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CHW Model for Population Health Carolina Nkouaga University of New Mexico Health Sciences Center WHO IS A “CHW”? “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 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.” THE MANY NAMES… Shasthyo Sebika Village Health Workers Agente Comunitario de Salud Lady Heath Workers Saksham Sahaya Community Health Agents Agente comunitário de saúde Visitadora Women Group Leaders Maternal Health Worker Community Nutrition Worker Anganwadi Workers Maternal & Child Health Promotion Workers Community-based Workers Female Community Health Volunteer Village Malaria Worker Maternal Child Health Workers Voluntary Malaria Workers Promotoras de Salud Nutrition Volunteers Raedat Accompagnateurs Community Health Volunteer Behvarz Village Health Guide Nutrition Worker Colaborador Voluntario Community Drug Distributor Village Health Helper Posyandu Mother Coordinator Village Drug-Kit Manager Lay Health Worker Community Reproductive Health Worker Lay Health Visitor Mental Health Workers Postnatal Support Worker Community Volunteer Community Health Advocates Community Health Aide Village Health Promoters Rural Health Worker Brigadistas Community-based Skilled Birth Attendant Dai Bidan Kampong Skilled Birth Attendants Traditional Midwives Dayas Community Volunteers Facilitator Female Peer Facilitator Change Agents Doot Peer Educators Lay Counselor Volunteer Counselor Volunteer Peer Counselor Peer Support Worker HOW MANY ARE THERE? Only rough estimates can be made… • Worldwide: Unknown • United States: ~ 120,000 (about two-thirds paid) • New Mexico: ~ 575 SCOPE OF PRACTICE CHW QUALITIES TENSIONS/BARRIERS IN CHW MODEL Community member Lay person Health care system member Credentialed/Professional On the job, tailored training Standardized training Broad, encompassing roles Tailored, specific roles Independent Direct out-of-pocket payment Volunteer Integrated, interdependent Services reimburseable Paid % Population % Population % of Cost LEVEL III: INTENSIVE INTERVENTION CARE COORDINATION % Population % of Cost LEVEL II: INDIVIDUAL / FAMILY SUPPORT AND EDUCATION LEVEL III: INTENSIVE INTERVENTION CLINICALLY INTEGRATED CARE PATIENT SUPPORT COORDINATION % Population % of Cost LEVEL I: POPULATION FOCUS LEVEL II: INDIVIDUAL / FAMILY SUPPORT AND EDUCATION COMMUNITY HEALTH LEVEL III: INTENSIVE INTERVENTION CLINICALLY INTEGRATED CARE PATIENT SUPPORT COORDINATION % Population % of Cost Engage Break Bread Community cooking classes, in Spanish, with guest chefs, child care and diabetes education Built Environment – Wellness Center – Walking trails Build Community • Community farm • Jobs
