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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 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 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 Health Toolkit.

Resources to Learn More

Paving a Path to Advance Community Health Worker Workforce in New York State: A New Summary Report and Recommendations
Document
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
Date: 10/2011

Building a Sustainable Community Health Worker Workforce in Massachusetts
Presentation Slides
Defines CHWs and their roles within the healthcare system. Identifies legislative activity in Massachusetts supporting their certification and training and presents information on the governing boards, core competencies, and sustainability issues that support the development of CHW programs.
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.
Document
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
Date: 12/2016

I Am Who I Serve — Community Health Workers in Family Planning Programs
Document
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)
Date: 2010

A Sustainability Planning Guide for Healthy Communities
Document
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 Planners' Perspectives
Document
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 systems.
Author(s): Koskan, A., Friedman, D.B., Hilfinger Messias, D.K., , et al.
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?
Document
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
Date: 12/2011

Winning Policy Changes to Promote Community Health Workers: Lessons from Massachusetts in the Health Reform Era
Document
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., et al.
Citation: American Journal of Public Health, 101(12), 2211-2216
Date: 12/2011