Canadian primary care needs community health workers as relational infrastructure

Canada's primary care system faces persistent challenges related to access, continuity, and coordination. These pressures are commonly framed in terms of health workforce shortages, long waits, and growing demand associated with population aging and immigration. But capacity constraints do not fully account for the problem. Many access failures also arise before and between clinical encounters: needs go unrecognized, entry points are unclear or culturally misaligned, referrals break down across handoffs, and follow-up is not sustained. These breakdowns disproportionately affect people facing structural barriers such as language, poverty and food insecurity, limited digital access, geographic isolation, and administrative complexity. This policy analysis argues that community health workers (CHWs) can address these failures by providing the relational infrastructure needed to strengthen prevention, navigation, follow-up, and linkage to community-based supports, while complementing regulated providers. Drawing on comparative experience (Brazil, Rwanda, and England) and Canadian precedents, the paper distills design requirements for routinizing CHW functions at scale: assigning responsibility for outreach and follow-up, embedding CHWs within team workflows and pathways with supervision, enabling CHWs to bring community knowledge and priorities into service planning and decision-making, and ensuring stable financing. The analysis further emphasizes that equity benefits depend on pathfway design, community-sector capacity, and measurement that prioritizes connection achieved and sustained rather than referral counts alone. The paper concludes with recommendations for a Canadian policy framework that enables provincial adaptation while establishing common standards for role definition, training, supervision, accountability, and equity-aligned evaluation.