Ensuring good health and the well-being of all has been recognized as one of the 17 major sustainability goals of the United Nations.
However, access to healthcare remains extremely difficult for many. The UN General Assembly has reported that more than half of the world’s population still does not have access to essential health services. It’s a stark statistic that affects even the so-called “developed nations”, as the National Association of Community Health Centers has reported that more than 100 million people in the U.S. — nearly a third of the population — lack access to primary care.
This lack of access is especially devastating to underserved and disadvantaged communities, which can face greater challenges in accessing care or social needs such as food, housing and transportation. It is in these areas that community health workers are essential frontline agents, working to reduce health disparities and provide essential basic care.
If you’re interested in helping communities receive the health services they deserve, then you could become a community health worker (CHW). In the U.S. CHWs are more akin to health educators, working to make communities aware of preventative measures for health. However, in many low and middle-income countries, CHWs are very important in monitoring health, assisting doctors and nurses, and following up on community members who have health issues.
As CHWs are not as common in the U.S. as other healthcare professions — such as nursing or emergency medical technicians — there is a lack of national standardization for the certification of community health workers. This can make it difficult to understand the different responsibilities that CHWs have and who hires them.
This post will explain more about the CHW position, how community health worker certification varies by state, who hires community health workers and the education programs and important steps for anyone who is considering becoming a CHW.
What Is Community Health?
Community health is a multidisciplinary field that focuses on the health and well-being of individuals within a specific geographic area or community. It encompasses various aspects of public health, medicine, disease prevention, health education, social work and community organization to address the health needs of populations. Unlike individual healthcare — which focuses more on diagnosing and treating the needs of a specific person — community health aims to create environments that support healthy lifestyles and reduce health disparities.
Community health workers play an essential role in the promotion of community health, acting as liaisons between healthcare providers and the community, offering culturally appropriate health education, advocating for patients and connecting individuals with necessary services.
What Does a Community Health Worker Do?
Community health workers (CHWs) are public health workers and trusted members of the communities they serve. They work as community advocates and intermediaries between community members and private healthcare systems or public health departments. CHWs are also known as community health advisors, lay health advocates, promotores de la salud, community health representatives, peer support specialists, and peer health promoters.
CHWs are better able to serve their communities because they understand the population, as they are highly likely to share much in common with members of their community, whether it’s ethnicity, culture, language, socioeconomic status or life experiences. A U.S survey from the National Association of Community Health Workers had 31.7% of community health workers self-identify as Black/African American, 37.7% identify as Hispanic and 11.1% identify as multiracial or other. This is in contrast to demographic reports of U.S. physicians (5.8% Hispanic, 5.0% Black/African American, 1.0% mixed race) and nurses (6.9% Hispanic, 6.3% Black or African American, 2.5% mixed race).
According to the U.S. Bureau of Labor Statistics (BLS), common responsibilities of community health workers include:
- Coordinating care and conducting outreach for individuals and the larger community
- Providing culturally appropriate health and informational resources
- Overseeing case management and resource access
- Advocating for individuals and communities regarding housing, food security, and other needs
- Providing coaching, social support and services such as basic health screenings and first aid
- Increasing participation in health assessments and education
Studies have demonstrated that CHWs can help to reduce costs and improve patient care due to their ability to help people better understand and access health and social service systems, thereby reducing the need for emergency and specialty services. When included as part of a healthcare system, CHWs can assist clinical practices in meeting quality standards, decreasing costs and alleviating the rates of service utilization.
How CHWs differ from other medical professionals
Though they’re considered valued members of the healthcare community, community health workers do not have the same formal training or certification requirements as other health professionals, such as formally trained nurses, medical assistants, physicians or emergency medical technicians (EMTs).
While CHWs are not required to have a college or an advanced degree, they do undergo training that may last anywhere from a few weeks to several months. There are no national standards for CHW training, and certification requirements will vary state-by-state.
CHWs do not usually deliver medical care; instead they focus on helping people to navigate the healthcare system, access services, manage chronic diseases and adhere to treatment plans. Specific community health worker duties will depend on the community they serve and can include:
- Performing regular home visits and administering first aid in an emergency
- Organizing community events, health screenings and workshops to promote health and wellness
- Educating communities about healthy behaviors, disease prevention and available services
Who Hires Community Health Workers?
