lessons in terms of rapidly creating and iterating upon courses, as well as partnering with employers to reskill furloughed workers. Federal and state governments could fund providers through an outcomes-based payment model to ensure that only programs with strong outcomes—according to the third-party credentialer—receive taxpayer dollars.

As the COVID-19 outbreak plateaus in some regions and peaks in others, government leaders have finally been able to start pivoting into a more forward-looking mode. May they proactively seize this opportunity to bolster the nation’s healthcare system, both now and in the future, and support millions of Americans experiencing job insecurity. We can no longer afford anything less.

Jessica is a research associate at the Clayton Christensen Institute for Disruptive Innovation, where she focuses on business model innovation in healthcare, including new approaches to population health management and person-centered care delivery.

As a research fellow on the Christensen Institute's higher education team, Richard helps investigate novel business models in postsecondary education, professional development, and lifelong learning.