Barriers to Establishing Community Health Worker Programs in Rural Areas

Rural communities can experience barriers that can make it difficult to support community health worker (CHW) programs. Some of the common barriers to supporting CHW programs are described below.

Limited evidence on the effectiveness of CHWs. CHWs have played a role in delivering services and addressing health issues in the United States for more than 70 years. However, research on the effectiveness of CHW programs is still somewhat limited and varies across different health conditions and diseases. The Community Prevention Services Task Force has found strong evidence for and recommends engaging CHWs in programs that address cancer screening, cardiovascular disease prevention, diabetes prevention, and diabetes management. Future research can help build the evidence of CHW programs for other types of health conditions.

Lack of shared understanding of CHWs' purpose and value. Within communities, organizations, and healthcare settings, there may be a lack of consensus regarding the roles, responsibilities, and value of CHWs. Factors contributing to this lack of consensus and understanding include the different titles CHWs may hold, differences in certification and training pathways, and the varied roles CHWs may fill within programs.

Lack of sustainable funding, low wages, and wage discrepancies. Many CHW programs are funded through grants or other short-term funding opportunities. This can negatively impact job security, salary, and turnover rates within the CHW workforce. According to the U.S. Bureau of Labor Statistics, the median annual wage for CHWs in 2024 was $51,030. Wage disparities also exist within the CHW workforce.

Lack of male representation. The CHW workforce is primarily composed of women. The predominance of women and lack of males in the CHW workforce contributes to challenges including wage disparities, risk of harassment, and reduced institutional support.

For more information on specific challenges rural communities may experience when establishing CHW programs, see Implementation Challenges for Community Health Worker Programs in Module 4.