Health conditionalities in the Brazilian Income Transfer Program and food and nutritional surveillance: narratives by primary healthcare workers

Abstract

The study aimed to understand the narratives of primary healthcare workers in the city of Rio de Janeiro, Brazil, on the challenges and potentialities of food and nutritional surveillance activities in the context of the Brazilian Income Transfer Program, vis-à-vis the limits of its implementation. The study adopted a qualitative, evaluative, and participatory approach. From 2018 to 2019, five focus groups were held with 60 university-level healthcare workers from 24 health units and one focus group with 13 community health agents. The material transcribed from the focus groups was used to construct narratives for each group, producing a synthesis of the core arguments in the discourses. Five hermeneutic groups were later held for validation of the narratives and in-depth discussions. The last meeting identified problems and proposals related to follow-up of the Brazilian Income Transfer Program. In practice, follow-up of the conditionalities is limited to "weighing and measuring" individuals without necessarily conducting a nutritional diagnosis to identify cases of nutritional risk and intervention. Factors contributing to this scenario include practices such as mass assessment ("mutirão") at the end of coverage by Brazilian Income Transfer Program and anthropometric measurements taken by community health agents, with no link to the existing lines of care. A bureaucratic vision of these health conditionalities prevails, merely to guarantee that the family does not lose the benefit and that the program's administrative targets are met. Over the course of the study, the healthcare workers developed a critical analysis of this practice and acknowledge their own potential to care for the families' health and nutrition.