Elaboration and validation of a booklet on diabetes for Community Health Workers.

OBJECTIVES: to develop and validate a diabetes booklet for Community Health Workers. METHODS: methodological study developed in seven steps: Bibliographic review; Development of the booklet; Calculation of readability and comprehensibility scores; Validation of the booklet by the committee of judges; Discussion between experts; Validation of the booklet by the target audience; and Final discussion between experts. Validation was performed by 10 judges via e-Surv and on a face-to-face test with 5 Community Health Workers, considering the minimum Content Validity Coefficient of 0.80. RESULTS: the booklet had a mean Content Validity Coefficient of 0.97 in the validation by the committee of judges, and the images had 96.67% approval. In the face-to-face test, the Community Health Workers considered the material clear and appropriate to the function. CONCLUSIONS: the booklet was developed and validated on its content and relevance, and it can be used by Community Health Workers for diabetes education.

[I promotori di salute come attori-protagonisti delle cure primarie nel controllo delle malattie comunicabili e non comunicabili e nell' empowerment delle comunità. Esperienza e risultati di lungo periodo in aree marginali in Ecuador dal 1980 al 2018.] / The community health promoters as protagonist actorsof primary health care and community empowerment:a long term field-report from 1980 to 2018.

. INTRODUCTION: Against the increasing recognition of the critical importance of a direct participation of community members to assure effective health care in peripheral areas of Middle and Low Income Countries (MLIC), representative field experiences of their essential role are only occasionally available. AIMS AND METHODS: We report a narrative, factual documentation of a spectrum of projects covering the basic and specific health needs of the disperse communities in Ecuador, a model MLIC, and discuss the broader implications of the role and performance of HPs over a long period, 1980-2018, in the project activation, implementation and monitoring. RESULTS: The role of 60 HPs, with the coordination of a small core group of professionals of the Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET) is documented through their main achievements which include: infectious diseases and in particular Neglected Tropical Diseases (eradication of onchocerciasis and yaws; virtual elimination of malaria and of strongyloidiasis; identification and control of a new focus of Chagas Disease; control of tuberculosis), mother and child health, reproductive health, hypertension (as model of the emergence of non-transmissible, chronic diseases). The most effective and sustainable strategies and methods are discussed also in terms of their more general transferability, already partially tested in programs in Bolivia, Burkina Faso, undeserved areas of Argentina. CONCLUSIONS: The systematic availability of non-professional, trained HPs should be recommended as a sustainable and reliable component of health care strategies and interventions targeted to marginalized settings, to assure a concrete accessibility to the fundamental human right to life.

Elaboration and validation of a booklet on diabetes for Community Health Workers / Elaboración y validación de una cartilla sobre diabetes para los Agentes Sanitarios / Elaboração e validação de cartilha sobre diabetes para Agentes Comunitários de Saúde

ABSTRACT Objectives: to develop and validate a diabetes booklet for Community Health Workers. Methods: methodological study developed in seven steps: Bibliographic review; Development of the booklet; Calculation of readability and comprehensibility scores; Validation of the booklet by the committee of judges; Discussion between experts; Validation of the booklet by the target audience; and Final discussion between experts. Validation was performed by 10 judges via e-Surv and on a face-to-face test with 5 Community Health Workers, considering the minimum Content Validity Coefficient of 0.80. Results: the booklet had a mean Content Validity Coefficient of 0.97 in the validation by the committee of judges, and the images had 96.67% approval. In the face-to-face test, the Community Health Workers considered the material clear and appropriate to the function. Conclusions: the booklet was developed and validated on its content and relevance, and it can be used by Community Health Workers for diabetes education.

RESUMEN Objetivos: desarrollar y validar una cartilla sobre diabetes para los Agentes Sanitarios. Métodos: se trata de un estudio metodológico desarrollado en siete etapas: Estudio bibliográfico; Preparación de la cartilla; Cálculo de las fórmulas de legibilidad y aprehensibilidad; Validación de la cartilla por el comité de jueces; Discusión entre expertos; Validación de la cartilla por el público objetivo; y Discusión final entre los expertos. Diez jueces realizaron la validación vía e-Surv; y la prueba cara a cara, cinco Agentes Sanitarios, considerando el Coeficiente de Validez de Contenido mínimo de 0,80. Resultados: la cartilla tuvo un Coeficiente de Validez de Contenido promedio de 0,97 en la validación del comité de jueces, y las imágenes obtuvieron el 96,67% de aprobación. En la prueba cara a cara, los Agentes Sanitarios consideraron que el material era claro y apropiado para la función. Conclusiones: la cartilla se diseñó y se validó en cuanto a su contenido y a su relevancia y los Agentes Sanitarios podrán usarla en acciones de educación sobre la diabetes.

