Contribution of community health workers to primary health care performance in Brazil
DOI:
https://doi.org/10.11606/s1518-8787.2020054002327Keywords:
Primary Health Care, Community Health Workers, Health Services Research, BrazilAbstract
OBJECTIVE: To associate the strength of community health workers interventions with primary health care strategies for women’s and children’s health, diabetes, and hypertension. METHODS: This is a cross-sectional study assessing 29,778 family health teams working in primary health care in Brazil in 2014. The association between community health workers activity levels and primary health care facilities was analyzed using multiple logistic regression. RESULTS: We found higher levels of community health workers activities strongly associated with primary health care practices (OR = 6.88) for those activities targeting hypertension management, followed by children’s health (OR = 6.56), and women’s health (OR = 6.21). CONCLUSIONS: At a time when Brazil discusses whether community health workers should or should not remain in the same scale-up and skill level as they currently are, our results reinforce the importance of these workers for the care model advocated by the Brazilian Unified Health System.
References
Lewin S, Dick J, Pond P, Zwarenstein M, Aja GN, Wyk BE, et al. Lay health workers in primary and community health care. Cochrane Database Syst Rev. 2005;(1):CD004015. https://doi.org/10.1002/14651858.CD004015.pub2
Lehmann U, Sanders D. Community health workers: what do we know about them? The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva: World Health Organization; 2007 [cited 2018 Nov 28]. Available from: https://www.who.int/hrh/documents/community_health_workers.pdf
Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014;35:399-421. https://doi.org/10.1146/annurev-publhealth-032013-182354
Landers S, Levinson M. Mounting evidence of the effectiveness and versatility of community health workers. Am J Public Health. 2016;106(4):591-2. https://doi.org/10.2105/AJPH.2016.303099. 5. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 2010;2010(3):CD004015.
https://doi.org/10.1002/14651858.CD004015.pub3
Ministério da Saúde (BR). SAGE - Sala de Apoio à Gestão Estratégica. Brasília, DF; 2016 [cited 2017 Sept 21]. Available from: http://sage.saude.gov.br/?link=paineis/acs/corpao&flt=false¶m=null
Melo EA, Mendonça MHM, Oliveira JR, Andrade GCL. Mudanças na Política Nacional de Atenção Básica: entre retrocessos e desafios. Saude Debate. 2018;42 Nº Espec 1:38-51. https://doi.org//10.1590/0103-11042018s103.
Giugliani C, Harzheim E, Duncan MS, Duncan BB. Effectiveness of community health workers in Brazil: a systematic review. J. Ambul Care Manage. 2011;34(4):326-38. https://doi.org/10.1097/JAC.0b013e31822cbdfd
Ministério da Saúde (BR). Programa de Melhoria do Acesso e da Qualidade na Atenção Básica. Manual instrutivo para as equipes de Atenção Básica (Saúde da Família, Saúde Bucal e Equipes Parametrizadas) e NASF. Brasília, DF; 2013 {cited 2018 Sept 21]. Available from: http://189.28.128.100/dab/docs/portaldab/publicacoes/manual_instrutivo_PMAQ_AB2013.pdf
Kok MC, Dieleman M, Taegtmeyer M, Broerse JEW, Kane SS, Ormel H, et al. Which intervention design factors influence performance of community health workers in low- and middle-income countries? A systematic review. Health Policy Plan. 2015;30(9):1207-27. https://doi.org/10.1093/heapol/czu126
Källander K, Strachan D, Soremekun S, Hill Z, Lingam R, Tibenderana J, et al. Evaluating the effect of innovative motivation and supervision approaches on community health worker performance and retention in Uganda and Mozambique: study protocol for a randomized controlled trial. Trials 2015;16:157. https://doi.org/10.1186/s13063-015-0657-6
Kim K, Choi JS, Choi E, Nieman CL, Joo JH, Lin FR, et al. Effects of community-based health worker interventions to improve chronic disease management and care among vulnerable populations: a systematic review. Am J Public Health. 2016;106(4):e3-e28. https://doi.org/10.2105/AJPH.2015.302987
Allen JK, Himmelfarb CRD, Szanton SL, Bone L, Hill MN, Levine DM. COACH trial: a randomized controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers: rationale and design. Contemp Clin Trials. 2011;32(3):403-11. https://doi.org/10.1016/j.cct.2011.01.001
Brownstein JN, Chowdhury FM, Norris SL, Horsley T, Jack Jr L, Zhang X, et al. Effectiveness of community health workers in the care of people with hypertension. Am J Prev Med. 2007;32(5):435-47. https://doi.org/10.1016/j.amepre.2007.01.011
