How do community health workers institutionalise: An analysis of Brazil's CHW programme

Author(s)

Krieger, Morgana G. Martins ; Wenham, Clare ; Nacif Pimenta, Denise ; Nkya, Theresia E. ; Schall, Brunah ; Nunes, Ana Carolina ; De Menezes, Ana ; Lotta, Gabriela

• Document type: Journal article
• Source: GLOBAL PUBLIC HEALTH; v. 17, n. 8, p. 18-pg., 2021-06-22.

Abstract

Community health workers (CHWs) are framed as the link between communities and the formal health system. CHWs must establish trusting relationships with the community and with the broader health service. How to find the optimal balance between the various strands of work for CHWs, and how to formalise this, has been the focus of different studies. We performed an extensive documentary analysis of federal legislation in Brazil to understand the institutionalisation of the CHW workforce in Brazil over the last 3 decades. The paper offers three contributions to the literature: the development and application of an analytical framework to consider the institutionalisation process of CHWs; a historical analysis of the professional institutionalisation of CHW in Brazil; and the identification of the paradoxes that such institutionalisation faces: firstly, institutionalisation focused on improving CHW remuneration created difficulties in hiring and paying these professionals; when CHW are incorporated within state bureaucracy they start to lose their autonomy as community agents; and that the effectiveness of CHW programmes depends on the improvement of clinical services in the most deprived areas. (AU)

• FAPESP's process: 19/13439-7 - Therapeutic itineraries of Bolivian women in the central region of São Paulo: conditions of life, work and access to health
• Grantee: Eugenia Brage
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 19/24495-5 - Street-level bureaucracy and social inequality: reflections from a comparison between Brazil and Denmark
• Grantee: Gabriela Spanghero Lotta
• Support Opportunities: Regular Research Grants