PHOENIX — Karina Fernandez said she knew she wanted to pursue a career as a community health worker when she saw immigrants like herself waking up early for labor-intensive jobs in the fields under arduous weather conditions.
“That moment was when I said, ‘I want to help them in any way,’” she said.
Now, she is a certified community health worker with the Arizona Community Health Workers Association, trained to help connect communities with healthcare, resources and health education.
Jeremiah Wiebe-Anderson, program manager for a community health worker program at the University of California San Diego, described the job as someone who has “stories of being a helper and making connections for their community and for their families.”
Wiebe-Anderson manages the kind of program a new World Health Organization policy guide says governments need to build and protect.
In its latest guidance, the WHO urges agencies to stop treating community health worker programs as temporary side projects and instead integrate them into national health systems – with long-term commitments to funding, training and support.
The Community Health Worker Action Program, or CHWAP, operated through the University of California San Diego and trained immigrants as community health workers, helping recent newcomers assimilate into the U.S. and understand the complex healthcare system.
They served as cultural liaisons, a role that has become increasingly important in the Southwest as immigrant populations grow and many continue to lack access to healthcare.
CHWAP came to an abrupt end earlier this year after its funding collapsed.
Roughly one in five lawfully present immigrants lacks medical insurance, according to 2023 health policy research, leading many to face serious barriers to medical care, including paying out of pocket.
Fernandez said one of the many things community health workers do is assist immigrants with a lack of transportation and feelings of isolation.
Many immigrants without cars rely heavily on public transportation – representing about one-third of all users. In rural areas without the services, Fernandez “was able to transport them to the medical appointments,” she said.
Beyond physical medical assistance, Fernandez said many immigrants she serves struggle with loneliness.
While seeing clients one-on-one, she said “they started telling me everything about their lives.” Fernandez, in these moments, directs her clients to a psychologist. She stated that because she is an immigrant herself, she quickly “empathizes with them.”
“The most important thing to feel is that they can count on us or trust in us,” she said. “In that way, they don’t feel alone. They can see us as someone to talk to get help from in any way, or just to talk.”
“I feel I succeed when I see people improve their lives,” Fernandez said.
Community health worker programs often struggle to secure long-term funding because many rely on temporary grants, while reimbursement systems in U.S. healthcare do not consistently pay for outreach, navigation and preventive services.
Mustafa Sahid is the director of operations at Somali Family Service of San Diego, which has been preparing community health workers in San Diego for over 15 years. Sahid said embedding health workers can also help reduce healthcare costs. When they educate newcomers on small medical issues, fewer immigrants find themselves in hospitals for potentially avoidable circumstances.
This “also would save those important (hospital) times and slots for those with more urgent needs,” Sahid said.
Wiebe-Anderson agreed. “Not only is it an ethical and moral thing to do to empower people to better serve themselves, but it just makes economic sense to empower people to help them and their communities live happier and healthier lives.”
“This was actually a request by the community themselves,” said Wael Al-Delaimy, a professor of public health at the University of California San Diego. “They reached out to me. … They knew more about what the needs in the community were, and they felt that this program would be able to fill in the gap of healthcare access.”
The program launched with a $3 million federal grant from the Health Resources and Services Administration of the U.S. Department of Health and Human Services, but the funding was never intended to last forever.
Over the last several years, the WHO has been urging governments to implement transition plans for community health programs built entirely on external funding, or a domestic financing strategy that outlasts any single grant cycle.
CHWAP plans to maintain courses and training, though the program will likely require fees from students.
“If one counts how much money and funds this prevention program or public health will save, they would invest in it,” Al-Delaimy said.
Wiebe-Anderson echoed Al-Delaimy: “It’s a very difficult time to find funding and find institutional support for programs that are intended to empower, uplift and improve the health of immigrants and refugees.”
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