Module 5: Planning for Sustainability

Three critical issues are linked to the sustainability of community health worker (CHW) programs:

  • Evaluation
  • Financing
  • Credentialing

Evaluation
CHW programs with an evaluation component are better able to convey the impact of their programs. Rigorous program evaluations may enable the program to demonstrate the return on investment (ROI) for utilizing CHWs. Programs could use ROI information to demonstrate program effectiveness to community partners, some of which may be willing to invest resources in program sustainability. To date, few rural CHW programs have had resources to calculate ROI. Additional information on evaluation is available in Module 6.

Financing
CHW programs should identify financial models for sustaining activities post-funding. Most CHW programs receive support through federal or state grants and foundations. Another potential financial model is third-party reimbursement for CHW services. Several rural communities have explored third-party reimbursement for CHW’s health education services through Medicaid. Some states have expressed concern third party reimbursement would necessitate rigorous credentialing of CHWs.

Credentialing
Credentialing is a controversial topic as opponents suggest widespread credentialing would limit the scope of CHW activities and reduce flexibility in responding to a community’s needs.

Impact of health care reform
Health reform legislation may offer new opportunities for sustaining CHW programs. The Patient Protection and Affordable Care Act (ACA) recognizes CHWs as members of the health care work force and allows Congress to establish a federal grant program to support use of CHWs in medically underserved areas. Further, the ACA supports a number of models for the coordination of care that could benefit from peer supporters such as community health workers.

In this module: