The case for community health workers in high-income countries

Health systems in high-income countries (HICs) face multiple complex challenges, including ageing populations, multimorbidity, workforce shortages, and increasing health-care costs. Some of these challenges can be addressed by community health worker (CHW) programmes that extend first-contact access, bridge gaps in the social determinants of health, and reinforce continuity of care in the community. Although the recognition of CHWs is growing across HICs, their role remains fragmented, inconsistently financed, and often limited to pilot initiatives or marginalised populations. In this Viewpoint, we highlight the need for integrated CHW programmes in HICs that could collaboratively work with interprofessional primary care teams and communities to provide holistic, person-centred primary health care. We propose embedding CHW programmes within the existing health systems and provide a range of potential community-based services for the population. To optimise the contribution of CHW programmes to health-care systems, contextualised system-wide investments and reforms are needed, including strong political commitment, reliable funding, clear role descriptions, and accountability mechanisms. Although lessons can be taken from programmes in low-income and middle-income countries, repositioning CHW programmes as an integral part of primary care teams in HICs should be grounded in the experiences and insights gained from existing small-scale CHW programmes in these countries. A shift towards community-centred primary health care is essential if health systems in HICs are to respond to social and structural inequities in accessing health care, improving health outcomes, and achieving the UN Sustainable Development Goals.