Banca de DEFESA: CAMILA DE JESUS FRANÇA

The work of the Community Health worker in the face of the Covid-19 pandemic: Analysis of the production of technical and scientific 

knowledge and of multiple cases in the Brazilian Northeast.

Community Health Worker. Primary Health Care. Covid-19.

This dissertation aimed to identify, systematize, and analyze the implications of the Covid-19 pandemic for community health work. This is a research that included an integrative synthesis review, two document reviews, and a multiple case study on the work of Community Health Workers (CHWs) in the pandemic context. The analysis was based on the reference of community orientation and work in health and the debate around the work process, for the understanding of the organization of actions in the pandemic context and the contextual challenges in the national socio-political scenario in the most recent conjuncture. The results were presented and discussed in four articles: The first is a quick synthesis of evidence in bibliographic bases, about the work of Community Health Workers (CHWs) during the pandemic period in different countries. The second is in the form of a book chapter and aimed to provide a brief critical overview of the current perspective on the conformation of the work of CHWs during the pandemic period, based on the recommendations issued by the Ministry of Health in Brazil. However, due to the scarcity of governmental publications in the initial period of the pandemic, the third article sought to identify and analyze the recommendations for the organization of the work of CHWs, based on the analysis of guidelines and governmental and non-governmental orientations aimed at delimiting the response of PHC in Brazil. We admitted documents conveyed and made available by teaching and research institutions and/or of non-governmental nature, including videos, newsletters, taken as a source for the understanding of the research problem. Finally, although there may have been changes in the activities related to the work of CHWs, the literature brought few elements to understand the central characteristics of the work of these professionals in the response to Covid-19. Given the above, the fourth article aimed to identify the organization and characterize the work of CHWs in three municipalities in the Northeast of Brazil, between January 2020 and August 2021. When considering the set of productions derived to answer the questions of this study, this dissertation raises reflections about the role of community health workers, as part of the frontline health workforce in fighting the pandemic in several countries, contributing to unveil the potential of actions directed to the social determinants of health, beyond the control and prevention of pandemics, and especially to reflect on the potential of community guidance in situations of health crises and how it may have been underused or neglected. It is evident in Brazil that the institutional support, training, and continuing education for CHWs during the pandemic were insufficient, which culminated in their leaving their territories. The lack of clear guidelines that are based on the strengthening of the attributes inherent in the work of CHWs, according to community and territorial orientation, is a concern in face of the impossibility of carrying out resolutive actions for the consolidation of a strong and robust PHC, to adequately respond to the needs arising from localized or comprehensive health crises or the premises of the care model prioritized in Brazil. It is observed the need for research to better understand the real potentialities of community orientation, and more cost-effective forms of intervention, to evaluate the results achieved so far and to direct the reorganization of necessary processes, given the configurations of work in PHC currently, in rural and urban Brazilian territories.