RESUMO Objetivos: elaborar e validar uma cartilha sobre diabetes para os Agentes Comunitários de Saúde. Métodos: estudo metodológico desenvolvido em sete etapas: Levantamento bibliográfico; Elaboração da cartilha; Cálculo das fórmulas de legibilidade e apreensibilidade; Validação da cartilha por comitê de juízes; Discussão entre especialistas; Validação da cartilha pelo público-alvo; e Discussão final entre especialistas. A validação foi realizada por 10 juízes via e-Surv; e o teste face a face, por 5 Agentes Comunitários de Saúde, considerando o Coeficiente de Validade de Conteúdo mínimo de 0,80. Resultados: a cartilha teve um Coeficiente de Validade de Conteúdo médio de ٠,٩٧ na validação pelo comitê de juízes, e as imagens tiveram ٩٦,٦٧٪ de aprovação. No teste face a face, os Agentes Comunitários de Saúde consideraram o material claro e adequado à função. Conclusões: a cartilha foi elaborada e validada quanto ao conteúdo e relevância, podendo ser utilizada pelos Agentes Comunitários de Saúde nas ações de educação em diabetes.

Discretion, power and the reproduction of inequality in health policy implementation: Practices, discursive styles and classifications of Brazil's community health workers.

This article explores the mobilization of power by health workers during policy implementation, showing how in a context of discretion and resource scarcity they can reproduce inequalities in access to health services. The argument innovates theoretically by supplementing the 'street-level bureaucracy' literature, which emphasizes frontline worker discretion, with a conceptualization of power as domination encompassing the shaping of behavior, the constitution of subjects and the reproduction of inequality. Empirically, the article focuses on Brazilian community health workers (agentes comunitários desaúde, CHWs). CHWs are a neglected but highly important segment of the health workforce that traditionally functions as a link between the health system and disadvantaged groups. The article examines how Brazilian CHWs act as street-level bureaucrats mobilizing power in their interactions with users. They operate within a severely under-resourced public health system, the Sistema Único de Saúde, which places constraints upon their action and forces them to make allocation decisions with little training and support. The article highlights the ways in which inequalities in access to health services are reproduced (inadvertently or not) through the practices, discursive styles and classifications of CHWs. Methodologically, the paper is based on ethnography with 24 CHWs and interviews with 77 other CHWs in Brazil.

Jornadas APS 2018: El trabajo de los equipos del primer nivel de atención: E-posters / APS 2018 Conference: The work of primary care teams: E-posters

Jornadas dirigidas a profesionales, técnicas/os, auxiliares, administrativas/os y funcionarias/os del sistema público de salud de la Ciudad de Buenos Aires, así como a referentes y promotores comunitarios e integrantes de organizaciones de la sociedad civil con trabajo en el primer nivel de atención. Se presentan experiencias desarrolladas en ámbitos institucionales y comunitarios, con el fin de generar debates e intercambios que promuevan la mejora y la transformación de las prácticas en salud. Incluye el documento marco de las Jornadas, resúmenes y e-posters

Integrative and complementary practices: use by community health agents in self-care.

OBJECTIVE: To verify the use of integrative and complementary practices (ICPs) by community health agents working in family health teams. METHODS: Cross-sectional, quantitative research, conducted in the city of Montes Claros, Minas Gerais. An structured form was used for the characterization of participants and use of ICPs. Descriptive and bivariate analyses were conducted. RESULTS: Use of ICPs was referenced by 94 (40.7%) agents. The use of medicinal plants was predominant (32.5%). There were associations between: ICPs in general and negative self-perception of health (p=0.032), homeopathy and higher education (p=0.015), massage and living with partner(p=0.024), chiropractic care and income equal to or greater than four minimum wages (p=0.031), relaxation/meditation and religion (p=0.028). CONCLUSION: The use of ICPs was verified in the healthcare of community agents. It is necessary to strengthen these practices for the promotion of health and prevention of diseases.

