How COVID-19 Has Affected Frontline Workers in Brazil: A Comparative Analysis of Nurses and Community Health Workers

Abstract

The need to respond to the COVID-19 pandemic has created challenges for services delivered by frontline workers (FLW). This paper analyzes how the Brazilian government regulated the reorganization of Primary Health Care (PHC) and how FLW responded to these initiatives, comparing the roles played by nurses and community health workers. Given the multilevel health system, it was expected that the high level of ambiguity would stimulate innovations. However, data show that the ambiguity created different situations for each profession. While nurses were able to adapt their work and act with more autonomy, CHW lost their role in the policy.

Street-Level Bureaucrats at the Forefront of Pandemic Response: A Comparative Perspective

“…Specifically, articles in this special issue demonstrate that health professionals and police officers were compelled to direct interactions (e.g. Lotta et al 2021;Møller 2021), whereas most teachers and providers of social services, even those working with vulnerable populations, were directed to adjust to online delivery (e.g. Collins et al 2020;Malandrino and Sager 2021;Pérez-Chiqués et al 2020).…”

“…In order to respond to unexpected, continuously changing circumstances (Farazmand 2001;Daléus and Hansén 2011;Henderson 2014;Savi 2014;Dunlop et al 2020), many countries, although not all, constantly and rapidly updated policy measures to stem the pandemic and address the crisis. Many of the articles in this special issue indeed demonstrate that formal policy decisions adjust policy instruments to newly emerging conditions by requiring additional and modified tasks, higher workload, and also increased risk exposure for SLBs in varied policy sectors, including education, policing, social services, and most prominently in healthcare (Collins et al 2020;Cox et al 2021;Davidovitz et al 2021;Lotta et al 2021;Malandrino and Sager 2021;Meza et al 2021;Møller 2021;Pérez-Chiqués et al 2020). Interestingly, absence of government measures (Lotta et al 2021), frequent updates (Davidovitz et al 2021), and contrasting approaches in multi-level government settings all reflect intensified policy ambiguity (Pérez-Chiqués et al 2020).…”

“…Health professionals were obligated to treat, and thus directly interact with, COVID-19 patients (e.g. Lotta et al 2021;Meza et al 2021), whereas others were instructed either to adopt virtual delivery of their services (e.g. Collins et al 2020;Pérez-Chiqués et al 2020) or to target only extreme cases (Møller 2021).…”

“…The more new tasks SLBs are assigned, and the higher the policy ambiguity, the broader is the expansion of granted discretion (e.g. Davidovitz et al 2021;Malandrino and Sager 2021;Lotta et al 2021). Enhancement of SLBs' granted discretion also derives from formal relaxation of restrictions and more flexibility of services (Collins et al 2020).…”

“…The former is evidenced both in public visibility and attention (Musheno et al 2021), as well as in official policy decisions, known as policyas-designed or policy-as-written, which reflect the formal duties, tasks, and responsibilities that decision-makers require from SLBs in treating the pandemic (Collins et al 2020;Cox et al 2021;Davidovitz et al 2021;Pérez-Chiqués et al 2020). Implications for the ways in which street-level implementation is practiced, known as policy-aspracticed, are evidenced in SLBs' actions and responses to the conditions imposed by the crisis and by official government policy decisions (Brodkin 2021;Cox et al 2021;Lotta et al 2021;Malandrino and Sager 2021;Meza et al 2021;Møller 2021).…”