Primary health care

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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Community health workers’ attitudes, practices and perceptions towards the COVID-19 pandemic in Brazilian low-income communities

Background: Community Health Workers (CHW) are a category of social workers described in many countries' health systems as responsible for engaging people in their residences and communities, and other non-clinical spaces to enable access to health services, especially in low-income areas. These professionals have been exposed to numerous new risks during the COVID-19 pandemic. Objective: This study describes how the COVID-19 pandemic is perceived by CHWs who work in poor communities or slums in Brazil. Methods: We conducted an online survey with a random sample of 775 CHWs operating in 368 municipalities of the 26 Brazilian states. At a confidence level of 95%, results of the survey were subject to a maximum sampling error of 4%. Results: Our data indicate that the negationist agenda increases the challenges to the performance of CHWs within low-income communities, preventing the consensus on the necessity of social distancing, business closures and other measures to face the COVID-19 pandemic. Conclusion: The pandemic imposes unexpected challenges on the usual modes of interaction of public health officers with poor communities. This study provides evidence that these challenges have been ignored or minimized in Brazilian policy prescriptions for primary care in the face of the COVID-19 pandemic.

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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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Assessing community health workers’conditions for delivering care to patients in low-income communities

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In this paper we study the working conditions of Community Health Workers in performing house calls within low-income, violent communities in order to understand the challenges in delivering primary care in developing countries. We conducted field studies in two primary healthcare clinics and telephone surveys for 5 months in 2017 within systematic sample of 1690 community health workers based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. A number of 759 interviews were completed, approximately 50% of the sample, 86% men and 14% women. Most participants are 30-39 years old (35%), followed by 27% of 40-49 years old participants. Results show that exposure to territorial violence and environmental or health-related diseases significantly affects CHWs. Moreover, CHWs have to develop a significant set of skills to cope with aspects of the territory, and those skills are not present in their training. As community health workers 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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Supporting decision-making in patient risk assessment using a hierarchical fuzzy model

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Abstract In this paper, we present a hierarchical fuzzy model to support patient triage in primary health care. In developing countries like Brazil, public health must usually cover degraded territories; thus, allocating patients to health services is very hard due low availability, enormous demands, and the complexity of assessing patient conditions—which must account for more then physical aspects of patients, but their social conditions as well. This approach combines the fuzzy set theory under the AHP framework in order to illustrate the inherent imprecision in the evaluation of patient risk. Fieldwork was conducted in a primary healthcare facility in Brazil to demonstrate the applicability of the proposed approach. The proposed approach represents criterion in the formation of patients’ risk scores encompassing important aspects of primary care triage such as the structure of families, the conditions of residences, exposure to urban violence, and other aspects of patients’ lives, taking the risk assessment beyond the simple evaluation of symptoms and physiological conditions. Our approach focuses on enforcing decisions of public health workers by improving the awareness of patients’ conditions, which we believe will make the employment of triage criteria uniform and capable of showing tendencies on patients’ risks, as well as avoiding bias in patient triage.

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Patient visits in poorly developed territories: a case study with community health workers

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In this paper, we study the effects of poor conditions of territories in patient visits performed by community health workers and the consequences to primary care policies. We carried a case study with community health workers in Rio de Janeiro, Brazil, including ethnographic observations in two primary healthcare clinics. Moreover, we present an analysis of the collected data with the support of the function resonance analysis method and we point out relations between the findings and the execution of the primary healthcare policy in a systemic approach. Thus, our study highlights the impacts of work situations in the health assistance of poorly developed communities, indicating how community health workers cope with adverse conditions, and how such situations affect the effectiveness of primary care policies.

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