Complexidade e potencialidade do trabalho dos agentes comunitários de saúde no Brasil contemporâneo / Complexity and potentiality of the community health workers' labor in contemporary Brazil

RESUMO O objetivo deste artigo foi analisar o escopo de práticas dos Agentes Comunitários de Saúde (ACS) relacionando-o à situação social e de saúde, bem como os elementos facilitadores e os limitantes. Trata-se de um estudo transversal de abordagem mista, e estratégia explanatória sequencial, realizado em quatro municípios do Ceará. No estudo quantitativo, a amostra de 160 ACS foi aleatória com instrumento estruturado. No qualitativo, realizou-se seis grupos focais e entrevistas. Prevaleceram, na amostra, mulheres (139; 86,9%), casadas (111; 69,4%), com renda familiar maior ou igual a 2 salários mínimos (102; 63,7%), nível técnico incompleto (68; 42,5%), da zona urbana (114; 71,3%), atuando como ACS há menos de 10 anos (93; 58,2%). As principais atividades foram visitação domiciliar de grupos prioritários e cadastramento de famílias. Evidenciou-se a complexidade do trabalho, que inclui ações de promoção e vigilância à saúde como pré-natal, imunizações, hipertensão, diabetes, cuidado com idosos, entre outros. Como limitantes das práticas, identificaram-se: deficiência da formação técnica, suporte reduzido no trabalho e violência. Como potencializadores: educação permanente e gestão participativa. O escopo de práticas dos ACS é complexo e abrangente, incluindo a articulação de políticas públicas no território, o que se constitui em uma potencialidade para promoção da saúde de comunidades vulneráveis.(AU)

ABSTRACT The aim of this article was to analyze the Community Health Worker' (CHW) scope of practices, relating it to the social and health situation faced, as well as with facilitating and limiting elements of their practice. This is a cross-sectional study utilizing a mixed approach, including sequential explanatory strategy, carried out in four municipalities of Ceará. In the quantitative study, the sample of 160 CHW was randomized, and a structured instrument was used to collect data. In the qualitative study, six focal groups and interviews were carried out. We mainly found women (139; 86.9%), married (111; 69.4%), with a family income greater than or equal to 2 minumm wages (102; 63.7%), incomplete professional trainning (68; 42.5 %), from the urban area (114, 71.3%), acting as CHW for less than 10 years (93, 58.2%). The main activities were home visitation of priority groups and families registration. The complexity of the work was evidenced, which includes actions of health promotion and surveillance, such as prenatal care, immunizations, hypertension, diabetes, care for the elderly, among others. As limitations of their practices, we identified: deficiency of technical/professional training, reduced work support, and violence. As facilitators, we observed: permanent education and participatory management practices. The scope of CHW practices is complex and broad, including the articulation of public policies in the territory, which constitutes a potential for health promotion of vulnerable communities.(AU)

Os agentes comunitários na atenção primária à saúde no Brasil: inventário de conquistas e desafios / Community workers in primary health care in Brazil: an inventory of achievements and challenges

O artigo analisou a construção do perfil de atuação profissional dos Agentes Comunitários de Saúde - conhecidos internacionalmente como Community Health Workers -, apoiado na discussão sobre as disputas em torno do seu trabalho. Foram examinados documentos das políticas de saúde, com destaque para as inflexões produzidas sobre suas atribuições e formação profissional. Buscou-se compreender a racionalidade e os argumentos que sustentam as alterações induzidas pelas políticas e seus possíveis resultados sobre as práticas. Identificou-se que esse trabalho tem assumido conformações crescentemente próximas da educação para a saúde em uma vertente biomédica, agravada por mecanismos de gestão que promovem sua fragmentação e simplificação. Não houve avanço na implementação do Curso Técnico de Agente Comunitário de Saúde e, em paralelo, vêm se instituindo qualificações breves e impulsionadas por demandas pontuais. Entende-se que as políticas dirigidas a esse trabalhador se orientam por uma perspectiva de curto prazo e expressam, no contexto brasileiro atual, o próprio enfraquecimento do Sistema Único de Saúde. Observa-se a redução do papel do Agente Comunitário de Saúde na consolidação de estratégias que poderiam contribuir para concretizar a Atenção Primária à Saúde como espaço de fortalecimento da universalidade e da integralidade.(AU)

