JACM SPECIAL ISSUE ON COMMUNITY HEALTH WORKERS AND COMMUNITY HEALTH WORKER PRACTICE (PART 2)
The first special issue of the Journal of Ambulatory Care Management (Vol. 34, No. 3) on community health workers (CWHs) presented studies aimed at helping to stimulate discussion and debate about the definitions, roles and responsibilities, training, evaluation, and professional development of community health workers within primary care settings. This second special issue completes the first by providing additional studies, commentaries, and CHW testimonials that further demonstrate the flexibility, adaptability, and effectiveness of CHWs in primary care. This issue also underscores the critical challenges that need to be addressed to further enhance CHWs' roles and long-term prospects in a rapidly changing world.
In Brazil, The Family Health Strategy provides primary health care to nearly 100 million inhabitants and employs nearly 250 000 community health agents as wage-earning health workers. Two articles help elucidate the role of CHWs in Brazil. Giugliani and colleagues present results of a systematic literature review on the effectiveness of community health agents within Brazil and conclude that, to date, the evidence base is still evolving and the quality of studies documenting CHW effectiveness needs to be improved. Still, they found a consistently beneficial effect of interventions utilizing CHWs across a broad range of outcomes, especially those related to child health. Fausto et al analyze the experience of the community health agents in 4 large Brazilian cities. Their analysis focuses on factors that contribute to the community health agents' effectiveness and finds that their complex roles (community health agents must act as mediators linking the community with health services, while simultaneously serving as community organizers and as health care providers) present important challenges.
A number of the studies in this issue highlight the different roles that CHWs can play in enhancing chronic disease management. Balcazar and colleagues describe their "Salud Para Su Corazon" model that employs community health workers in addressing cardiovascular disease risk reduction in Hispanic communities. Their study details elements of program success and reiterates the need for horizontally integrated models of care linking multiple health care professionals and vertical integration linking actions at the individual, health worker, health system, and policy levels.
All empirical articles also contain the Key Comparative Elements Table, an online feature designed to help standardize documentation and comparison between CHW practice approaches (see supplemental digital content available at http://links.lww.com/JACM/A10).
The issue continues to provide a platform for CHW voices. Mahamud Ahmed introduces the experiences of a team of CHWs at Pastoralist Concern in Ethiopia, a portrait of Maria Murphy, a CHW from New York City, and an interview with CHW national leader Lisa Renee Holderby Fox.
Finally, in his commentary, Allen Herman provides an overview of CHW programs and approaches in the United States and internationally and discusses ways in which they can help in building more integrated models of primary care. These range from enhancing access-especially among high risk, hard to reach, and other vulnerable populations-increasing continuity of care and patient self-efficacy, and contributing to care coordination-each vital to the development of a comprehensive medical home.
We hope these 2 issues have accomplished their objectives of introducing readers unfamiliar with the diversity and complexity of community health workers to a number of important experiences and also engaging CHW experts in a continued discussion about the state of the field, its many challenges, and its great promise.
-James Macinko, PhD Guest Editor
Department of Nutrition, Food Studies & Public Health, New York University, New York
-Elizabeth Lee Rosenthal, PhD, MS, MPH
Guest Editor
Mesa Public Health Associates, LLC,
El Paso, Texas