Community health workers: assessing capacity for health workforce innovation through a global lens

Abstract Background Community health workers (CHWs) are increasingly recognised but evidence of their benefits is mostly limited to low- and middle-income countries in the global South. Very little information is available for Europe. This study aims to identify the transformative capacities and new solutions of a global model for European health systems. Methods A qualitative comparative methodology served to conduct an assessment of CHWs. We developed a contrasting research design, comprising Brazil and South Africa as two pioneering countries in the global South, and Denmark, Germany, Netherlands, Portugal, Romania, and United Kingdom/England as selected European cases. The analysis draws on expert information and secondary sources. Results Our study reveals high variety in the organisation and governance of CHWs. Agreed standards are lacking and occupational categories vary, including CHW-related groups. Experiences from the Global South do not seem to inform the policy debate, yet the European models, although mostly in pilot phase, highlight important similarities: community health workers and related occupational groups are expected to build bridges between health and social services, to identify and respond to the needs of the population in their living context, improve community care and primary care, and serve vulnerable populations thus contributing to equity. Differences exist in the educational standards, formal integration in primary care and gate-keeping role, and work conditions. Conclusions Strengthening the role of CWS and related groups may support health system transformations towards stronger primary care, implementation of the SDGs, and more effective use of the health and care workforce. Policy dialogue and knowledge exchange globally could greatly contribute to use these capacities more effectively. Key messages • Community health workers include diverse models, but similar capacities to transform health systems to respond to population needs and the workforce crisis. • Community health workers must become more visible and knowledge exchange with countries in the Global South improved to identify policy capacities for Europe.