The article analyzed the construction of the profile of professionals internationally known as Community Health Workers, supported in the discussion about the disputes surrounding their work. Health policy documents were examined, with emphasis on the inflections produced on their attributions and professional training. It was sought to comprehend the rationality and the arguments that sustain the changes induced by the policies and their possible results on the practices. It was identified that this work has assumed conformations increasingly close to health education in a biomedical aspect, aggravated by management mechanisms that promote its fragmentation and simplification. There was no progress in the implementation of the Technical Course of Community Health Worker and, in parallel, short qualifications have been introduced and driven by specific demands. It is understood that the policies directed to this worker are guided by a short-term perspective and express, in the current Brazilian context, the very weakening of the Unified Health System. It is observed the reduction of the role of the Community Health Worker in the consolidation of strategies that could contribute to implement Primary Health Care as a space for strengthening universality and integrality.(AU)

Integrative and complementary practices: use by community health agents in self-care / Prácticas integradoras y complementarias: utilización por agentes comunitarios de salud en el autocuidado / Práticas integrativas e complementares: utilização por agentes comunitários de saúde no autocuidado

ABSTRACT Objective: To verify the use of integrative and complementary practices (ICPs) by community health agents working in family health teams. Methods: Cross-sectional, quantitative research, conducted in the city of Montes Claros, Minas Gerais. An structured form was used for the characterization of participants and use of ICPs. Descriptive and bivariate analyses were conducted. Results: Use of ICPs was referenced by 94 (40.7%) agents. The use of medicinal plants was predominant (32.5%). There were associations between: ICPs in general and negative self-perception of health (p=0.032), homeopathy and higher education (p=0.015), massage and living with partner(p=0.024), chiropractic care and income equal to or greater than four minimum wages (p=0.031), relaxation/meditation and religion (p=0.028). Conclusion: The use of ICPs was verified in the healthcare of community agents. It is necessary to strengthen these practices for the promotion of health and prevention of diseases.

RESUMEN Objetivo: Verificar la utilización de prácticas integradoras y complementarias (PICs) por agentes comunitarios de salud actuantes en los equipos de salud de la familia. Método: Investigación transversal, cuantitativa, realizada en la ciudad de Montes Claros, Minas Gerais. Se utilizó formulario estructurado para caracterización de los participantes y del uso de las PICs. Se realizaron análisis descriptivos y bivariados. Resultados: La utilización de las PICs fue referida por 94 (40,7%) de los agentes. Predominó el uso de las plantas medicinales (32,5%). Hubo asociaciones entre: las PICs en general y la autopercepción negativa para la salud (p=0,032), la homeopatía y la educación superior (p=0,015), el masaje y la vida en pareja (p=0,024), la quiropraxia y el ingreso igual o menor que cuatro salarios mínimos (p=0,031), la relajación/meditación y tener una religión (p=0,028). Conclusión: El uso de las PICs fue verificado en el cuidado en salud de los agentes comunitarios. Es necesario reforzar estas prácticas para la promoción de la salud y prevención de enfermedades.

RESUMO Objetivo: Verificar a utilização de práticas integrativas e complementares (PICs) por agentes comunitários de saúde atuantes nas equipes de saúde da família. Método: Pesquisa transversal, quantitativa, realizada na cidade de Montes Claros, Minas Gerais. Utilizou-se formulário estruturado para caracterização dos participantes e do uso de PICs. Foram conduzidas análises descritiva e bivariada. Resultados: A utilização de PICs foi referida por 94 (40,7%) dos agentes. Predominou o uso de plantas medicinais (32,5%). Houve associações entre: PICs no geral e autopercepção negativa da saúde (p=0,032), homeopatia e ensino superior (p=0,015), massagem e viver com companheiro (p=0,024), quiropraxia e renda igual ou superior a quatro salários mínimos (p=0,031), relaxamento/meditação e ter religião (p=0,028). Conclusão: O uso de PICs foi verificado no cuidado em saúde dos agentes comunitários. É preciso fortalecer essas práticas para a promoção da saúde e prevenção de agravos.

Cartografia do cuidado em saúde mental no encontro entre agente comunitário de saúde e usuário / Map-making in mental health care in meeting of health community agent and users

