Importance of Sustainability Planning for Rural Community Health Worker Programs
Identifying strategies to sustain a community health worker (CHW) program from the onset of program planning may
be critical to ensuring that services and operations can continue over the long term. One of the most
common challenges for CHW programs is achieving financial sustainability. Program planners can create a
sustainability plan to document potential actions and strategies for sustainable financing. Sustainability plans
can include information such as:
- Sources for financial support, such as reimbursement from health insurers and grant funds
- Resources from community partners
- Anticipated changes in program size or scope to reflect available resources
- Potential challenges and solutions to continuing services and operations
- Approximate timeline for sustainability activities
To meet the particular needs of each community, CHW program planners may consider working with local partners to
identify community resources that could sustain a program in the long term. A CHW program's sustainability plan
may also include strategies for following or staying up-to-date with evidence-based or promising practices,
identifying clear operational systems and models, engaging a quality workforce, and integrating multisector
teams and systems.
Demonstrating the value of a CHW program can be essential to securing initial funding and creating the business
case for continued financial support. Program planners may need to estimate inputs and outcomes of CHW programs,
including projected caseloads, salaries, and health outcomes. For example, a Connecticut Health
Foundation report demonstrates the business case for four sustainable financing models for CHW services
in Connecticut, with detailed examples of key inputs and outcomes. Families USA also offers an Impact
Estimator Tool for CHWs who focus on asthma and diabetes.
Building a business case often goes hand-in-hand with selecting evaluation measures to demonstrate success. CHW
programs with an evaluation component are often better able to convey the impact of their programs. For more
information on evaluating CHW programs, see Module
Rural communities may also need to consider how credentialing — a process of documenting and evaluating a
CHW's qualifications — will affect sustainability. 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 4.
For additional information about planning for sustainability, see How to Plan for Sustainability and Why Sustainability Plans Are Needed in the Rural Community
Resources to Learn More
a Path to Advance Community Health Worker Workforce in New York State: A New Summary Report and
Provides research-based recommendations on CHW roles, training/certification, and financing.
Author(s): Matos, S., Findley, S., Hicks, A. et al.
Organization(s): The New York State Community Health Worker Initiative
the Gap: Applying Global Lessons Toward Sustainable Community Health Models in the U.S.
Highlights key principles for developing sustainable and effective CHW programs. Discusses the risks of hiring
non-clinical workers and considers the persistent challenges and emerging opportunities regarding financial
sustainability of CHW programs. Offers guidance when planning and implementing CHW programs that link clinical
care systems with communities.
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
I Am Who I Serve
— Community Health Workers in Family Planning Programs
Discusses the benefits and challenges of the role of CHWs in family planning programs across the nation.
Author(s): Gold, R.B.
Citation: Guttmacher Policy Review, 13(3)
Sustainability Planning Guide for Healthy Communities
Synthesizes science- and practice-based evidence to help coalitions, public health professionals, and community
stakeholders develop, implement, and evaluate a sustainability plan. Provides a process for sustaining coalition
efforts and approaches. Includes a variety of modules demonstrating the benefits, challenges, and the
evidence-base for sustainability planning.
Authors: Batan, M., Butterfoss, F.D., Jaffe, A., & LaPier, T.
Organization(s): Centers for Disease Control and Prevention
Sustainability of Promotora Initiatives: Program
Analyzes the results of a survey of 22 promotora programs focused on Hispanic women's health in ten
states. Discusses program components, logistics, and barriers encountered by CHW program planners. Addresses the
implications for community health planning, management, and policy, including the development of sustainable
strategies during program planning stages, that may effectively integrate promotoras into existing healthcare
Author(s): Koskan, A., Friedman, D.B., Hilfinger Messias, D.K., , et al.
Citation: Journal of Public Health Management Practice, 19(5), E1-E9
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., et al.
Citation: American Journal of Public Health, 101(12), e1-e5
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
Author(s): Mason, T., Wilkinson, G., Nannini, A., et al.
Citation: American Journal of Public Health, 101(12), 2211-2216