Brazil has more than 286,000 community health workers who are integrated into the national primary health care program. These professionals form a wide network serving 75% of the population, especially low-income families who do not have health insurance and who are most affected by the COVID-19 pandemic.
“Back in March, researchers at Imperial College London listed Brazil’s network of community health workers as a valuable asset that can guarantee an effective response to the pandemic. According to the article, the services they provide are an example that other countries should follow. But the response is not. effective, there is no national plan, and the services provided by public health workers are deemed unimportant for controlling disease until July.
They are not even considered health professionals and so are not provided with personal protective equipment [PPE], just to take one example, “said Gabriela Lotta, a professor at the Getúlio Vargas Foundation (FGV). Lotta is affiliated with the Center for Metropolitan Studies (CEM), one of the Centers for Research, Innovation and Dissemination (RIDC) funded by São Paulo. Research Foundation – FAPESP.
In collaboration with researchers at the Oswaldo Cruz Foundation (Fiocruz, a leading public health research institute linked to the Brazilian Ministry of Health), York University (UK), and the London School of Economics, Lotta wrote an article published in the Comments section on Lancet warned that community health workers in Brazil were treated with neglect during the pandemic.
Few countries have community health workers, but researchers at Imperial College London are focusing on Brazil’s advantage in this as it was one of the first countries to create such a network as an integral part of primary care and national health systems. [in Brazil, Sistema Único de Saúde, SUS]. In most countries, community health workers are not part of the official health system but belong to NGOs or civic associations. “
Gabriela Lotta, Professor at the Getulio Vargas Foundation
Thanks to these structural features, he added, Brazilian community health workers will be able to perform important functions during the pandemic, “provided they have PPE, training, government policy support, support and recognition of its significance”.
Three levels of government
For Lotta, the neglect of community health workers shows an effect on cities that do not have a national plan to fight the pandemic: although the services they provide are run by local authorities, the federal government is responsible for funding and other support mechanisms.
“There are big differences between cities in Brazil,” said Lotta. “Municipalities feel bound if they lack the funds and other resources to define their own strategies. There must be a national plan, with substantial transfers from the federal government to fund community health workers. It’s up to local governments to. Of course, if a city has the resources, it does. can use them, but the federal government has to shoulder most of the burden and establish policies. That includes determining whether community health workers are health professionals and whether they should be paid harm. All of these decisions should apply to all national health services. “
During the first four months of the pandemic, continued Lotta, public health workers received neither training nor PPE. They were finally classified as key workers only on July 21, 2020, when President Bolsonaro signed Law 14,023/2020.
“Because there is no national plan and they are not even classified as health professionals, only 9% received training in infection control and PPE. Their union says around 100 people have died from COVID-19, but the true number is probably three times as high, “said Lotta.
Brazil has one of the highest mortality rates for nurses, nursing assistants and nursing technicians in the world affected by COVID-19, according to the International Council of Nurses (ICN). In its latest update, the Brazilian Federal Council of Nurses (COFEN) pointed to 441 deaths. The number of doctors who died from the disease had reached 244 in September, according to the São Paulo Doctors Association.
“The law is positive, although it has not been implemented yet,” said Lotta. “Better late than never. At least there is a rule of law that states that public health workers have the right not to go to work if they are not given PPE. They have no prior rights. They are very vulnerable.”
However, he added, the law does not necessarily solve the problems of public health workers or ensure they play an effective role in fighting the pandemic. “This is an important contribution, but it doesn’t necessarily translate into a better policy,” he said. “Even with this law, local governments lack the means to prioritize community health workers in fighting the pandemic until strategic plans and funding schemes are established.”
Main function, key workers
Among the functions that community health workers can perform during the pandemic, Lotta highlighted key activities such as tracing the contacts of infected people, fighting fake news by spreading reliable information, and monitoring social isolation on confirmed cases.
“They are already acting as health educators. They live in the communities where they work and are seen as trustworthy and legitimate,” he said. “Keeping their neighbors well informed about personal hygiene, and the importance of face coverings and social isolation is an effective way to neutralize fake news. Some cities have community health workers circulating in cars with loudspeakers to provide this kind of information.”
Contact tracing will not be a problem for them, said Lotta. “They have done something very similar to contact tracing when they were monitoring public health care needs. In some Brazilian cities that have been doing contact tracing, it is being done by community health workers,” he said.
They can phone bank staff to call patients with isolated illnesses at home and assess their need for hospitalization if local authorities provide thermometers and pulse oximeters, he added.
They can also set up roadblocks at entrances to many cities. “The disease is transmitted to many small and medium-sized cities by visitors who are infected but show no symptoms, especially if the place becomes a tourist attraction,” said Lotta. “Some local authorities put up roadblocks manned by community health workers, who take people’s temperature when they arrive by car and inform them of steps to deal with the pandemic. Of course, in this case, they have to provide PPE and another kind of support. We have the structure, and if those seemingly simple but important measures are implemented universally, it will have a positive impact in terms of containing the transmission of the virus. “