Adranae Mena, a community health worker, at the Southwood Resource Center in South Side
It was an easy mistake to make.
One day, a resident of Southwood, an apartment complex in South Side Richmond with predominantly Hispanic residents, reached out to Adranae Mena, saying she wasn’t feeling well. Mena, a community health worker, asked the woman to visit the Southwood Resource Center, a place that offers clinical and community services to Southwood.
At the center, the staff learned that the woman was taking a prescribed medication 11 times a day; she was only supposed to take it once daily. “Once” translates to “11” in Spanish, and the woman misunderstood the instructions on her medicine bottle to be taken “once a day.” The team at the resource center helped the woman understand the correct dosage.
“We have so many stories,” says Mena, a senior certified community health worker with the Richmond and Henrico health districts.
Community health workers are frontline public health workers who serve as a bridge between vulnerable populations and the resources needed to help them. Often hailing from the communities that they’re trying to assist, these trusted workers provide guidance for the populations they serve.
According to one survey, roughly 70% of community health workers nationally are people of color; 87% are female. Community health workers can be employed by state governments, local health districts — which oversee the public health of Virginians — clinics, nonprofits, schools, faith-based organizations and other health groups.
Anyone with an interest in supporting public health can become a community health worker, which requires training that covers technical skills and soft skills, and can include certification, though it’s not required. In April 2018, the Virginia Department of Health established a certification program to better cement community health workers’ roles in the state. The certification requires 60 hours of education and one year of full-time work in the role or 2,000 hours of volunteer or paid work.
Community health workers can connect people to homeless shelters and food banks. They can rally communities to get screened for hypertension and diabetes. They can help educate on everything from installing children’s car seats to administering Naloxone to reverse an opioid overdose. Though these health care workers have held an established job classification since the mid-20th century, their importance was made clear during the outbreak of the COVID-19 pandemic, proving critical in getting marginalized communities vaccinated and informed on the nation’s response.
As of early 2024, federal funding was about to end for more than 100 community health workers at health districts across Virginia when, in a mid-May special session, the General Assembly approved $6.4 million over two years to maintain those positions. A separate effort by the state legislature to explore Medicaid reimbursements for community health workers at nonprofits and clinics stalled.
Without a sustainable plan for continued funding, some of Virginia’s community health worker positions and the services they provide may be in jeopardy.
Community Health Worker Emely Baez Salazar with the Fan’s Health Brigade
Trust and Connection
As a community health worker with the nonprofit free clinic Health Brigade, formerly known as the Fan Free Clinic, Emely Baez Salazar — who emigrated from the Dominican Republic at age 2 — has many stories that illustrate the need for her work.
With parents who help run events in Richmond’s Hispanic community, Baez Salazar has long enjoyed helping others. For three years she was a home-care nurse, but ultimately decided it wasn’t for her. “I knew I wanted to help people, I just didn’t know how that would translate into a real job,” she says.
Baez Salazar first intended to volunteer with Health Brigade when she learned they had a job opening for a community health worker. She’s been there two years.
Shanteny Jackson, executive director of the Virginia Community Health Worker Association, compares community health workers to trusted neighbors. Community health workers may engage locals at civic meetings through outreach, visiting church services or simply by walking around their neighborhoods.
“Some call them aunties, other communities call them cousins. Other communities, they call them tía, abuela,” Jackson says. “Because of that trust, you are able to connect, you are able to identify, you are able to relate, and you are able to open up and help support.”
Community health workers also focus on social determinants of health — conditions that can factor into someone’s health and well-being, such as economic stability or access to food. And because community health workers are connected to the populations that they serve, they are often better able to recognize issues that may go unseen by other care providers.
Paula Masters, chief health disparities officer at regional hospital chain Ballad Health based in Southwest Virginia, recalls a patient who was seeking treatment through the health system. A community health worker was able to figure out that the patient was living underneath the structure of a local playground. After helping them secure housing, the health system treated them for chronic obstructive pulmonary disease, diabetes and an undiagnosed behavioral health issue.
