Opportunities, Challenges, and Strategies for the Professional Development of Community Health Workers: Lessons from the PACT Project (Dorchester, MA)

The integration of community health workers (CHWs) into multidisciplinary care teams can be a key enabling strategy for primary healthcare delivery. CHWs not only deliver culturally-appropriate care to marginalized and hard-to-reach populations, but also offer a potential solution to human resources shortages in many health systems worldwide. As a result, the number of CHWs has expanded rapidly over the last decade. But what does this mean for the lives and careers of CHWs themselves? How can the integration of community members in the delivery of health care serve not just to improve clinical and program outcomes, but also more ambitious goals of community development and social change? We offer a frank review of career advancement challenges for CHWs by presenting the experience of the Prevention and Access to Care and Treatment project (PACT). The basic strength of CHWs, their identification with the lived experience of care-seekers, can present obstacles in their development as health professionals. Managerial skills must be built, racism, structural violence and social isolation must be confronted. At PACT, internal promotion of frontline CHWs to managerial positions has been inadequate. While several have progressed to more responsible positions within the organization, effective skills-building for project management has lagged behind training and supervision to meet program objectives. CHWs who have gone on to advanced professional training did so utside the framework of the project. We consider possible causes and strategies for remediation, and discuss the implications of our experience for other CHW programs.