Resumo: O estudo mapeou parte da produção de cuidado em saúde mental que acontece no encontro entre Agente Comunitário de Saúde (ACS) e usuário na Atenção Primária à Saúde (APS). A metodologia utilizada foi a cartografia, fundamentada na esquizoanálise, teoria filosófica de Gilles Deleuze e Félix Guattari, cujo interesse é mapear as linhas de força que conectam o objeto de estudo. Para a captura da produção de cuidado, realizaram-se grupos focais com ACS de equipes de Estratégia Saúde da Família (ESF) de Montes Claros-MG. Como resultado, verificam-se deslocamentos no cuidado dos ACS, quando, saindo das linhas duras "profissionais psi cuidam" e "cuidar sem se envolver", são atravessados por linhas maleáveis e de fuga, "oferecer escuta" e "pensar sobre o encontro com o usuário"; contudo, há reterritorialização por nova linha dura: "escutar não basta". Aponta-se a potencialidade do ACS no cuidado em saúde mental na APS: um trabalhador aberto à invenção de sua subjetividade e à Reforma Psiquiátrica. Para tal, são necessários agenciamentos que contribuam para novas formas de cuidado em seu território de trabalho, dando-lhes visibilidade e reconhecimento.

Abstract The study mapped part of the production of mental health care that happens in the meeting between Community Health Agent (ACS) and users in Primary Health Care (PHC). The methodology used was cartography, based on schizoanalysis, the philosophical theory of Gilles Deleuze and Felix Guattari, whose interest is to map the lines of force that connect the object of study. To capture care production, focus groups were conducted with ACS from the Family Health Strategy (ESF) teams of Montes Claros-MG, Brazil. As a result, there is dislocation in the care of ACS, when, leaving the hard lines "psi professionals care" and "care without getting involved," are crossed by malleable lines and escape, "offer listening" and "thinking about the encounter with users". However, there is reterritorialization through a new hard line: "listening is not enough". The potential of ACS in mental health care in APS is pointed out: a worker open to the invention of his subjectivity and to the Psychiatric Reform. In order to do this, it is necessary to organize agencies that contribute to new forms of care in their territory, giving them visibility and recognition.

Conhecimento sobre plantas medicinais e fitoterápicos de agentes comunitários de saúde de Ijuí/RS / Conocimiento sobre plantas medicinales y remedios herbarios de agentescomunitarios de salud de Ijuí/RS / Knowledge on medicinal plants and herbal medicines by community health agents of Ijuí/RS

Objective: to assess the knowledge of medicinal plants and herbal medicines by Community Health Agents (ACS) in a ESF municipality Ijuí/RS. Method: Cross-sectional study, quantitative and qualitative, with 13ACS. Data collection occurred in April 2014, and the analysis of quantitative data was done using descriptive statistics. The qualitative data were presented through the Collective Subject Discourse. Results: The main understanding of ACS on herbal medicine is related to the use of medicinal plants. Everyone agrees on the availability of plants and herbal medicines in the NHS, and provide information as to the mode of preparation and storage plants. Also believe that the incorrect use of plants can cause health hazards. Conclusion: There is a lack of knowledge about herbal medicine for ACS. Herbal medicine can and should be considered as a field of interaction of knowledge and practice that values and considers cultural resources, practices and localknowledge, with the involvement of the professional health care team.

Objetivo: avaliar o conhecimento sobre plantas medicinais e fitoterápicos por Agentes Comunitários de Saúde (ACS) em uma ESF do Município de Ijuí/RS. Método: Estudo transversal, quanti-qualitativo, com 13 ACS. A coleta de dados ocorreu em abril de 2014, e a análise de dados quantitativos foi feita através de estatística descritiva. Já os dados qualitativos foram apresentados através do Discurso do Sujeito Coletivo. Resultados: O principal entendimento dos ACS sobre fitoterapia está relacionado ao uso de plantas medicinais. Todos concordam com a disponibilização de plantas e fitoterápicos no SUS, e prestam informações quanto ao modo de preparo e armazenamento das plantas. Também acreditam que o uso incorreto de plantas pode causar riscos à saúde. Conclusão: Existe uma lacuna de conhecimento a respeito da fitoterapia pelos ACS. A fitoterapia pode e deve ser considerada como um campo de interação de saberes e práticas que valoriza e considera os recursos culturais, práticas e saberes locais, com o envolvimento dos profissionais da equipe de saúde.

