Community health workers (CHWs) are frontline public health workers who are trusted and have a clear understanding of the communities they serve. They have proven effective in community interventions ranging from health education to clinical care extension to community-based research, with numerous trials demonstrating their cost-effectiveness. 

Despite this, CHWs remain underutilized—even as the costs for poor health outcomes continue to rise.

Milken Institute Public Health conducted focus groups with 17 CHWs in two comparable cities: Philadelphia and Baltimore. Combined, these participants represent nearly 40 years of field experience. Six main themes emerged, each containing four subthemes that further refined the issues identified. The CHWs’ feedback also included recommendations to address the challenges they face. Participants emphasized that any interventions developed must be innovative and responsive to the broad array of needs they are tasked to meet. 

CHWs and the populations they serve will continue to face significant challenges. Without additional support, the systems that deploy CHWs will become overburdened, leading to a decline in their numbers—at a time when projections confirm a sustained increase in demand. 

We simply must do better.