Post-pandemic, what now for community health workers?

Isabelle Lewis

When COVID-19 cases put enormous pressure on North Carolina’s health care system, the state turned to local health workers to step up public health efforts to slow the spread of the virus.

The state’s health leaders have played a key role in helping local health workers accelerate the availability of the COVID-19 vaccine, coaching parents on how to navigate their children’s virtual schooling, and helping people get food. He said he helped him access it.

The new coronavirus infection is no longer classified. public health emergencythe federal funding that helped expand this workforce has all but dried up, and many community health workers are worried about what the future holds.

Rubi Morales is one of the community health workers, also known as .Promoter de Salou” she works for El Centro Hispanoa triangle-based organization with a history of 30 years.

Morales said when she first joined the community health effort in early 2020, the focus was on educating others about nutrition, blood pressure monitoring and diabetes prevention.

Then, the COVID-19 pandemic was declared, changing the priorities of local health workers. In North Carolina, fears of unemployment and food insecurity were widespread, along with physical illness from the virus. Morales got to work, knocking on Chapel Hill doors, educating people about the pandemic and addressing concerns.

To stay up to date on the evolving virus and the new science surrounding it, Morales attended weekly training sessions open to community health workers across the state. Morales said her training opportunities are no longer offered, but she advocates continued access to free training so she and her colleagues can be better informed. .

While the health system is now better prepared to deal with COVID-19, which has alleviated some of the urgent need for community health workers, Morales said there is still widespread work to be done. I believe it remains. Aging and chronic diseases continue to affect people, and access to healthcare remains critical. The pandemic has not eradicated these problems.

Morales and El Centro’s colleagues visit the North Carolina legislature three times a month to encourage legislators to continue funding local health care workers as the state weathers the COVID-19 crisis. there is She believes investing in local health workers is essential to helping keep North Carolina healthy.

Some state officials have expressed similar sentiments.

Earlier this year, the state Department of Health and Human Services proposed: A plan to utilize local health care workers to help serve children and adults enrolled in the state’s Medicaid program. The goal is to get people in need to help connect them to safety net organizations. It also helps connect local populations to primary and preventive care.

If implemented, the strategy could create more than 350 new community health worker jobs in North Carolina, according to association president Honey Estrada. North Carolina Community Health Practitioners Association. Estrada said it was “a step in the right direction”.

Role of Community Health Workers

“Community health workers are more than just a job,” Estrada said. “That’s who we are.”

of Definition of Community Health WorkerAccording to the American Public Health Association, CHWs are often referred to as “front-line public health workers who are either trusted members of their communities or who have an unusually deep understanding of their communities.” They are an important part of Latin America’s healthcare system, often provide needed bridges for marginalized populations, and are becoming more prominent in many parts of the United States, especially in the Hispanic community. .

What sets them apart from other healthcare professionals is the way they connect individuals with resources beyond the traditional clinical setting. Many work in low-income neighborhoods and regions where people are afraid to join the health care system.

“We have CHWs working in different locations,” Estrada said. Some work directly with community members, while others work at the policy and advocacy level.

CHWs are employed by numerous agencies, including county health departments, hospitals, and community-based organizations such as El Centro. Some serve as volunteers. Due to the wide range of employers, salaries for community health workers vary greatly from state to state.

In an interview with NC Health News, Mecklenburg County-based community health worker Gloria Council shared some of her work experiences.

In her four years at Novant Health, the council estimates she has treated about 2,500 patients. Through her work, the Council assumes multiple responsibilities. She sees herself as an advocate for patients, advocating not only for their health, but also for affordable housing and safety in Mecklenburg County. She is also empathetic and a trustworthy listener.

However, her work is not without its challenges. He said the city council was “unprepared” when the coronavirus outbreak hit. Although the threat of the pandemic has now subsided, the council still faces challenges.

Earlier this year, Novant Health laid off several employees, including executives. Among them were the council’s superiors.