Objetivo: evaluar el conocimiento de las plantas medicinales y los medicamentos a base de hierbas por los Agentes Comunitarios de Salud(ACS) en una ESF Municipio Ijuí/RS. Método: Estudio transversal,cuantitativo y cualitativo, con 13 CHA. La recolección de datos tuvo lugar en abril de 2014, y el análisis de los datos cuantitativos se realizó mediante estadística descriptiva. Los datos cualitativos se presentaron a través del Discurso del Sujeto Colectivo. Resultados: La comprensión primaria de ACS en la medicina herbal se relaciona con el uso de plantas medicinales.Todo el mundo está de acuerdo sobre la disponibilidad de plantas y hierbas medicinales en el NHS, y proporcionar información en cuanto a la forma de las plantas de preparación y almacenamiento. También creen que el uso incorrecto de las plantas puede causar riesgos para la salud. Conclusión: Existe una brecha de conocimiento con respecto a la fitoterapia por ACS. La medicina herbaria puede y debe ser considerado como un campo de interacción de los conocimientos y la práctica que valora y considera los recursos culturales, las prácticas y el conocimiento local, con la participación del equipo profesional de la salud.

Training of Community Health Agents in health hearing children: current perspectives.

PURPOSE: To characterize the training of Community Health Workers in the field of child hearing health. RESEARCH STRATEGY: A systematic literature review on Biblioteca Virtual em Saúde (BVS) and Biblioteca Digital de Teses e Dissertações of USP databases was performed. SELECTION CRITERIA: The search strategy was oriented by the specific question: "How have the Community Health Workers been trained to work in the field of child hearing health?" The study selection criteria involved consistency with the proposed theme, belonging to the category of scientific papers, dissertation or thesis, and publication in Brazilian Portuguese. DATA ANALYSIS: A total of 2,687 studies were found. After analyzing the title and abstract, eight studies were chosen for full reading, however, only four of them met the proposed criteria and were included in the review. RESULTS: The studies indicated live and virtual classes with the use of video conferencing or CD-ROM as training strategies for Community Health Workers. Trainings were effective. Only one questionnaire about hearing and language monitoring was described. Different possibilities for the activities of Community Health Workers were identified. CONCLUSION: Different learning methodologies have been used for training the Community Health Worker in the field of child hearing health, and all of have proven effective for knowledge acquisition. Community Health Workers play an important role in promoting and monitoring child hearing health.

Capacitação do Agente Comunitário de Saúde na saúde auditiva infantil: perspectivas atuais / Training of Community Health Agents in health hearing children: current perspectives

RESUMO Objetivo: Caracterizar a capacitação dos Agentes Comunitários de Saúde (ACS) na área da saúde auditiva infantil. Estratégia de pesquisa Foi realizada uma revisão sistemática da literatura no Portal de Pesquisa da Biblioteca Virtual em Saúde (BVS) e na Biblioteca Digital de Teses e Dissertações da USP. Critérios de seleção: A estratégia de busca foi direcionada por uma questão específica "Como tem sido realizada a capacitação do Agente Comunitário de Saúde na área de saúde auditiva infantil?". Os critérios de seleção dos estudos envolveram a coerência com o tema proposto, pertencer à categoria artigo, dissertação ou tese e ser publicado na língua portuguesa. Análise dos dados: Foram localizados 2.687 estudos. Após análise do título e resumo, 8 estudos foram selecionados para leitura completa. Destes, apenas 4 atenderam aos critérios propostos e foram incluídos na revisão. Resultados: Os estudos apontaram como estratégias de capacitação dos ACS a aula presencial e as aulas a distância com o uso de videoconferência ou de CD-ROM. As capacitações foram consideradas efetivas. Foi apontado apenas um questionário de monitoramento sobre a audição e linguagem. Distintas possibilidades de atuação dos ACS foram identificadas. Conclusão: Atualmente, diferentes modalidades de ensino têm sido utilizadas para a capacitação do ACS na área de saúde auditiva infantil, todas se mostrando efetivas quanto à retenção do conhecimento. O ACS desempenha um papel importante na promoção e vigilância da saúde auditiva infantil.

ABSTRACT Purpose To characterize the training of Community Health Workers in the field of child hearing health. Research strategy A systematic literature review on Biblioteca Virtual em Saúde (BVS) and Biblioteca Digital de Teses e Dissertações of USP databases was performed. Selection criteria The search strategy was oriented by the specific question: "How have the Community Health Workers been trained to work in the field of child hearing health?" The study selection criteria involved consistency with the proposed theme, belonging to the category of scientific papers, dissertation or thesis, and publication in Brazilian Portuguese. Data analysis : A total of 2,687 studies were found. After analyzing the title and abstract, eight studies were chosen for full reading, however, only four of them met the proposed criteria and were included in the review. Results The studies indicated live and virtual classes with the use of video conferencing or CD-ROM as training strategies for Community Health Workers. Trainings were effective. Only one questionnaire about hearing and language monitoring was described. Different possibilities for the activities of Community Health Workers were identified. Conclusion Different learning methodologies have been used for training the Community Health Worker in the field of child hearing health, and all of have proven effective for knowledge acquisition. Community Health Workers play an important role in promoting and monitoring child hearing health.

