Recruitment, Hiring, and Retention of Community Health Workers

Recruitment, hiring, and retention are key elements of successful rural community health worker (CHW) programs.

Recruitment

A program's scope and community needs will drive CHW recruitment strategies. Prior to recruitment, employment status of CHWs should be considered, including work schedule, duration of employment, payment (paid or unpaid), and benefits. Options that rural programs should consider include:

• Paid employee, via stipend, salary, or hourly wages
• Benefits, including retirement
• Volunteer, with or without stipend
• Full- or part-time employment
• Seasonal (especially for CHWs serving migrant communities) or year-round
• Positions tied to short-term grant funding

Programs should develop a job description that clearly conveys essential information regarding the CHW's requirements and responsibilities. A CHW job description should address: expectations, desired knowledge and skills, desired background or experiences (for example, veterans, individuals who have experience with specific health conditions, individuals who have been incarcerated), time commitments, required travel, compensation or benefits packages, and career development opportunities, if any. Rural programs can review sample job descriptions for ideas for how to convey the requirements and responsibilities of the role to potential candidates.

Multiple recruitment approaches can be implemented at the same time, including outreach through formal and informal networks, such as:

• Radio and television programming
• Websites and social media
• Newspapers
• Posters and fliers
• Churches and other community groups
• Community meetings or discussions with community members
• Recreational centers
• Local colleges and universities
• Schools (for example, parent-teacher organizations)
• Social events such as dances, fairs, and sporting events
• Worksites and local businesses
• CHW associations or groups
• Employment agencies
• Word of mouth
• Referrals from current or former CHWs
• Internal recruitment within the organization

Hiring

The CHW hiring process should follow several formal steps, including screening and interviewing. Depending on program needs, screening may involve application and resume review, background checks, and phone screening.

Interviewing provides an opportunity for the program to assess candidates' experiences, qualities, and skills. In addition to standard questions and discussions of position logistics, interview processes for CHWs may also integrate role playing exercises, activities to assess candidate problem-solving processes and skills, and other creative interviewing strategies. It is also important to assess the candidate's comfort with performing specific job duties, such as traveling to clients' homes or talking about sensitive subjects. Program staff who may participate in the interview process include members of the care delivery team (if applicable), other CHWs, program leadership, partners, members of the community to be served, and others.

After screening and interviewing is complete, hiring managers can compare the qualifications of candidates against the hiring criteria. Hiring managers can also request and incorporate recommendations from community members, prior employers, and others, when possible.

Retention

Key challenges affecting CHW retention include limited recognition, few opportunities for advancement, low wages, and high stress that can lead to overwhelm and burnout.

Program leadership and staff should anticipate common challenges and identify strategies to address them to support job satisfaction and retention. Strategies for addressing retention barriers include offering benefits and incentives to CHWs such as health insurance, retirement plans, paid leave, performance-based recognition and rewards, child care, competitive wages, professional development opportunities, gym memberships, and reimbursement for job-related expenses, such as transportation, or continuing education.

For additional information regarding staff recruitment and retention for rural programs, see Implementation Considerations in the Rural Community Health Toolkit.