State of Evaluation: Community Health Workers

Abstract

This paper presents the findings of a qualitative research which analyses the characteristics of the evaluation process of community health agents' work. The research was undertaken in three different municipalities. Community health agents, their supervisors, and Primary Health Care managers took part in the investigation, which consisted of semi-structured interviews and focus groups. The discussion was organized according to content analysis, and based on the concept of health work process. Four categories of analysis were proposed: work load minimization, productivism, disease control and supervision. These categories show the predominance of evaluation practices that emphasize quantitative results, particularly those related to coverage targets and to the performance of activities structured by the biomedical approach. Conclusions point to the importance of considering the limitations of the kind of evaluation practices used in Primary Health Care, and to the need for elaborating theoretical and methodological frameworks for evaluation that will effectively contribute to improve the health agents' work. DESCRIPTORS: Community health workers. Health evaluation. Family health. Health education. AVALIAÇÃO EM SAÚDE E REPERCUSSÕES NO TRABALHO DO AGENTE COMUNITÁRIO DE SAÚDE RESUMO: Este artigo apresenta resultados de uma pesquisa qualitativa que analisa as características do processo de avaliação relacionado ao trabalho do agente comunitário de saúde. A investigação foi desenvolvida em três municípios, tendo nela participado agentes de saúde, seus supervisores e gestores da Atenção Primária com os quais foram realizadas entrevistas semiestruturadas e grupos focais. A discussão foi organizada com base na análise de conteúdo e apoiada na noção de processo de trabalho em saúde. Foram compostas quatro categorias: minimização da carga de trabalho, produtivismo, controle de agravos e supervisão. Estas apontam o predomínio de práticas de avaliação, que enfatizam o alcance de resultados quantitativos, sobretudo relativos às metas de cobertura e à realização de atividades com enfoque biomédico. As conclusões sinalizam a importância de pensar as limitações deste tipo de práticas avaliativas difundidas na Atenção Primária e de elaborar proposições teórico-metodológicas que contribuam para o componente educativo do trabalho do agente comunitário. DESCRITORES: Agente comunitário de saúde. Avaliação em saúde. Saúde da família. Educação em saúde. LA EVALUACIÓN EN SALUD Y SUS REPERCUSIONES EN EL TRABAJO DEL AGENTE COMUNITARIO DE SALUD RESUMEN: Este artículo presenta resultados de una investigación cualitativa que analiza las características del proceso de evaluación relacionado al trabajo del 'Agente Comunitario en Salud'. La investigación fue desarrollada en tres municipios, teniendo como sujetos: agentes de salud, sus supervisores y gestores de Atención Primaria. Fueron realizadas entrevistas semi-estructuradas y grupos focales. La discusión fue organizada teniendo como base el análisis de contenido, apoyada en la noción de pr...

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