Community health worker denominations: a global review through the case of French Guiana.

Abstract

Across more than 60 countries, individuals who bridge the gap between communities and formal health systems are designated by a wide array of terms-community health workers, promotores de salud, agentes comunitários de saúde, health mediators, and many others. This proliferation of denominations is often treated as a reflection of contextual diversity. This review argues that it also reveals a deeper structural reality: the incomplete institutionalisation of a workforce that is nonetheless essential to health systems worldwide. Drawing on a comparative analysis of over 60 denominations across regions, and grounded in the case of French Guiana-a French territory marked by geographic isolation, cultural diversity, and significant health inequalities-we examine both the common features shared by these roles and the meaningful distinctions embedded in their names. Across contexts, these workers occupy a similar structural position at the interface between communities and health systems, characterised by community embeddedness; a focus on prevention and access to care; and persistent tensions regarding remuneration, scope of practice, and professional recognition. At the same time, the diversity of denominations encodes variations in training, institutional affiliation, and underlying philosophies of engagement, particularly along the axes of community vs. system orientation, generalist vs. specialist mandate, and volunteerism vs. formal employment. While such distinctions are contextually meaningful, their multiplication contributes to fragmentation, limits comparability, and weakens the emergence of a shared professional identity. We argue that terminological proliferation functions as a substitute for institutional consolidation: in the absence of standardised training, stable employment frameworks, and clear professional recognition, naming becomes a site where these tensions are negotiated. Rather than multiplying labels, a more productive approach would combine a broad, inclusive category with a structured taxonomy of roles based on key dimensions such as training, function, and degree of integration into health systems. The case of French Guiana illustrates how diverse configurations of such roles can coexist within a single territory, while highlighting the need for clearer frameworks to support their recognition and sustainability.