Community health works

Community health workers are ordinary people in a community – usually in a poor community – who have no special education but a strong commitment to their community and willingness to learn and support health care. Because they are human beings who are doing vitally important work, programs like the PACT (Prevention and Access to Care and Treatment) Program, founded by Boston doctor, Heidi Behforouz, think it completely reasonable that they should regard their activities as a job and get paid. Because they are often newcomers to the health care team, the reality is that the money for their salary still must come out of research and program grants. This makes their job a little iffy. Well, in Boston right now, it means they have to look for a new job. There is something wrong with this picture.

Dr. Behforouz has been training and working with CHWs since 1997 in inner-city Boston. The CHWs she leads help their high-risk patients and the patients’ doctors talk to – and understand – each other. Over its 15 years, the program has:

  • Reduced the patient’s need for Medicaid-funded health care 16% per year, as measured two years after patients enrolled in the program.
  • Improved the lab test results (“biomarkers”) that measure how bad their disease is in 70% of enrolled patients.
  • Measurably improved blood results of those with diabetes; the change is in the blood test that measures how well the patient’s sugars have been in good control over a longterm.

In other words, CHWs save the system a lot of money. And Dr. Behforouz’s program has inspired models across the country.  How can we make good health care sustainable in the US when what works loses its funding? Let the successes of this great program inspire us all to work for change.

Update:  This op-ed was originally posted on this site on 5/15/13.  PACT is no more but the discussion continues. Join the conversation about CHWs at the new “Population Health” [virtual] community at the Global Health Delivery Project at Harvard University.

Read the 2014 article about the program:
Heidi Behforouz, “Bridging the Gap: A Community Health Program Saved Lives, then Closed its Doors,” Health Affairs 33/11 (2014):2064-2067.


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