Community Health Workers in Spain: a missing strategy to tackle hepatitis in migrant populations

Community health workers (CHWs) are health care providers which live and serve in the community and are responsible for the provision of health education to their communities, promoting healthy habits and lifestyles, diagnosing common illnesses, and encouraging the use of health services by linking people to health services. CHW programmes have been formally included as part of national health systems in many low- and middle-income countries (e.g., Ethiopia or Brazil), along with some high-income countries (e.g., Canada). Despite the major contribution CHWs have proven to make in health systems globally, Spain has yet to introduce a law acknowledging their role in the health system. The introduction of CHWs allows for the decentralization of health services and their extension beyond the regular forms of health service delivery (e.g. primary health centres or hospitals) as additional strategies for equity and person-centred care. CHWs have the capacity to reach underserved and vulnerable populations, including marginalized populations, which often encounter barriers to engage with their health systems. Migrant communities in Spain are an example of communities which are often marginalized and struggle to have their health needs met through their host health system. For instance, studies have reported a significantly higher prevalence of chronic infection of Hepatitis B virus (HBV) among migrants in comparison to the general Spanish population and late presentation to care in this population has been reported. CHWs have the potential to reach these underserved communities and provide culturally and linguistically appropriate health information, emphasizing the importance of HBV prevention, management and treatment, and vaccination. Ultimately, CHWs can offer decentralized and accessible health care and lead in co-creation processes for effective viral hepatitis - including HBV vaccination- services in community spaces and facilitate linkage to higher levels of care.