[Professional education and work of indigenous health agents in the Brazilian health system]. / La formación y el trabajo del agente indígena de salud en el Subsistema de Salud Indígena en Brasil.

OBJECTIVE: To discuss the role of indigenous health agents in the implementation of the model of differentiated attention or intercultural health in Brazil. MATERIALS AND METHODS: We revised the scientific literature about the work and professional education of indigenous health agents in the Brazilian indigenous health system. RESULTS: There is a subordination of the agents to the hegemonic medical model. With regards to professional education, we observe the absence and irregularity of these processes, with a general emphasis the biomedicine. There are conflicts with the health team and community, with devaluation of the agents. The agent does not plays the role of mediator between the different health knowledge and practices. CONCLUSIONS: We suggest that the discussion of the model of differentiated attention should strengthen the relationship between the health system and the selfcare.

Agentes Comunitários de Saúde, formação e perfil profissional: o caso de Duque de Caxias, RJ / Community Health Workers, training and professional profile: the case of Duque de Caxias, RJ

Este estudo teve como objetivo analisar o perfil de trabalho e descrever a formação profissional dos Agentes Comunitários de Saúde (ACS) no Município de Duque de Caxias. Trata-se de um estudo descritivo e de abordagem quantitativa e qualitativa, com base em uma perspectiva de triangulação de métodos. A pesquisa foi dividida em dois momentos distintos durante a coleta de dados. No primeiro, reuniram-se informações que configurassem todo o histórico de implementação do trabalho dos ACS, desde o surgimento das primeiras equipes. No segundo momento, aplicou-se um questionário aos 51 ACS que compõem o quadro funcional, sendo 23 de unidades da Estratégia Saúde da Família (ESF) e 28 da Equipe de Agentes Comunitários de Saúde (EACS). Foram também realizadas entrevistas individuais com oito participantes. Na análise dos dados, foi possível: a) construir a trajetória histórica dos ACS no Município, incluindo seu perfil sociodemográfico; b) mapear e descrever o perfil e condições de trabalho, a formação dos ACS, o interesse e as motivações quanto à profissão, as atividades de educação em saúde realizadas e o vínculo do ACS com o enfermeiro. O campo de pesquisa foi o município de Duque de Caxias, situado na Baixada Fluminense, no Estado do Rio de Janeiro. Os resultados mostram que a maioria dos participantes é do sexo feminino (94,1%), se encontrava na faixa etária entre 40-49 anos (43%), possui o segundo grau completo (72,5%); por outro lado, apenas 29,4% participam de alguma associação ou sindicato que represente a categoria, 84,3%, atuam em média há mais de sete anos, 84,3 % consideram o seu serviço gerador de estresse, 62,7% não tiveram acesso a algum curso/capacitação antes de serem inseridos na prática. Entre os motivos para atuar como um ACS, citam-se: ajudar a comunidade, estar perto dos filhos e trabalhar perto de casa; já entre as desvantagens do trabalho estão condições precárias de trabalho e baixo salário/vinculo trabalhista precário...

This study aimed to analyze the job profile and describe the training of Community Health Agents (CHA) in Duque de Caxias. This is a descriptive study with a quantitative and qualitative approach, based on a perspective of triangulation methods. The research was divided into two distinct periods during the data collection. At first we gathered information that would configure the entire history of implementing the work of the CHA, since the emergence of the first teams. In the second phase, a questionnaire was applied to 51 CHA that make up the workforce, with 23 units of the Family Health Strategy (FHS) and 28 of the Staff of Community Health Workers (SCHW). Individual interviews were also conducted with eight participants. In analyzing the data, it was possible: a) build the historical trajectory of CHA in the City, including their sociodemographic profiles; b) to map and describe the profile and working conditions, the training of CHA, interest and motivations regarding the profession, education activities in health in the CHA and the bond with the nurse. The research field was the municipality of Duque de Caxias, located in the Baixada Fluminense, in the State of Rio de Janeiro. The results show that the majority of participants were female (94.1%) were in the age group between 40-49 years (43%), has a high school degree (72.5%), and secondly, only 29.4% participate in any association or union representing the category, 84.3 % work for an average of more than seven years, 84.3% consider their generator service stress, 62.7% had no access to any courses/training before being inserted into practice. Among the reasons to act as an CHA, we mention: helping the community, being close to the kids and work close to home, already among the disadvantages of work are poor working conditions and low pay/precarious labor bond...