Hunt CW, Grant JS, Appel SJ. An integrative review of community health advisors in type 2 diabetes. J Community Health. 2011;36(5):883-93. https://doi.org/10.1007/s10900-011-9381-7
Palmas W, March D, Darakjy S, Findley SE, Teresi J, Carrasquillo O, et al. Community health worker interventions to improve glycemic control in people with diabetes: a systematic review and meta-analysis. J Gen Intern Med. 2015;30(7):1004-12. https://doi.org/10.1007/s11606-015-3247-0
Hoke TH, Wheeler SB, Lynd K, Green MS, Razafindravony BH, Rasamihajamanana E, et al. Community-based provision of injectable contraceptives in Madagascar: ‘task shifting’ to expand access to injectable contraceptives. Health Policy Plan. 2012;27(1):52-9. https://doi.org/10.1093/heapol/czr003
Prost A, Colbourn T, Seward N, Azad K, Coomarasamy A, Copas A, et al. Women’s groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. Lancet. 2013;381(9879):1736-46. https://doi.org/10.1016/S0140-6736(13)60685-6
HIP ~ Family Planning High Impact Practices. Community health workers: bringing family planning services to where people live and work. Baltimore, MD: Johns Hopkins University, HIP Family Planning High Impact Practices; c2020 [cited 2018 Nov 28]. Available from: https://www.fphighimpactpractices.org/briefs/community-health-workers/
Huber D, Saeedi N, Samdi, AK. Achieving success with family planning in rural Afghanistan. Bull World Health Organ. 2010;88(3):227-31. https://doi.org/10.2471/BLT.08.059410
Fernández ME, Gonzales A, Tortolero-Luna G, Williams J, Saavedra-Embesi M, Chan W, et al. Effectiveness of Cultivando la Salud: a breast and cervical cancer screening promotion program for low-income Hispanic women. Am J Public Health. 2009;99(5):936-43. https://doi.org/10.2105/AJPH.2008.136713
Engelstad LP, Stewart S, Otero-Sabogal R, Leung MS, Davis PI, Pasick RJ. The effectiveness of a community outreach intervention to improve follow-up among underserved women at highest risk for cervical cancer. Prev Med. 2005;41(3-4):741-8. https://doi.org/10.1016/j.ypmed.2005.06.003
Wells KJ, Luque JS, Miladinovic B, Vargas N, Asvat Y, Roetzheim RG, et al. Do community health worker interventions improve rates of screening mammography in the United States? A Systematic review. Cancer Epidemiol Biomarkers Prev. 2011;20(8):1580-98. https://doi.org/10.1158/1055-9965.EPI-11-0276
Crump SR, Shipp MPL, McCray GG, Morris SJ, Okoli JA, Caplan LS, et al. Abnormal mammogram follow-up: do community lay health advocates make a difference? Health Promot Pract. 2008;9(2):140-8. https://doi.org/10.1177/1524839907312806
Glenton C, Scheel IB, Lewin S, Swingler GH. Can lay health workers increase the uptake of childhood immunisation? Systematic review and typology. Trop Med Int Health. 2011;16(9):1044-53. https://doi.org/10.1111/j.1365-3156.2011.02813.x
Wadge H, Bhatti Y, Carter A, Harris M, Parston G, Dazi A. Brazil’s Family Health Strategy: using community health care workers to provide Primary Care. New York: The Commonwealth Fund; 2016 [cited 2018 Oct 29]. Available from: https://www.commonwealthfund.org/publications/case-study/2016/dec/brazils-family-health-strategy-using-community-health-care-workers
Protasio APL, Gomes LB, Machado LS, Valença AMG. Satisfação do usuário da Atenção Básica em Saúde por regiões do Brasil: 1º ciclo de avaliação externa do PMAQ-AB. Cienc Saude Coletiva. 2017;22(6):1829-44. https://doi.org/10.1590/1413-81232017226.26472015
Abreu DMX, Araújo LHL, Reis CMR, Lima AMLD, Santos AF, Jorge AO, et al. Percepção dos usuários sobre o cuidado prestado por equipes participantes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica no Brasil. Epidemiol Serv Saude. 2018;27(3):e2017111. https://doi.org/10.5123/S1679-49742018000300002
Teixeira MB, Casanova A, Oliveira CCM, Ensgtrom EM, Bodstein RCA. Avaliação das práticas de promoção da saúde: um olhar das equipes participantes do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Saude Debate. 2014;38 Nº Espec:52-68. https://doi.org/10.5935/0103-1104.2014S005
Pelissari DM, Bartholomay P, Jacobs MG, Arakaki-Sanchez D, Anjos DSO, Costa MLS, et al. Oferta de serviços pela atenção básica e detecção da incidência de tuberculose no Brasil. Rev Saude Publica. 2018;52:53. https://doi.org/10.11606/s1518-8787.2018052000131
Lima JG, Giovanella L, Fausto MCR, Bousquat A, Silva EV. Atributos essenciais da Atenção Primária à Saúde: resultados nacionais do PMAQ-AB. Saude Debate. 2018;42 Nº Espec 1:52-66. https://doi.org/10.1590/0103-11042018s104
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