More than half of volunteer community health care workers in 19 countries are experiencing labor exploitation, according to a study conducted by researchers at Mount Sinai. The study, which is the first systematic review of its kind, found that over 59% of unsalaried community health care workers in programs with both salaried and volunteer employees reported labor exploitation. This included receiving pay below the minimum wage, working excessive hours, and being tasked with complex responsibilities. The researchers emphasize the need for public policies that ensure fair compensation and safe working conditions for all community health care workers, which would ultimately improve the quality of care and health outcomes.
The researchers focused on dual-cadre programs, where salaried community health workers work alongside a group of volunteer workers. They analyzed 117 peer-reviewed reports published between 1988 and 2021, which included data on salaries, workload, task complexity, and self-reported experiences. The study revealed that a significant percentage of volunteers in dual-cadre programs, approximately 17%, would need to work 40 hours per week to fulfill their responsibilities. This expectation, coupled with the provision of complex tasks beyond their initial role, could lead to distress for these workers.
While community health workers can play a vital role in improving health outcomes and equity, this study highlights the potential negative impact of two-tiered community health worker programs on the quality of health care provided. The researchers argue that labor laws should be enforced, fair contracts prioritized, and volunteers should not bear the majority of the responsibilities for delivering essential health services. They suggest that future strategies should focus on optimizing the roles and responsibilities of community health care workers to ensure effective service delivery without overburdening them.
The shortage of health care workers globally has led to an increase in dual-cadre community health worker programs, particularly in low- and middle-income countries. However, this study underscores the importance of addressing labor exploitation within these programs to ensure the well-being of these workers and the quality of care they provide. Community Health Impact Coalition, a nonprofit directed by one of the study’s authors, co-led the research.
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, consisting of multiple hospitals, outpatient practices, labs, and educational institutions. The organization is committed to advancing health care through scientific discovery, innovative treatments, medical education, and community care.