“It was the most heartbreaking event,” the council said. Novant Health did not respond to NC Health News’ questions about how many people had lost their jobs.

Declining funding has led to widespread layoffs.

“Public health funding is common, but community health worker funding certainly has a boom-bust cycle,” said Advocate for North Carolina Community Health Workers at Partners in Health. One Taylor Norris said:

To address this issue, “we need to find a way to integrate CHW into the healthcare community system,” Norris said. This means more employers will hire community health workers. He believes this will reduce volatility in funding.

“It’s been a long time coming,” John Resendez, program manager for the North Carolina Department of Health and Human Services’ Rural Health Service, said in an interview with North Carolina Health News. [employers] We are starting to move towards hiring more people who are preferably CHWs or act like CHWs. ”

Community health workers can effectively engage with “people in very difficult circumstances”. [for most of the health care system] to get there,” he added.

The North Carolina Health Service is working with community health workers across the state to develop plans to ensure reliable employment opportunities and professional funding.

Alison Owen, deputy director of North Carolina’s DHHS Rural Health Department, said the department is “back to the basics we started during the COVID-19 outbreak.”

Efforts by community healthcare workers

Community health workers have been part of care delivery systems around the world for decades, but it is only in the last two decades that the United States has officially started recognizing their contributions.

In 2007, the U.S. Department of Health and Human Services and the Office of Health Professional Services Administration National Labor Force Survey of Community Health Workers. The study recognized community health workers as “a component of cost-effective strategies to address the health care needs of underserved communities.”

Efforts to Respond to the Needs of Local Healthcare Workers Since then it has gained momentum in the country.

In 2014, the North Carolina Department of Health assessed the needs of community health workers in the following ways: NC Community Health Workers Initiative.

The goal, Owen said, was to formally recognize the contributions community health workers have made statewide in bridging the divide between communities and the health care system.

Until state and national level initiatives were launched, many CHWs faced barriers to getting their patients the care they needed. Other stakeholders in the health system were less familiar with the roles and responsibilities of community health workers.

and In 2018, the North Carolina Health Service issued a report containing recommendations for the CHW workforce.. One goal was to create a standardized training curriculum.

“[Community health workers] I wanted to be certified. They wanted everyone to have the same name, to have the same training, to have some kind of license or certification to maintain a kind of homogenous workforce,” Resendes said. He added that community colleges are the best places to get uniform training. Because the campus is more accessible to many people in the state, tuition is cheaper, and classes are available for specific disciplines.

there is 10 Community Colleges Where CHW Can Get Accredited, according to the website of the North Carolina Community Health Practitioners Association. Certification is not required.

Shortly after the rollout of standardized training for CHWs began in earnest in North Carolina, something unexpected happened.

Increase and retreat of funds

“Covid-19 has flooded the sector with cash,” Resendes said.

Resendez said that during the pandemic, DHHS received $56.6 million in funding from the Centers for Disease Control and Prevention to support North Carolina’s community health workers through this period.It enabled the state to Employ and train about 600 CHWs, He said. However, Resendez said the funding ran out in December 2022.

The CDC gave the state the following awards $9 million grant In 2021, it has been designated for a three-year expansion of community health workers. The funds were directed to the state to boost CHW workforces statewide and weren’t just limited to COVID-19 related costs.

The $9 million is expected to run out by the end of the year, which is one reason the identification of the next source of funding is in dispute.

uncertainty about what will happen next

The pandemic is a formidable force for local healthcare workers to act as a bridge to healthcare for many people in the state, especially those who often lack the insurance, finances and transportation that allow easy access to healthcare providers. showed that

Throughout North Carolina and across the country, community health workers are celebrated for their contributions and recognized for their role. Reduction in medical expenses.

But funding is essential to sustain this kind of effort.

“I know the entire state and we are working on this, but we have not yet identified what that sustainable payment will look like,” Estrada said. .