Implementation Challenges for Community Health Worker Programs
Many of the implementation challenges faced by rural community health worker (CHW) programs are similar to the
challenges experienced by other rural health programs. For an overview of rural implementation issues, see Common
Implementation Challenges in the Rural Community Health Toolkit. Some of the unique challenges rural CHW
programs face include:
Lack of access to transportation: The populations that CHWs serve often have limited access
to transportation. Therefore, CHWs often travel to rural communities to provide services or conduct
outreach. When possible, CHWs should be reimbursed for travel costs.
Safety issues: Programs must ensure the safety of CHWs. CHWs may travel to remote areas
where roads may be unsafe or impassable due to inclement weather. CHWs also may encounter safety issues when
working in patients' homes. Programs may provide safety
training to CHWs, which can include strategies for maintaining awareness and personal safety and for
de-escalating unsafe situations. Other strategies to promote safety include daily reporting to supervisors,
sharing travel routes and anticipated return times for home visits, providing CHWs with emergency
information cards, storing sensitive client information in a locked file within a locked vehicle, and not
transporting cash or medications.
Lack of program resources: CHW programs emphasize the importance of providing resources
such as weather survival kits, wireless Internet access cards, and other technologies. However, if program
funds are limited, such resources may not be available.
Cultural barriers: Program implementers may need to adapt materials, such as information
packets, to ensure all program materials are culturally appropriate. For example, if patients are not
comfortable with computers, CHWs may use paper charts to collect information during a home visit.
Patient referral issues: Programs may encounter difficulties referring patients to
healthcare providers or mental health professionals, and coordinating services with outside providers and
agencies. Some programs have acknowledged challenges integrating CHWs into healthcare systems.
Partnership issues: Programs with limited partnerships may struggle to implement a program
with a broad scope. Agreements with partners in the community and identifying opportunities to work with new
organizations will help extend the reach of the CHW program.
Additional information on implementation considerations for different program models is available in Module 2.