1191: Community Health Workers: Building a Sustainable Workforce

JOHN SHEEHAN:  00:01

This is Public Health Review Morning Edition for Monday, August 24, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

 

It's National Community Health Workers Week. Community health workers, or CHWs, help bridge the gap between the healthcare system and the everyday realities of the people it serves. They connect patients to care and community resources, support chronic disease management, and help people navigate barriers such as transportation, provider shortages, and limited broadband access. On today's episode, ASTHO Assistant Director of Access to Care, Ashley Cram, explains how states are supporting this essential workforce through training, supervision, career pathways, and sustainable funding-the focus of a recent health policy update. Ashley Cram, welcome back to the show.

 

ASHLEY CRAM: 

Thanks for having me.

 

SHEEHAN: 

So, Ashley, who are community health workers, and what do they do?

 

CRAM: 

Community health workers, or CHWs, are trusted members of the communities they serve who help individuals with their health and related needs. They often share lived experiences, backgrounds, or community connections with the people they're supporting, which helps build trust in ways that the healthcare system may struggle to do. One of the biggest gaps they often fill is the space between healthcare and everyday life. So someone might receive a clinical diagnosis or a recommendation for care, but if they don't have the transportation or don't know how to navigate the health system, the CHW is there to help them navigate that, face those challenges, connect to resources, and stay engaged to care. So, at the end of the day, they're really helping make healthcare more understandable and they're responsive to people's day to day needs.

 

SHEEHAN: 

So what kinds of supports are necessary for the CHWs? Is it training? Is it supervision?

 

CRAM:

I would say kind of all the above. CHWs have demonstrated their value across a wide range of settings, but many still face challenges around workforce stability. So one area is sustainable funding. Many CHWs are supported through short-term grants, which can create uncertainty for the workers and the communities they serve. Training, like you said, is also important, particularly for ongoing professional development. As healthcare evolves, CHWs need opportunities to build new skills while maintaining a community-centered approach that makes their work effective. Also, clear career pathways is a way to support the workforce. So, creating leadership roles or supervisory positions and advancement opportunities can help retain those experienced workers, and with those supervisory positions, those can help CHWs as they support people as they navigate those challenges and those life experiences. The mentorship and support and professional growth opportunities support both the CHW themselves and the communities that they serve.

 

SHEEHAN: 

And what is CHW certification?

 

CRAM: 

CHW certification is a process that states can use to formally recognize individuals who meet certain standards related to training, experience, and core competencies. So, states choose certification for different reasons. Some see it as a way to strengthen workforce recognition, create consistency, and support reimbursement opportunities through programs like Medicaid. Though I do want to note that some states have Medicaid reimbursement and do not have certification, so that is not necessarily a requirement. At the same time, some states are cautious about certification and have chosen not to establish it. I think one of the strengths of the CHW workforce is that it's rooted in community trust and lived experience. So if those certification requirements became too burdensome, there's concern that that could unintentionally create barriers for people who are well positioned to serve. So, in the end, CHW certification is really something that states can have a discussion with the CHWs that they work with and determine whether that's an appropriate step.

 

SHEEHAN: 

I see. It strikes me that CHWs are probably really useful, important, impactful in rural communities. Is that right?

 

CRAM:

Definitely, absolutely. Rural residents in particular face long travel distances and provider shortages, maybe limited broadband access, or enhanced difficulty kind of navigating those available services just given the geographic distance that they are in, so because CHWs are embedded in their communities, they can again help people connect to care, support things like chronic disease management, provide health education. We're seeing a growing recognition of CHWs in rural health initiatives. So many states are incorporating CHWs in their rural health transformation program plans, in their Medicaid programs, and other public health initiatives, so both at the federal and the state level, looking at investments in workforce development that can support CHWs.

 

SHEEHAN: 

And you mentioned at the top that you know sustainable funding is one of the constant challenges. Are there plans in place to help the CHW network that way?

 

CRAM:

Financial sustainability is a huge part of sustaining the workforce. So, we're seeing a number of states establish Medicaid reimbursement pathways, and we know that there is a return on investment for CHW programs that result in cost savings. So, another strategy for long-term sustainability is for CHW programs and health systems to evaluate the impact of the CHWs to understand what impact they have on patient engagement, on chronic disease management, and potentially reduce utilization of healthcare services because of those enhanced health outcomes. So I think this could support a long-term kind of business case for investment in the workforce. And I would say sustainability really requires a lot of collaboration. So looking at healthcare organizations, looking at public health agencies, and community-based organizations-they all benefit from robust CHW programs and shared investment, so that they can ensure the workforce remains strong, supported, and available to support the communities they are in.

 

JSHEEHAN:

Ashley Cram, thanks so much.

 

CRAM: 

Thanks for having me.

 

SHEEHAN: 

 Ashley Cram is assistant director for Access to Care at ASTHO.

 

Approximately half of U.S. jurisdictions have or are developing a certification program for community health workers. Certification can be employed as a tool to define a clear scope of practice and competencies within the CHW workforce, create a more simplified path to recruitment, and create a shared vision for integrating CHWs into healthcare teams. A certification program may also chart a path to a more defined and stable career ladder for CHWs. At its core, certification is a declaration by an issuing authority that a CHW has met a standard set of qualifications such as skills, education, work or volunteer experience, or training. Each jurisdiction that has developed a CHW certification program, however, has taken its own approach to setting requirements for certification and determining how to administer the program. Learn more at the link in the show notes.

 

In a new American Journal of Public Health article, ASTHO Chief Medical Officer Susan Kansagra explores how public health systems can better align resources with health goals, and strengthen the infrastructure needed to meet evolving community needs. She highlights opportunities to share shared services, scale effective approaches across jurisdictions, invest in the right mix of health priorities, and build flexible infrastructure that can support a range of public health needs. Access the article through the link in the show notes. This has been Public Health Review Morning Edition.

 

I'm John Sheehan for the Association of State and Territorial Health Officials.