What is a community health worker? It needs to be clearer, say experts
Gillian Rutherford - 21 January 2025

Stephen Hodgins
A University of Alberta expert in global health is leading the charge to improve patient care in low- and-middle-income countries by creating a new classification system for community health workers.
In a paper published today in the online journal PLOS Global Public Health, associate professor Stephen Hodgins presents a proposed list of job tasks and a naming system for a wide range of front-line health providers, from full-time government employees to volunteers who step in to provide public health services during a disaster.
The new list — or “taxonomy” — will help governments and international aid organizations such as the World Health Organization, UNICEF and the World Bank deliver better, more universal health-care services to remote communities.
“Confusion over categories and training has consequences for program decisions, which in turn affect the services that are made available to the people,” explains Hodgins, who trained as a family physician and is now program director for global health in the School of Public Health and editor-in-chief of the journal Global Health: Science & Practice.
In general, community health-care workers in low-and-middle-income countries provide services and health education related to immunizations, treatment for a limited number of childhood illnesses such as malaria, diarrhea and pneumonia, dispense family planning aids, support patients receiving care for TB and HIV, and counsel about other health risks.
But sometimes people with similar training are overlooked or not allowed to deliver critical services, based partly on confusion over what they are called. For example, treatment of childhood illnesses is done by “extension workers” based in health posts in rural Ethiopia, Hodgins explains. Meanwhile, in neighbouring Uganda, their equivalent — “auxiliary nursing” or “midwifery workers” — were bypassed to play such a role.
By standardizing the job titles, matching tasks with training and learning from each other, the quality of care could be improved, says Hodgins.
“There’s been a need for a while to adequately recognize the diversity but also to nail down some common language to describe these different variations in programs,” he says.
“Often they’ve got essentially the same job description, they’ve got equivalent training, but because they haven’t had that label, they’re not thought of in that way.”
Hodgins began work on the new classification system in 2021 with funding from the Gates Foundation. Using a consensus-building process, he brought together 33 community health experts from 19 countries as co-authors.
Hodgins says it was sometimes challenging to find language that could be universally accepted by labour activists, community development workers and humanitarian aid providers, all of whom work in the health field, but he’s confident he’s found a workable solution.
“A big part of the challenge with this paper was to come up with language that was acceptable to all of those camps because there has tended to be a tension between them,” he notes.
Hodgins plans to share his work with international colleagues through webinars for organizations like CHW Central, the Community Health Impact Coalition and USAID.