Abstract
Background: Community Health Workers (CHWs) are proven to be highly effective in low- and middle-income
countries with many examples of successful large-scale programs. There is growing interest in deploying CHW programs
in high-income countries to address inequity in healthcare access and outcomes amongst population groups facing
disadvantage. This study is the first that examines the scope and potential value of CHW programs in Australia and the
challenges involved in integrating CHWs into the health system. The potential for CHWs to improve health equity is
explored.
Methods: Academic and grey literature was searched to examine existing CHW roles in the Australian primary healthcare
system. Semi-structured telephone interviews were conducted with a purposive sample of 11 people including policymakers,
program managers and practitioners, to develop an understanding of policy and practice.
Results: Literature on CHWs in Australia is sparse, yet combined with interview data indicates CHWs conduct a
broad range of roles, including education, advocacy and basic clinical services, and work with a variety of communities
experiencing disadvantage. Many, and to some extent inconsistent, terms are used for CHWs, reflecting the various
strategies employed by CHWs, the characteristics of the communities they serve, and the health issues they address. The
role of aboriginal health workers (AHWs) is comparatively well recognised, understood and documented in Australia
with evidence on their contribution to overcoming cultural barriers and improving access to health services. Ethnic
health workers assist with language barriers and increase the cultural appropriateness of services. CHWs are widely seen
to be well accepted and valuable, facilitating access to health services as a trusted ‘bridge’ to communities. They work best
where ‘health’ is conceived to include action on social determinants and service models are less hierarchical. Short term
funding models and the lack of professional qualifications and recognition are challenges CHWs encounter.
Conclusion: CHWs serve a range of functions in various contexts in Australian primary healthcare (PHC) with a
common, valued purpose of facilitating access to services and information for marginalised communities. CHWs offer
a promising opportunity to enhance equity of access to PHC for communities facing disadvantage, especially in the face
of rising chronic disease.