Complexity and potentiality of the Community Health Workers' labor in contemporary Brazil

ABSTRACT The aim of this article was to analyze the Community Health Worker' (CHW) scope of practices, relating it to the social and health situation faced, as well as with facilitating and limiting elements of their practice. This is a cross-sectional study utilizing a mixed approach, including sequential explanatory strategy, carried out in four municipalities of Ceará. In the quantitative study, the sample of 160 CHW was randomized, and a structured instrument was used to collect data. In the qualitative study, six focal groups and interviews were carried out. We mainly found women (139; 86.9%), married (111; 69.4%), with a family income greater than or equal to 2 minumm wages (102; 63.7%), incomplete professional trainning (68; 42.5 %), from the urban area (114, 71.3%), acting as CHW for less than 10 years (93, 58.2%). The main activities were home visitation of priority groups and families registration. The complexity of the work was evidenced, which includes actions of health promotion and surveillance, such as prenatal care, immunizations, hypertension, diabetes, care for the elderly, among others. As limitations of their practices, we identified: deficiency of technical/professional training, reduced work support, and violence. As facilitators, we observed: permanent education and participatory management practices. The scope of CHW practices is complex and broad, including the articulation of public policies in the territory, which constitutes a potential for health promotion of vulnerable communities.

摘要 本文旨在分析社区卫生工作者（Community Health Worker, CHW）的执业范围，并将其与服务所处的社会与健康现状、执业过程中的促进及制约因素相关联。本研究为采用顺序解释策略的横断面混合研究，在巴西塞阿拉州（Ceará）的4个自治市开展。定量研究阶段，研究随机抽取160名社区卫生工作者作为样本，采用结构化研究工具收集数据。定性研究阶段，开展6次焦点小组访谈及个别访谈。研究对象主要为女性（139例，占比86.9%）、已婚者（111例，占比69.4%），家庭收入不低于2倍最低工资标准（102例，占比63.7%），未完成专业培训（68例，占比42.5%），来自城区（114例，占比71.3%），担任社区卫生工作者时长不足10年（93例，占比58.2%）。社区卫生工作者的核心执业活动为优先服务群体家庭访视与家庭建档。研究证实其工作具有较高复杂性，涵盖健康促进与健康监测相关工作，例如产前保健、免疫接种、高血压与糖尿病管理、老年照护等。其执业面临的主要制约因素包括：专业/技术培训不足、工作支持匮乏，以及遭遇暴力行为。而执业促进因素则包括继续教育与参与式管理实践。社区卫生工作者的执业范围复杂且广泛，涵盖在地公共政策的统筹协调，这为脆弱社区的健康促进工作提供了潜在发展空间。