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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Well-Woman Visit.

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Strategy. Community Health Workers

Approach. Establish a network of community health workers within communities of low preventive care service utilization

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Overview. Community health workers (CHWs)—sometimes called lay health workers, promotores de salud, community health advisors, or community health representatives—provide a variety of services that may include outreach, education, case management, referral and follow-up, and home visiting services. CHWs may work autonomously in the community or as part of a multidisciplinary team in primary or specialty care.

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • CHW Network records and documentation/meeting minutes
  • CHW activity log and outreach data
  • Qualitative feedback from CHWs, community partners, and other healthcare providers

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Health Care Access for All MCH Populations.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Community Organizing (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of CHWs recruited and trained to provide outreach, education, and navigation services for preventive care in communities. (Measures the capacity building efforts to establish a CHW network)
  • Number of community events and outreach activities conducted by CHWs to promote preventive care services and connect residents to resources. (Measures the implementation of community-based strategies to increase awareness and access)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of CHWs who complete a comprehensive training program on preventive care services and health education. (Measures the quality and depth of CHW workforce development efforts)
  • Percent of healthcare providers and community-based organizations that have established formal agreements and protocols for collaborating with CHWs. (Measures the level of system integration and coordination to support CHW effectiveness)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of CHWs trained in policy and systems change promotion to address challenges to preventive care. (Measures the CHW network's capacity to influence upstream factors)
  • Number of community-based participatory research studies conducted to evaluate and improve CHW program effectiveness and impact. (Measures the integration of research and evaluation to drive continuous improvement and evidence-based practice)
  • Number of preventable health conditions and risk factors identified and addressed through CHW-facilitated preventive care services. (Measures the CHW network's impact on early detection and intervention for key health issues)
  • Number of policies and systems changes implemented to support CHW sustainability and integration into healthcare and public health systems. (Measures the long-term impact and institutionalization of CHW programs)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of CHW programs that are designed and implemented with direct input and leadership from the communities they serve. (Measures the level of community ownership and governance of CHW interventions)
  • Percent of CHWs who receive ongoing professional development and career advancement opportunities to promote retention and leadership. (Measures the investment in CHW workforce sustainability and growth)
  • Percent increase in preventive care service utilization rates in communities served by CHWs, compared to baseline rates and communities without CHW interventions. (Measures the population-level impact of CHW programs on closing gaps in preventive care access)
  • Percent of healthcare cost savings and return on investment associated with CHW programs, based on averted hospitalizations, complications, and disability. (Measures the CHW network's long-term impact on health system efficiency and sustainability)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.