House calls

Community health workers’ non-technical skills for delivering primary healthcare in low-income areas

BACKGROUND: To overcome the poor conditions of low-income areas in developing countries like Brazil, Community Health Workers (CHWs) are required to exceed the regular set of formal skills they are used to employ. OBJECTIVE: In this study, we aim at identifying the non-technical skills CHWs must develop to cope with the extraordinary situations that occur in vulnerable communities. METHODS: 41 CHWs based in two primary healthcare clinics in Brazil underwent two rounds of in-depth interviews. The analysis was carried out using the Analytical Hierarchy Process, resulting in the prioritization of social skills according to their calculated importance to house calls. RESULTS: Among the ten higher-scored skills, we find communication and advocacy skills being of high importance. Civility was found to be the most important attribute, confirming that community action relies strongly on the relationship between health professionals and the community. CONCLUSION: The results of our study contribute primarily to the improvement of community-based primary care programs as it helps to identify major skills required for community action.

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Effects of Urban Violence on Primary Healthcare: The Challenges of Community Health Workers in Performing House Calls in Dangerous Areas

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Community health workers in developing countries usually perform house calls in degraded and violent territories. Thus, in this paper we study the effects of urban violence in the performance of CHWs in poorly developed territories, in order to understand the challenges of delivering care to dangerous communities in developing countries. We conducted telephone surveys for 5 months in 2017, within a systematic sample of 2.000 CHWs based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. We completed 766 interviews, approximately 40% of the sample, 86% man and 14% women. Most participants are 30 to 39 years old (35%), followed by 27% of 40 to 49 years old participants. As CHWs work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difficulties in implementing primary care policies.

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