Challenges facing community health workers inBrazil's Family Health Strategy:Aqualitative study

Abstract

Community health worker (CHW) programs are implemented in many low- and middle-income countries such as Brazil to increase access to and quality of care for underserved populations; CHW programs have been found to improve certain indicators of health, but few studies have investigated the daily work of CHWs, their perspectives on what both helps and hinders them from fulfilling their roles, and ways that their effectiveness and job satisfaction could be increased. To examine these questions, we observed clinic visits, CHW home visits, and conducted semistructured interviews with CHWs in 7 primary care centers in Brazil-2 in Salvador, Bahia, and 5 in São Paulo, SP-in which CHWs are incorporated into the work of all primary care health teams. In addition to enhancing communication between the medical system and the community, CHWs consider their key roles to be helping persuade community members to seek medical care and increasing health professionals' awareness of the social conditions affecting their patients' health. Key obstacles that CHWs face include failure to be fully integrated into the primary care team, inability to follow-up on identified health needs due to limited resources, as well as community members' lack of understanding of their work and undervaluing of preventative medicine. Increased training, better incorporation of CHWs into clinic flow and decision making, and establishing a clear community awareness of the roles and value of CHWs will help increase the motivation and effectiveness of CHWs in Brazil.

Improving post-partum family planning services provided by female community health volunteers in Nepal: a mixed methods study

“…The qualitative findings also provided more information about the challenges FCHVs face while working in the communities. Some challenges were similar to those faced by community health workers (CHW) in other countries, such as Brazil, which included lack of understanding among the people and lack of respect of their work in communities [26]. FCHVs in this study, also pointed out the social barriers and deep-rooted misconceptions among the mothers about modern contraceptives making it difficult for them to convince the people in the communities of their benefits.…”

The community health worker as service extender, cultural broker and social change agent: a critical interpretive synthesis of roles, intent and accountability

“…28 Programmatic, social, management and political dynamics can shape the feasibility of cultural brokerage. For example, Brazilian CHWs felt their ability to elicit information about community needs was dependent on the long-term nature of their relationship with the neighbourhoods in which they work, 40 suggesting frequent staff turnover might constrain cultural brokerage. The hierarchical nature of health systems can prioritise the downward flow of information, such that health workers are expected to tell CHWs what to do, not gather information from them.…”

Examining Interprofessional teams structures and processes in the implementation of a primary care intervention (Health TAPESTRY) for older adults using normalization process theory

“…However, similar to the challenges experienced by physicians and medical residents who were typically working outside of the huddle in our study, volunteers also largely worked on the periphery of the interprofessional team, expressing the desire to be more connected to the primary care team. Fully integrating lay community health workers into the primary care team has been shown to be a challenge by others [31]. To improve future HT implementation, strategies are needed to strengthen multi-directional communication and engagement among all primary care team members including physicians and volunteers.…”