From Brazil to South West London: Lessons from a Multi-Site Evaluation of the Community Health and Wellbeing Worker Model
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Authors
Mohamed Elshishtawy
Thomas Herweijer
Contact
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Issue Date
06-May-26
Type
Conference Abstract
Language
Keywords
Neighbourhood health & place-based working , Working with people and communities , Rapid evaluation
Alternative Title
Abstract
Background & Objectives
Recent UK policy shifts emphasise three fundamental transitions: moving from treatment to prevention, analogue to digital, and hospital to community. As highlighted by the Marmot Review, addressing health inequalities requires innovative care models grounded in equitable prevention. Inspired by the Brazilian Family Health Strategy, the Community Health and Wellbeing Worker (CHWW) programme integrates community-based prevention within primary care to support vulnerable populations. This evaluation investigated the model's acceptability, feasibility, and impact across six South West London boroughs: Wandsworth, Croydon, Merton, Sutton, Richmond, and Kingston.
Methods
A 12–18 month mixed-methods evaluation was conducted across the six sites. Quantitative impact was tracked through primary care patient records (EMIS) and household data collection sheets to monitor the uptake of preventative services. These findings were complemented by qualitative data, including focus groups and resident case studies, which explored practical barriers to implementation and the requirements for systemic scaling within the NHS.
Results
The programme successfully engaged underserved residents throughout South West London, demonstrating that relational trust is the essential bridge to primary care. In Wandsworth, engaged residents were 2 to 8 times more likely to attend screenings than those not engaged, with the site recording 1,046 meaningful contacts. Sutton saw similar clinical gains, with screening and immunisation uptake 2.2 to 2.7 times higher in the engaged group. In Kingston, average wellbeing scores rose by 28% (from 5.88 to 7.56) following engagement. The model proved highly versatile; in Merton, the pilot reached complex, multigenerational households of up to seven individuals, addressing overlapping needs across health, housing, and social welfare. Additionally, Croydon facilitated 90 GP re-engagements and 6 new registrations, while Richmond recorded 2,119 total contacts focused on mitigating social isolation.
Discussion/Learning for Wider Community
The CHWW model offers a robust blueprint for achieving national policy shifts by increasing the uptake of preventative services and reducing health inequalities. For the wider community, the primary learning is that sustainability depends on transitioning from short-term pilots to long-term funding. Success requires full integration into primary care data systems, ensuring that proactive, community-led prevention becomes a permanent feature of the healthcare landscape rather than an isolated intervention.