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

Autor: Krieger MGM; Getulio Vargas Foundation (FGV EAESP), Sao Paulo, Brazil., Wenham C; Department of Health Policy, LSE, London, UK., Nacif Pimenta D; Oswaldo Cruz Foundation - Fiocruz, Belo Horizonte, Brazil., Nkya TE; Pan-Africa Mosquito Association, Nairobi, Kenya.; International Center of Insect Physiology and Ecology, Nairobi, Kenya.; College of Health and Allied Sciences, University of Dar es Salaam-Mbeya, Mbeya, Tanzania., Schall B; Oswaldo Cruz Foundation - Fiocruz, Belo Horizonte, Brazil., Nunes AC; Getulio Vargas Foundation (FGV EAESP), Sao Paulo, Brazil., De Menezes A; Department of Geography and Environment, LSE, London, UK., Lotta G; Getulio Vargas Foundation (FGV EAESP), Sao Paulo, Brazil.
Jazyk: angličtina
Zdroj: Global public health [Glob Public Health] 2022 Aug; Vol. 17 (8), pp. 1507-1524. Date of Electronic Publication: 2021 Jun 23.
DOI: 10.1080/17441692.2021.1940236
Abstrakt: 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.
Databáze: MEDLINE
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