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Rural Health Information Hub

Importance of Sustainability Planning for Rural Community Health Worker Programs

Identifying strategies to sustain a community health worker (CHW) program at the start of program planning is important for ensuring that services and operations can continue over the long term. Financial sustainability is one of the most common challenges for CHW programs. To mitigate this challenge, program planners can develop a sustainability plan to outline and document potential actions and strategies for sustainable financing.

Sustainability plans may include information on:

  • Financial sources
    • Sources of financial support, such as reimbursement from health insurers and grant funds
    • Efforts to secure long-term funding
  • Program partnerships
    • Partnerships with community organizations and healthcare providers
    • Resources provided by community partners
    • Plans for CHW integration into existing healthcare systems
  • CHW workforce development
    • Trainings and certification opportunities for CHWs to build the skills necessary for program implementation and career development
    • Mentorship opportunities for CHWs
  • Program trajectory
    • Anticipated changes in program size or scope based on available resources
    • Potential challenges and solutions for continuing and maintaining services and operations
    • Approximate timeline for sustainability activities

To meet the needs of their given community, CHW program planners may consider working with local partners to identify existing community resources that could sustain a program in the long term. A CHW program's sustainability plan may also include methods of monitoring progress toward sustainability goals, strategies for staying up to date with evidence-based or promising practices, establishing 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. To do this, program planners may need to estimate inputs and outcomes of CHW programs, including projected caseloads, salaries, health outcomes, and medical costs.

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 5.

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 addressing community needs. For an overview of CHW credentialing and certification, see State Certification Programs in Module 4: Legal Considerations for Community Health Worker Programs.

For additional information about planning for sustainability, see Planning for Sustainability of Your Community Health Program in the Rural Community Health Toolkit.