Community health worker career advancement conundrum: The disconnect between higher education and higher pay

The Boston Community Health Worker Initiative (BCHWI) presents an emerging conundrum in Community Health workforce development: more education for CHWs does not necessarily result in more pay. Systemic, widespread advancement opportunities for CHWs will only occur with workforce systems changes at the employer, funder and governmental policy setting level. Unique challenges characterize the CHW labor market today. The overwhelming majority of CHWs, passionate and committed to their work, express a strong desire to remain in the community health field as well as a strong interest in education and training. Employers of CHWs value their work and wish to pay more; however, the short-term, grant-based realities of funding constraints restrict them from rewarding increased competency, not to mention loyalty and hard work, with pay raises. Often, little correlation exists between skill levels, education and training and increases in wage gains within the community health field. BCHWI details strategies it and others are undertaking to address this issue. As a result, the BCHWI coalition, with strong CHW leadership, has developed an advocacy plan for systemic changes in the funding policies constricting CHW wage levels. BCHWI-led workforce systems policy work— both with employers and at the State level— should lead to broad wages gains. This, in turn, will provide opportunities for the field and achievement of BCHWI's mission of CHW career advancement. The BCHWI coalition is committed to working at the micro-level (i.e., education and training for individuals) and the macro-level (i.e., systems change). This could be an effective model for programs elsewhere.