Community health workers were found to be the unsung heroes of the healthcare system’s pandemic response, according to a study led by a team of public health researchers from the University of California, Irvine, and their community partners. Findings also show that current funding and reimbursement mechanisms remain inadequate to sustain their work.
Community health workers (CHW) are increasingly recognized for their ability to address health inequities by reducing the barriers to care between marginalized communities and public health institutions like hospitals and government agencies. Now in the years following the worst of the COVID-19 pandemic, healthcare administrators and public health agencies can’t ignore the urgency of incorporating CHWs into the healthcare system and the vital role they play in reaching the most vulnerable communities.
In a study published in the journal Social Science & Medicine – Qualitative Research in Health, corresponding author Brittany Morey, MPH, PhD, associate professor of health, society and behavior at the UC Irvine Joe C. Wen School of Population & Public Health, along with a team of community leaders and researchers, revealed the critical role CHWs played during the COVID-19 pandemic. This included the deep trust and relational ties they had within their communities and how these traits were central to their success.
“Without CHWs, vulnerable communities such as racial/ethnic minorities and those who spoke languages other than English were not being reached by healthcare and government institutions that did not have the same level of trust with communities that CHWs had,” said Morey. “They filled the gaps left by traditional public health institutions during an especially vulnerable and stressful time for the healthcare system.”
Without CHWs, vulnerable communities such as racial/ethnic minorities and those who spoke languages other than English were not being reached by healthcare and government institutions that did not have the same level of trust with communities that CHWs had.”
– Brittany Morey, MPH, PhD
As part of the Community Activation to Transform Local Systems (CATALYST) Project, researchers analyzed in-depth interviews with 15 institutional representatives and policymakers involved in COVID-19 response efforts in Orange County, California. The study underscores the lifesaving role of community health workers (CHWs), who acted as critical links between vulnerable, low-income, and communities of color and essential resources like testing, treatment, and accurate public health information. Other communities nationwide experienced similar dynamics. For example, without CHWs, rural counties in the Northeast and Mid-Atlantic—already facing higher infection and mortality rates due to underfunded health systems—lacked the capacity to deliver timely, life-preserving interventions. These findings highlight that investing in CHWs is not just a matter of equity but a matter of saving lives.
Alana M.W. LeBrón, MS, PhD associate professor of health, society and behavior at the UC Irvine Joe C. Wen School of Population & Public Health was one of the principal investigators of the CATALYST Project and senior author on this study. “While our interviews highlighted CHWs’ crucial role in connecting with, understanding, and accompanying underserved community members, we learned that they were often undervalued by healthcare and government systems, which lacked the infrastructure to integrate and support them effectively,” LeBrón added. “There were some organizations that had established relationships with public health decision makers, so they were able to mobilize CHWs quickly, however, others faced barriers due to weak institutional ties, administrative delays, and insufficient funding.”
The study’s findings emphasize the need for systemic changes to support and sustain CHW models moving forward, including:
- Equal partnerships: Building authentic, collaborative relationships between CHWs, community-based organizations (CBOs), and institutional leaders.
- Sustainable funding: Ensuring long-term, flexible funding models to hire and retain CHWs as professionals.
- Administrative capacity: Providing resources for CHW-hiring organizations to develop infrastructure needed to access funds and navigate reimbursement systems.
- Valuing CHW expertise: Recognizing CHWs’ essential roles through fair compensation, leadership opportunities, and integration into decision-making processes.
Importantly, the study underscores that while CHWs are increasingly recognized for their impact, the current funding and reimbursement mechanisms fall short of what is needed to maintain their role in the larger healthcare system. For example, reimbursement rates under programs like Medi-Cal often fail to account for outreach and administrative costs, leaving smaller CBOs struggling to maintain their CHW workforce.
