Community health workers: a comparative assessment of capacities of a global policy approach in selected European health systems

Background Interest in community health workers (CHWs) and the benefits for health systems are growing globally, but research is focused on low- and middle-income countries and high-income Anglo-American countries. Objective This comparative assessment focuses on community health systems and health and care workers as advocates and boundary spanners, aiming to connect global evidence to high-income European countries and assessing the capacities for transformative change. Methods A qualitative comparative approach and case study design were chosen, aligning global expertise of the CHW pioneers, Brazil and South Africa, and selected European countries: Denmark, Germany, Netherlands, Portugal, Romania, UK/England. Case studies were collected in April/May 2025, drawing on country experts and secondary sources; thematic analysis was performed following an explorative interactive consensus-based procedure. Results European countries create diverse occupational pathways into health systems that move beyond primary healthcare, clinical tasks, and CHWs as defined globally. Promising capacities emerge if occupational programs are interconnected with health system reform, community-based social and care services, the establishment of a regulated multi-professional community-centred group, and strengthening of public health and social support services. No country uses these capacities effectively. Conclusions Community-centred health and care workers need greater attention in Europe to drive health system transformations and global policy learning.