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How to Plan for Sustainability

Sustainability ensures that a community health worker (CHW) program is structured and financed to provide services over time. A sustainability plan must meet the particular needs of a community, with each community having different requirements. Working with local partners, a sustainability plan should take into account the three critical sustainability issues of:

  • Evaluation: CHW programs with an evaluation component are better able to convey the impact of their programs. Information on evaluation is available in Module 6.
  • Financing: CHW programs that are grant-funded should identify financial models to ensure they can continue activities after funding ends. Demonstrating the value of the CHW program is often key to financing.
  • Credentialing: Credentialing refers to a process of documenting and evaluating a CHW's qualifications. Proponents of credentialing suggest it may increase recognition of CHWs, but opponents suggest it may limit the scope of CHW activities and reduce flexibility in responding to a community's needs. For an overview of CHW credentialing and certification, see State Certification Programs in Module 3.

A CHW program's sustainability plan should also address the needs of the patient and community, follow evidence-based or promising strategies, identify clear operational systems and models, engage quality workforce, and integrate healthcare teams and systems.

For additional information, see How to Plan for Sustainability in the Rural Community Health Toolkit.

Resources to Learn More

Advancing Community Health Worker Practice and Utilization: The Focus on Financing
Explores sustainable financing mechanisms for community health workers with a focus on funding, reimbursement and payment policies.
Author(s): Dower, C., Knox, M., Lindler, V., & O'Neil, E.
Organization(s): National Fund for Medical Education, UCSF Center for the Health Professions
Date: 12/2006

Building a Sustainable Community Health Worker Workforce in Massachusetts
Presentation Slides
Presentation highlighting best practices for community health worker programs and how to establish their infrastructure.
Author(s): Hirsch, G.
Organization(s): Massachusetts Department of Public Health
Date: 10/2015

Closing the Gap: Applying Global Lessons Toward Sustainable Community Health Models in the U.S.
Identifies eight key principles for developing sustainable and effective Community Health Worker (CHW) programs. Discusses how CHW program leaders can document the business case for CHWs. Identifies current options for financing CHW programs.
Organization(s): Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, Office of the UN Special Envoy for Health in Agenda 2030 and for Malaria
Date: 12/2016

I Am Who I Serve—Community Health Workers in Family Planning Programs
Policy brief that discusses the benefits and challenges of CHW programs across the nation.
Author(s): Gold, R.B.
Citation: Guttmacher Policy Review, Summer 2010, Volume 13, Number 3
Date: 2010

A Sustainability Planning Guide for Healthy Communities
A synthesis of science- and practice-based evidence designed to help coalitions, public health professionals, and other community stakeholders develop, implement, and evaluate a sustainability plan. Provides a process for sustaining policy strategies and related activities, introduces various approaches to sustainability, and demonstrated sustainability planning in action with real-life examples.
Organization(s): Centers for Disease Control and Prevention

Sustainability of Promotora Initiatives: Program Planners’ Perspectives
Analysis of several different promotora programs and the barriers encountered to the programs’ sustainability. Addresses how promotora workers relate to their career and the implications posed by federal, state, and local policies.
Author(s): Koskan, A., Friedman, D.B., Hilfinger Messias, D.K., Brandt, H.M., & Walsemann, K.
Citation: Journal of Public Health Management Practice, 19(5):E1-E9
Date: 11/2013

Transforming the Delivery of Care in the Post–Health Reform Era: What Role Will Community Health Workers Play?
Examines opportunities to sustain the role of CHWs, focusing on accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).
Author(s): Martinez, J., Ro, M., Villa, N.W., Powell, W., & Knickman, J.R.
Citation: American Journal of Public Health, 101(12): e1-e5
Date: 12/2011

Winning Policy Changes to Promote Community Health Workers: Lessons from Massachusetts in the Health Reform Era
Describes the Massachusetts collaboration between CHW leaders of a statewide CHW association and their public health allies. To reach CHW workforce and public health objectives, collaborators focused on alliance building and organizing, legislative advocacy, and education in the context of opportunities afforded by healthcare reform.
Author(s): Mason, T., Wilkinson, G., Nannini, A., Martin, C., Fox, D., & Hirsch, G.
Citation: American Journal of Public Health, 101(12): 2211-2216
Date: 12/2011