How do community health workers institutionalise: An analysis of Brazil’s CHW programme

Abstract

Community health workers (CHWs) are framed as the link between communities and the formal health system. CHWs must establish trusting relationships with the community and with the broader health service. How to find the optimal balance between the various strands of work for CHWs, and how to formalise this, has been the focus of different studies. We performed an extensive documentary analysis of federal legislation in Brazil to understand the institutionalisation of the CHW workforce in Brazil over the last 3 decades. The paper offers three contributions to the literature: the development and application of an analytical framework to consider the institutionalisation process of CHWs; a historical analysis of the professional institutionalisation of CHW in Brazil; and the identification of the paradoxes that such institutionalisation faces: firstly, institutionalisation focused on improving CHW remuneration created difficulties in hiring and paying these professionals; when CHW are incorporated within state bureaucracy they start to lose their autonomy as community agents; and that the effectiveness of CHW programmes depends on the improvement of clinical services in the most deprived areas.

Inequality in the middle of a crisis: an analysis of health workers during the COVID-19 pandemic from the profession, race, and gender perspectives

“…The results show that inequalities materialize differently in several contexts regarding the health emergency. Because of their recent professionalization 30 , CHW/CEW are the professionals with the lowest level of structure to work 31 , which is reflected in deficient access to material resources, lower support from managers, and lower support to take care of their mental health. At the same time, they indicated that their mental health was less affected and that they were slightly less exposed to harassment as they are professionals who did not work directly in hospitals, places with greater exposure to contamination and, thus, more significant pressure.…”

Desigualdade em meio à crise: uma análise dos profissionais de saúde que atuam na pandemia de COVID-19 a partir das perspectivas de profissão, raça e gênero

“…Os resultados mostram que as desigualdades se articulam de formas distintas em diferentes contextos à luz da emergência sanitária. Os ACS/ ACE, até por seu recente processo de profissionalização 30 , são os/as profissionais que contam com menos estrutura para atuar 31 . Isso se reflete no acesso mais precário a recursos materiais, no menor suporte recebido das chefias e em menos apoio para cuidar da saúde mental.…”

Pandemic-Related Impairment in the Monitoring of Patients With Hypertension and Diabetes and the Development of a Digital Solution for the Community Health Worker: Quasiexperimental and Implementation Study

“…To assess patients with hypertension, the CHW used an automatic arm BP monitor (OMRON HEM-7320). However, in Brazil, CHWs’ basic training for their role does not include performing nursing procedures, such as measuring capillary blood glucose [ 17 ]. So, in cases of DM, they guided patients to use dipsticks to assess glycosuria in an isolated urine sample.…”

“…The intervention was centralized in the CHW because of their close contact with the community through home visits, activities in support groups, and performance of preventive actions. They know about the families’ health and social conditions, adherence to treatment, and attendance at consultations at the PHCC [ 17 , 18 ].…”