Community health workers are typically hired by a variety of organizations, depending on the specific needs and goals of the community they serve. CHWs can find employment with:
- Government health departments — including state, local or national health departments to work on public health initiatives
- Non-profit organizations — for the promotion of health and wellness services to communities
- Hospitals and health systems — to assist with patient care coordination and outreach
- Community clinics and health centers — as part of chronic disease management, health promotion or other educational programs
- Educational institutions — in support of student health services and public health projects
- Insurance companies — to help manage care and improve outcomes for members
Other agencies and health systems that hire CHWs include federally qualified health centers (FQHC), rural health centers, local public health agencies and safety net clinics or hospitals.
According to the BLS, the median annual wage for community health workers is $48,200. The employment of CHWs is also projected to grow 14% from 2022 to 2032, which is much faster than the average for all occupations.
How Do I Get Certified As a Community Health Worker?
While there is no national standard for community health worker education, training or certification, it’s important for CHWs to pursue certification where available. Not only are certified CHWs more likely to be hired, but some states may require a CHW certification and others may require certification for CHWs to be reimbursed for services or to operate in certain settings. Medicaid programs and private health insurers are also more likely to approve payments for services provided by certified CHWs.
Every state’s certification standards are different. While credentialing and certification programs are often implemented by a department of health or department of public health, many states have private or nonprofit organizations that play a key role in training and certifying CHWs.
The states that have certification programs will have their own list of core competencies, required number of course hours, required number of field hours, specified training courses and application requirements (including fees). Bear in mind that some required training courses or exams may carry additional costs.
The following 12 states operate their own certification programs. Click the links for the details and full requirements of each state’s community health worker certificate program.
- Arizona certification requirements include:
- A total of 960 hours of paid or volunteer CHW experience in core competencies; or
- Completion of a CHW certificate program provided by an accredited college and 480 hours of paid or volunteer CHW experience; or
- Completion of a CHW training program provided by an organization or certified CHW trainer
- A $100 application fee, plus a $200 initial certification fee
- Connecticut certification requirements include:
- Training and education by an organization approved by the Community Health Worker Advisory Body;
- A minimum of 1,000 hours of experience working as a community health worker during the three years prior to the date of such application; or
- A minimum of 2,000 hours of paid or unpaid experience as a community health worker
- A $100 application fee
- Colorado certification requirements include:
- Participation in a CDPHE-recognized Community Health Worker training program
- Passing the CHW core competency assessment
- Kentucky certification requirements include:
- Achievement of core competencies as outlined in the Kentucky Community Health Worker Certification Manual
- Completion of mental health first Aid training
- A $50 application fee
- Massachusetts certification requirements include:
- 4,000 hours of work experience; or
- 2,000 hours of work experience and a certification from a board approved training program
- A $35 application fee
- Maryland certification requirements include:
- The completion of an accredited CHW certification training program
- The program must have a minimum of 100 hours of instruction, which employ a curriculum framework based on the Maryland nine CHW core competencies
- An additional 40-hour supervised practicum
- Missouri certification requirements include:
- Completion of DHSS approved CHW Standard Training Program
- A $75 application fee
- New Mexico certification requirements include:
- Completion of a core competency training program (minimum of 100 hours); or
- Successful completion of Indian Health Service (IHS) Community Health Representatives (CHR) Basics Training; and
- 40 hours of experiential learning placement
- Ohio certification requirements include:
- Completion of an approved training program
- An online application to the Ohio Board of Nursing
- A $35 non-refundable application and eLicense System Transaction Fee
- Oregon certification requirements include:
- Completion of an approved training program; or
- Documentation of having worked or volunteered as a traditional health worker for at least 3,000 hours in Oregon from January 1, 2004 to June 30, 2019; or
- Completion of the THW Oral Health for Community Health Worker Training Program
- Texas certification requirements include:
- Demonstrated skills in eight core competencies
- Completion of an approved DSHS-certified 160-hour competency-based CHW training program; or
- At least 1000 cumulative hours of community health worker services within the most recent three (3) years
- Utah certification requirements include:
- Completion of the Utah Core Skills Training program
- 300 hours of work experience serving communities
- A $50 application fee
The following six states have state certification programs that are under development: California, North Dakota, Illinois, Tennessee and Mississippi.
