O processo de trabalho dos agentes comunitários de saúde: contribuições para o cuidado em territórios rurais remotos na Amazônia, Brasil

Abstract

Resumo: O objetivo do artigo é analisar o processo de trabalho dos agentes comunitários de saúde (ACS) em municípios rurais remotos e identificar especificidades e contribuições para o cuidado na atenção primária à saúde. O estudo qualitativo abrangeu 23 entrevistas com ACS e enfermeiros das equipes de saúde da família em cinco municípios rurais remotos do oeste do Pará, Brasil. A análise do processo de trabalho dos ACS contemplou duas dimensões interligadas: escopo de práticas e qualificação para o trabalho. O escopo de práticas mostrou-se abrangente, envolvendo acompanhamento familiar, cuidados e medidas preventivas individuais, abordagem coletiva e atividades administrativas. As visitas domiciliares constituem a principal ação dos ACS e uma importante forma de contato dos serviços de saúde com os usuários, atendendo a diferentes objetivos de cadastro, cuidado ou informação. Os ACS de localidades rurais remotas, em geral o único recurso de saúde acessível, apresentaram escopo de práticas mais abrangente que os da sede dos municípios, com inclusão de procedimentos individuais. A qualificação dos ACS para o trabalho pode potencializar ou limitar o desenvolvimento de suas práticas e foi expressa por alta motivação dos ACS, insuficiente supervisão e educação permanente e baixa integração com a equipe. São necessárias políticas que reconheçam as especificidades e garantam maior apoio (materiais, transporte e educação permanente) para o pleno desenvolvimento do trabalho do ACS nos municípios rurais remotos amazônicos. O conjunto ampliado de práticas dos Agentes sugere ser este um relevante ator para promover cuidados, facilitar acesso da população à rede de atenção à saúde e um elo real entre populações rurais e serviços de saúde em municípios rurais remotos.

Prevalence of not receiving a home visit by Community Health Agents in Brazil and associated factors

“…The work of the CHAs have often been focused on bureaucratic tasks and tasks of support provided to health units, for instance, sorting out files on the users, reception and welcoming, organization of lines, making phone calls, and even cleaning tasks, considered a deviation of function by the CHAs themselves 13 . There is evidence in the literature regarding the functions, strengths, and contributions of the work of the CHAs throughout the coun-try 3,12,26,[31][32][33] ; however, they have been losing some attributions, such as the demographic and sociocultural diagnosis of the community, and have been consolidating the commitment with fragmented activities, such as filing documents of the users of the micro-area 3 . One nationwide study showed fragilities related to the mapping of the FHS territories, neglecting the social context, since 84% of the teams used maps to define their territory, but only 6% of the teams that we studied indicated socioeconomic conditions of the areas as part of their sanitary responsibility 34 .…”

“…The results of the current study also show that the home visit by a CHA promotes health equity, since its prevalence is higher in poorer places like the Northeastern region of the country; in towns with smaller populations; and among users who are older and have less income, who have chronic health conditions, or who have a relative with physical disabilities at home. The contribution of the work of the CHAs and the FHS teams in improving the health indicators and promoting health equity is widely recognized and published in literature 5,8,9,12,16,26,37 .…”

“…In the context of the FHS, the CHAs provide overall primary health support, by visiting each family once a month regardless of need 11 . The home visits are the main activity of the CHAs 12 , to which they attribute high importance and are part of their work routine 13 . Through the home visits, the CHAs are prepared to produce family records and keep them updated; to help the FHS teams to identify risk areas, as well as individual and group risk situations; to refer people to the proper health services; to guide health promotion and protection; to follow the treatment and rehabilitation of sick people, following the advice of the health units; to mobilize the community to achieve better environments and health conditions, and to notify the cases of diseases which require surveillance 2,14 .…”

“…Through the home visits, the CHAs are prepared to produce family records and keep them updated; to help the FHS teams to identify risk areas, as well as individual and group risk situations; to refer people to the proper health services; to guide health promotion and protection; to follow the treatment and rehabilitation of sick people, following the advice of the health units; to mobilize the community to achieve better environments and health conditions, and to notify the cases of diseases which require surveillance 2,14 . In this context, the CHAs become a link between the community and health services, facilitating the creation of connections between users and professionals 2,12 .…”

Bases para la estructuración de un modelo en salud rural en Arauca

“…En esta revisión, diversos investigadores alrededor del mundo plantean estrategias para garantizar el reclutamiento de talento humano (27) o el apoyo con agentes comunitarios (28), los cuales son monitoreados desde las ciudades por profesionales. Cada uno plantea las ventajas de su propuesta y algunos de ellos presentan en sus resultados o discusiones la efectividad de estas.…”