This is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”. Community health workers (CHWs) are in an intermediary position between the health system <span class="attribute-to-highlight medbox">and</span> the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish <span class="attribute-to-highlight medbox">and</span> maintain benefcial relationships with both sets of actors, who may have diferent expectations <span class="attribute-to-highlight medbox">and</span> needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system <span class="attribute-to-highlight medbox">and</span> with communities.