The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil.

OBJECTIVE: To evaluate the effectiveness of a community-based intervention project aimed at reducing maternal and infant mortality in a poor urban district in the city of Natal, in the Northeast of Brazil. METHODS: The intervention, called the ProNatal project, introduced a program of integrated community health care to a geographically defined population. The interventions included the establishment of antenatal clinics at the district's health centers, the opening of the maternity facilities at the polyclinic for low-risk deliveries, the introduction of a family planning clinic and a breast-feeding clinic, support from pediatricians for under-5 (well-baby) clinics, children's outpatient services and children's emergency care, and the introduction of health agents recruited from the local community. Representative surveys of the population were taken at the project's inception (July 1995) and then 30 months later (December 1997), using a general health questionnaire adapted to the local conditions. Mortality data were collected from local registration systems as well as from an autopsy survey of perinatal and infant deaths. RESULTS: During 1995 there were 4 maternal deaths from 1 195 pregnancies (maternal mortality of 335/100 000); three of the deaths were related to hypertension and one to uterine perforation after an illegal abortion. During 1998 (post-intervention), there were no maternal deaths in pregnancy or childbirth. In 1993 no deliveries took place at the polyclinic, but in 1998 there were 946 deliveries at the clinic without any serious complications. The method of delivery, the incidence of prematurity, and the incidence of low birthweight did not change significantly over the study period. In the post-intervention survey, 75% of women reported receiving contraceptive advice from a doctor in the preceding year, compared to 50% in the first sample. A mortality survey carried out in 1993-1995 estimated the infant mortality rate to be 60/1 000 live births. By 1998, using data collected locally by active surveillance, the infant mortality rate was 37/1 000 live births. The causes of infant death in both those periods were dominated by respiratory infections and diarrheal disease. Over 95% of both samples initiated breast-feeding, but a higher proportion of the post-intervention sample reported breast-feeding for longer than 6 months (41% vs. 32%, P = 0.0005). No differences were apparent in the use of under-5 clinics, but immunization rates improved. Post-intervention, significant improvements were documented in the mothers' understanding of basic hygiene, their knowledge of causes of common diseases, and their management of acute respiratory infections and diarrhea in children. This was particularly true for the households visited by a community health agent. CONCLUSIONS: Inequalities in health care in poor urban populations can be reduced by integrated community-based interventions, including the use of health agents recruited from the local community.

Partnership for community health development.

A programme of community health development is reported from two villages in Haiti. It involves close cooperation between a district hospital, a local dispensary, and, most importantly, the inhabitants themselves. The programme is simple, financially realistic, adapted to local conditions, and linked to activities designed to meet basic requirements, such as those of food production and water supply.

PIP: The Albert Schweitzer Hospital in the Artibonite Valley of central Haiti was founded by William Larimer Mellon in 1956 to serve about 175,000 people. Early in 1977, the hospital decided to create a community health department and provide curative, preventive, and promotive health programs through 7 dispensaries. A mobile immunization team was established. In 1988, 2 villages with a total population of 1459, in the catchment area of the Plassac dispensary, were selected for a research and development project with a comprehensive baseline survey. Among children aged up to 5 years, 36% were of normal nutritional status, while 41%, 18%, and 4% suffered from first-, second- and third-degree malnutrition, respectively. Of these children, only 31% were completely immunized. 21% of the children had tuberculosis, malaria, and upper respiratory tract infections. The illiteracy rate was around 85%. A village development committee was elected by the community. Voluntary health workers, elected or selected among mothers, were trained in health promotional activities, and each was made responsible for 15-20 families. These workers, with the dispensary's health agents, delivered a minimum health care package, comprising maternal and child care, family planning, immunization, treatment of simple diseases, health and nutrition education, and environmental sanitation. In less than 2 years, there was a strong indication of declining mortality and malnutrition among children aged 1 to 3 years. No more cases of third-degree malnutrition were seen in the dispensary, and some 90% of children were fully immunized. Changes were evident in the health knowledge, attitudes, and practices of the population. It is expected that during 1993 the whole catchment area of the Plassac dispensary, with around 20,000 people, will be covered. The dispensary had to be upgraded to a community health center with 2 or 3 beds for emergency cases.