“If a clinic needs to connect somebody to a food bank or to other social services, a community health worker can often be the person who acts like a case manager, almost,” explains Rufus Phillips, CEO of the Virginia Association of Free and Charitable Clinics, of which Health Brigade is a member. “Our health system is highly fragmented and very specialized. Community health workers can help bridge that gap and make sure that there’s good continuity of care.”
In the pandemic, funding for community health workers expanded to help address the needs of vulnerable populations.
Not having community health workers just leads to a sicker community.
—Emely Baez Salazar, community health worker
“We saw across the board how instrumental community health workers were with vaccinations,” says Sarah Bedard Holland, CEO of Virginia Health Catalyst, a statewide nonprofit that works to ensure that people can access health care. “The COVID vaccine was more polarizing than any of us would have imagined on the front end. Having someone in the community that could provide accurate information that was culturally appropriate in the right language [was vital].”
As that pandemic-era funding was about to run out, a coalition of public health advocacy groups in Virginia pushed to support these positions at the state level. A $6.4 million budget amendment co-sponsored by Sen. Lashrecse Aird, D-Petersburg, was included in the final budget.
“This allows at least 100 community health workers to maintain their positions,” Aird says. “With this funding, we’re saying we value community health workers, and we want to see them continue to be part of the spectrum of health care.”
While this funding addresses community health workers employed by local health districts, it doesn’t fund community health workers who work for nonprofits and clinics.
“That’s a problem,” Phillips says. “We don’t really have a funding mechanism right now for community health workers beyond the free clinics trying to raise money. It’s hard to make a position sustainable for many years. Maybe you get a grant that lasts for a year or two, but it comes to an end.”
During the most recent General Assembly Session, House Bill 594 and Senate Bill 615, which did not pass, would have allowed Medicaid reimbursements to health care providers for the services that community health workers perform.
To Baez Salazar, the dangers of not funding these roles are clear: “Not having community health workers in the community just leads to a sicker community.”
Baez Salazar organizes supplies at Health Brigade free clinic.
Healing on Shaky Ground
By the numbers, Masters says there’s no question about the efficacy of community health workers.
Ballad Health System was one of five health care organizations nationwide to participate in a project through the Patient-Centered Outcomes Research Institute that examined the impact of community health workers. Measuring hospitalizations, total inpatient length of stay, readmissions and emergency room visits from 2019 to 2021, the results were clear.
“We saw a 29% reduction of hospitalizations for that population,” Masters says. “That’s a big deal. It’s a big deal for the health system, it’s a big deal for those providers, and it’s a really big deal for that client and their family.”
Ballad Health System now employs more than 85 community health workers on its own dime and has created new programs for assisting underserved communities.
“All of these programs we created because we saw the success that we were having using community health workers, but there’s still no reimbursement for that,” Masters says.
Holland says the positions are incredibly valuable. “For every dollar that we’re investing in a community health worker, we’re seeing about $2.50 back in reduced hospitalizations,” she says. “The use of community health workers reduced the number of hospital visits by 29%, almost 30%. That’s incredible. That not only makes great financial sense; it makes great moral sense.”
Without additional funding, positions including Baez Salazar’s could be in danger.
“We’re actively looking for ways to continue funding her position. We want to keep funding it, because we’ve seen a lot of success,” Jenee Johnson, a social work and support service manager with Health Brigade, says. “When the funding ends for these two programs, the clients in the communities that we serve, their needs don’t just go away. They’re still there.”
Those needs can sometimes include assisting with pregnancy, too. Mena recalls the time that a client called her in need of help as she was about to go into labor. Mena made arrangements for the woman to be driven to the hospital.
“That’s just what we do,” Mena says. “Community health workers are passionate across the board. It’s not just a job for us. It’s a way of life.”
