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Drs Anita Makkenchery and Brandy Farrar Discuss the Growing Need for Community Health Workers


Anita Makkenchery, MD, MPH, and Brandy Farrar, PhD, discuss how the pandemic has highlighted the need for community health workers and what sets them apart from other health care professionals.

Anita Makkenchery, MD, MPH, a research associate in the Quality Improvement and Innovation Division at IMPAQ International, and Brandy Farrar, PhD, a principal research associate in IMPAQ’s Health division, presented results from their study on community health workers in a poster at the Academy Health 2021 National Health Policy Conference.


How has the pandemic highlighted the need for a greater emphasis on community health workers?

Makkenchery: There are many people dealing with the pandemic. We are redirecting so many of our resources to clinics that even hospitals have had to do stop elective surgeries and pause some of their own procedures just to redirect resources to the pandemic. So, community health workers are helping fill a huge gap in care coordination by going out into the communities, finding people who need resources who need to know where they are to coordinate, and to be that liaison between the clinic and the patient. We have just seen an uptick. In Baltimore, they've hired about 300 community health workers to help with the pandemic, contact tracing, and care management and care coordination. So, I think community health workers are just a major necessity at this time.

Farrar: I would just add, in particular, in vulnerable communities where the pandemic has really wreaked havoc, we're seeing pretty dramatic—in some places—disparities in the prevalence as well as adverse outcomes with COVID-19. I think what community health workers do that other kinds of health care and public health workers don't is they're able to connect with these communities to do the things that Anita was mentioning in terms of connecting people to resources and providing accurate information in a way that people can receive it. For example, around COVID-19 and precautions. I think they have become more and more in focus because public health officials are realizing that this is really a resource to be able to address some of the unique challenges of COVID-19 and vulnerable communities.

What role can community health workers play in addressing structural issues that communities of color and low-income communities face, especially during the pandemic?

Makkenchery: Well, the one great thing about community health workers is that they usually are part of the community. They are one with the people. So, they understand how people in the community think, how they function from day-to-day, what their needs are, where the gaps are from the macro to the micro. They can fill in the gaps or notify the other health care workers in their community who are working with issues regarding the pandemic or other illnesses that have popped up and say, "Hey, we need extra help in this area. Hey, transportation is an issue, how do we arrange that?" versus having to say, "Oh, you know, something, something's wrong over here. What is it? We don't have enough people from this area coming to our clinics." What is happening when someone in the community who's part of it, who's living that same exact life, and is a representative that the people trust that can say, "Okay, here's the issue," is that it's really cutting a lot of the going from point A to point B very, very quickly.

Farrar: Yeah, they see where the systems break down. I think they are really well situated to be able to work with policymakers, leaders of health care organizations, public health, rotation agencies, as Anita mentioned. And really all of the systems that we know contribute to the issues that isolate vulnerable populations in certain communities. I think they're well situated to provide concrete and actionable recommendations about how to improve those systems in a way that that outsiders are not.

What are some of the advantages community health workers have over traditional health care delivery approaches?

Makkenchery: Piggybacking on what I said earlier is that they are, they're part of the community and there are a lot of issues and concerns that I think health care workers that work in the general population may not fully understand in terms of vulnerable populations. And the community health workers really help bridge that gap. It's a 2-way communication. The community health workers talk to the providers, and as Brandy mentioned before, they can also discuss policy, the major needs at a local or government level. But at the same time, they can also take the information that they're given by their governments and policymakers back to the community and help them implement any preventative measures or different solutions in terms of bridging that gap between delivery and access to care.

Farrar: Yeah, and I think to just drive home the point around that they know the community and the community knows them. Sometimes that's in a generic way, where they're a part of the community, they know where people go, know how to communicate in certain ways that will resonate. But sometimes it's actually they know people. I think about my grandmother. I was just so excited about this because when the vaccine rolled out in North Carolina, where she is and where my family is, local health officials worked directly with the faith community where she lives and they reached out directly to my grandmother's church, and they had this relationship that they had built already and that they had been working with the churches in the area. The workers from my grandmother's church went in and signed up all of the people in the church for the eligibility criteria for the vaccine. In that case, my grandmother was never going to call and get an appointment or go online to schedule an appointment. Someone that she physically knows that she sees every week called her and said, "Okay, we're gonna set it up. When can you go?" So, I think it's those types of connections and reach that goes into communities that would never proactively engage are really what make community health workers unique.

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