Community Health Worker Models in Chronic Disease Management: Scope, Training Standards, and Measurable Contributions to Care Continuity

Abstract

Community health workers (CHWs) are increasingly positioned at the interface between households and formal health systems, yet their contribution to chronic disease management depends on how their roles, competencies, supervision, and referral relationships are designed. This narrative review synthesizes evidence on CHW models for hypertension, diabetes, cardiovascular disease, and other long-term conditions, with particular attention to scope of practice, training standards, multidisciplinary integration, care continuity, equity, and sustainability. Across low-, middle-, and high-income settings, CHWs contribute through risk communication, screening, health education, care navigation, medication and self-management support, home monitoring, referral facilitation, and post-discharge follow-up. Evidence indicates that these functions can improve treatment linkage, appointment retention, referral completion, patient engagement, and selected clinical outcomes, including blood-pressure and glycaemic control, when CHWs operate within responsive primary-care systems. However, CHW presence alone is insufficient. Programme effectiveness is consistently conditioned by competency-based preparation, supportive supervision, reliable remuneration, manageable caseloads, access to medicines and diagnostic resources, shared documentation, and closed-loop clinical escalation. The review also identifies an important distinction between improved access and durable outcome equity: structural barriers may persist even when community reach expands. Sustainable scale-up therefore requires institutionalized financing, clear governance, formal workforce support, interoperable information systems, and performance frameworks that measure continuity as an observable process rather than an assumed consequence of contact. Future research should prioritize long-term comparative evaluations of effectiveness, cost-effectiveness, workforce retention, digital integration, equity, and implementation fidelity. CHWs are best understood as accountable connectors within multidisciplinary chronic-care systems, not as substitutes for professional care.