There are also 11 states with certification programs privately run by independent credentialing boards:
- Arkansas certification requirements include:
- Completion of an approved CHW Core Competency training
- Documentation of at least two years of experience (equivalent to 4,160 hours)
- Florida certification requirements include:
- 30 hours of content-specific training; or
- 500 hours of work and/or volunteer experience
- Successful completion of Certified Community Health Worker Exam
- A $50 application fee
- Indiana certification requirements include:
- Completion of a CHW Training course offered by an Indiana Community Health Workers Association-recognized certified CHW training organization
- Kansas certification requirements include:
- Completion of the Kansas Department of Health and Environment-approved CHW training program through the Kansas CHW Coalition or certified Kansas CHW education provider; or
- Completion of 800 work experience hours over three years, plus three letters of recommendation
- Nevada certification requirements include:
- Completion of Nevada Certification Board-Approved Foundational Training (“CHW 101”)
- A $75 application fee
- North Carolina certification requirements include:
- Completion of Standardized Core Competency Training coursework with an 80% or higher; or
- At least 2,000 hours of experience that demonstrates nine competencies
- Experience and knowledge of at least one population group
- A $50 application fee
- Pennsylvania certification requirements include:
- 75 total hours of education from a Pennsylvania Certification Board-accredited CHW training program within the last five years
- One year of full-time volunteer or paid employment as a CHW; or
- 2,000 hours of part-time or volunteer or paid employment as a CHW
- 60 hours of on-the-job supervision of qualifying work experience
- A $50 application fee
- Rhode Island certification requirements include:
- Six months of full-time experience; or 1,000 hours of part-time or volunteer work as a CHW
- 50 hours of on-the-job supervision of qualifying work experience
- 70 total hours of relevant education/training
- A $125 application fee
- South Carolina certification requirements include:
- Successful completion of a South Carolina CHW (SCCHW) Credentialing Council-approved Core Competency Training including 80 hours in the classroom and 80 hours of practicum
- Passing the SCCHW Core Competency Examination
- A $700 application fee
- South Dakota certification requirements include:
- A minimum of 200 hours of training and 40 hours of shadowing from an approved training program
- A professional reference
- A $50 application fee
- Virginia certification requirements include:
- One year of full-time or 2,000 hours of part-time volunteer or paid employment within the last three years of the application date
- 50 hours of supervision of qualifying work experience
- 60 total hours of education/training specific to all seven of the specified CHW domains
- A $100 certification fee
Some states, such as Louisiana and Wisconsin, do not have established certification programs and instead have invested in developing robust training programs intended to build core competencies. The states that are not listed do not currently offer certification, though they may offer CHW training and education programs.
States with the best CHW programs
Every state, even those without official community health worker certification, has its own set of CHW training programs. We recommend that you visit the National Association of Community Health Workers to review its comprehensive list of CHS certification and training programs to find the state program that best fits your needs.
Steps to Become a Community Health Worker?
If you’re interested in better serving the health needs of your community, you could find fulfilling work as a community health worker. Here are the recommended steps to start your career.
- Conduct some initial research — As established, the role, responsibilities, and job requirements of a CHW will vary greatly between locations. Start your research by looking up CHW networks and associations specific to your area. Consider joining your local state organization or larger professional organizations such as the National Association of Community Health Workers or the American Public Health Association.
- Consider state certification — Even if your state doesn’t require CHW certification, it can be a powerful asset to help advance your career. Look for accredited community health worker training programs offered by community colleges, universities or public health organizations. If you decide to become certified, make sure to understand all of the education and training requirements.
- Gain field experience — Nearly all CHW certifications require a specific amount of work experience. Look for volunteer opportunities that can provide you with valuable experience and expand your personal and professional network for future reference.
- Enroll in relevant education programs — Aside from the relevant certification programs, some employers may prefer CHW professionals with postsecondary education in health-related fields such as public health or social work. To ensure your work has long-lasting benefits and is comprehensive, you might consider furthering your knowledge and skills with a transdisciplinary degree. Such a degree would frame how community health relates to the underlying social, political, environmental, economic and engineered environment context.
The University of San Diego’s Master of Science in Engineering, Sustainability, and Health (MESH) Degree offers this framing. MESH is centered around transdisciplinary learning to understand the challenges of facing our natural and built environments and how they affect our most vulnerable populations, and making connections with other professions that can help you build upon your career to tackle these problems sustainably and considering just transitions to such solutions.