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Between bond and distance: challenges in the performance of Community Health Workers

Abstract

Community Health Workers (CHW) are street-level bureaucrats who play a key role in the implementation of Primary Health Care (PHC). Their function involves establishing a bond with the families assisted by this health service, which allows knowing the reality of the territory and the vulnerabilities of the population. This article aims to analyze the configuration of CHW interactions in PHC implementation, focusing on the consequences caused by recent changes in this policy and by the Covid-19 Pandemic. An ethnography was conducted in a PHC Health Unit in the city of Porto Alegre. During four months, we observed the work of six CHW, analyzing their main activities and changes in their routine. Furthermore, six semi-structured interviews were held to compose the analysis. It was possible to identify that the internal organization of the Health Unit is not oriented to community work and to the identification of demands in the territory. The CHW are losing the bond with the population and limiting themselves to bureaucratic functions. The most vulnerable territories and families are the most affected by these changes, as their problems are no longer recognized by this public policy.

Keywords:
Implementation; Street-level Bureaucracy; Interactions; Primary Health Care; Community Health Workers


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