Centro de Estudos Estratégicos (CEE), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
Centro de Estudos Estratégicos (CEE), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil; Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.
Appl Ergon. 2020 Jan;82:102944. doi: 10.1016/j.apergo.2019.102944. Epub 2019 Aug 28.
In this paper we study the working conditions of Community Health Workers in performing house calls within low-income, violent communities in order to understand the challenges in delivering primary care in developing countries. We conducted field studies in two primary healthcare clinics and telephone surveys for 5 months in 2017 within systematic sample of 1690 community health workers based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. A number of 759 interviews were completed, approximately 50% of the sample, 86% men and 14% women. Most participants are 30-39 years old (35%), followed by 27% of 40-49 years old participants. Results show that exposure to territorial violence and environmental or health-related diseases significantly affects CHWs. Moreover, CHWs have to develop a significant set of skills to cope with aspects of the territory, and those skills are not present in their training. As community health workers work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difficulties in implementing primary care policies.
本文研究了社区卫生工作者在低收入、暴力社区中进行上门服务的工作条件，以了解在发展中国家提供初级保健的挑战。我们于 2017 年在两个初级保健诊所进行了实地研究，并对巴西里约热内卢市的卫生区分布的诊所系统抽样的 1690 名社区卫生工作者进行了为期 5 个月的电话调查。共完成了 759 次访谈，约占样本的 50%，其中 86%为男性，14%为女性。大多数参与者年龄在 30-39 岁（35%），其次是 40-49 岁的参与者（27%）。结果表明，接触领土暴力以及环境或与健康相关的疾病会对 CHW 产生显著影响。此外，CHW 必须发展出一套应对领土问题的技能，而这些技能在他们的培训中是没有的。由于社区卫生工作者处于医疗保健系统的最前沿，负责外展、社区教育、咨询和社会支持，我们的研究为政府和管理层提供了有关社区内部工作条件、援助限制和实施初级保健政策困难的贡献。
