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Community Health and Wellbeing Workers (CHWWs)

What are they and how do they work? 

Community Health and Wellbeing Workers© (CHWW) are people recruited from their communities, who are embedded in Primary care teams and the community sector, to proactively assist in providing health and wellbeing services to those communities. 

This model started in Brazil over 30 years ago where it is now the delivery model for primary care with over 70% of the population now having a CHWW. Since the 1990s the results in population health improvement that Brazil has seen have been remarkable; 

  • 34% reduction of cardiovascular mortality 
  • 31% stroke mortality 
  • improved horizontal equity 
  • increased breastfeeding, vaccination and cancer screening rates, nationally. 

Listen to these CHWWs from Brazil talk about their work.

So how is this model different to other roles like Social Prescribers or Outreach workers or Community connectors? What makes CHWWs so special? 

We identified four key principles that make the model unique and effective when applied together- the CHUI – principle: 

  1. Comprehensive – Looking after the entire household and everyone in it and anything of concern. 
  1. Hyperlocal – Based around a defined geography of 120-150 households, ideally by people from the locality or with close proximity and connection to the locality. 
  1. Universal – Everyone in that geography is seen regularly regardless of need or selected characteristics, but help is proportionate to need. 
  1. Integrated – Fully integrated with the GP Practice and Local Authority and in the community. 

Their job is to build trusted relationships with their households and professionals and services on the patch. 

CHWWs visit every one of their 120 households in their patch every month, regardless of need and at these visits they deal with any pressing issues within the households across their physical, mental and social health. They form a team around the resident and work with the wider system including primary care networks and local authorities to support residents’ health and crucially help address the wider determinants of health.

CHWWs are recruited on character and there is no particular requirement for particular skills; CHWWs are natural problem solvers; empathic, culturally competent, emotionally intelligent, honest and integral, team players, have the right attitude; and recognise the need to be persistent, respectful and maintain confidentiality. The specially recruited teams get to know families and assess their health, social and wellbeing needs, promote healthy living, signpost to appropriate services and help residents navigate the health and care system. They become allies and advocates for their residents. 

In Westminster where the model was first implemented it has shown: 

  • The households were 47% more likely to have immunisations that they were eligible for and 82% more likely to have cancer screenings and NHS health checks. 
  • These households saw a 7.3% drop in unscheduled GP consultations. 
  • Residents were appreciative of the ease of access, support and comprehensive approach provided 
  • Engagement had been maintained with 60% of residents and increasing. Residents who engaged with CHWWs did not disengage. 
  • Multiple instances of issues being unearthed around suicidal ideation, child carers, domestic violence and intractable housing. 

In the Cornwall pilot residents experienced a 90% increase in Wellbeing measured by the MyCaw tool. 

Watch a 6 min clip ‘Community Health Workers in Churchill Gardens – Learning from the Brazilian Model’: https://youtu.be/MPtE4vwZvDI 

This model has already been rolled out across 25 other sites following the success of the early pilots, with more in the pipeline. 

The CHWWs have made a splash already including a mention in the HoL enquiry into the future of primary care, the Fuller Stocktake report, the Faith and place report, in the BBC news, New Local article and podcast, in PulsePCN, Independent nursing amongst others. For more resources including a video of a visit to Brazil or our podcasts on the initiative click here. 

Find more information here. 

Interested in CHWWs in your locality? We have created a Community of Practice for sites to come together, learn from each other and share resources.  If your locality is interested in adopting this model please join our  Community of Practice to get support from sites who have rolled out this model, gain access to resources such as job descriptions, business cases, training schedules, logo and an up to date Standard Operating Procedure: Join our Community of Practice 

Contact us here for more information: napc@napc.co.uk 

The CHWWs were nominated for the Primary and Community Care Innovation of the Year, this collaboration between NHS Cornwall and Isles of Scilly Integrated Care Board and Healthcare Central London Primary Care Networks exemplifies innovation in addressing health inequalities. Read more