Structural supports and challenges for community health worker models: Lessons from the COVID-19 response in Orange County, California

This is the authors' abstract. We don't add key points for this paper.

Public health relied on community health workers (CHWs) during the COVID-19 pandemic to connect with the most vulnerable communities, which saved lives and addressed inequities. Understanding the structural factors that supported and hindered the success of CHWs is essential for building a stronger public health infrastructure in the future. We analyzed semi-structured, in-depth interviews with 15 institutional representatives and policymakers who engaged in COVID-19 response involving CHWs in Orange County, California. Findings indicated that while participants realized during the COVID-19 pandemic how essential CHWs were in addressing health and social inequities, CHWs were often undervalued by systems that were not established to support them. Participants highlighted needs for government and healthcare systems to equally partner with CHWs, reimburse CHWs for their work, decrease administrative barriers, and fund CHW-hiring organizations sustainably. We discuss recommendations for supporting CHWs through systems changes. • Community health workers (CHWs) address social and structural drivers of health • Interviews revealed structural supports and barriers for CHW models during COVID-19 • CHWs were instrumental but often undervalued by healthcare and government systems • Effectiveness depended on CHW’s relational capital with public health institutions • Equitable pay and sustained, less restricted funds are needed to support CHW models