Community Health Agents Research Articles

A IMPORTÂNCIA DA EDUCAÇÃO PERMANENTE PARA OS AGENTES COMUNITÁRIOS DE SAÚDE NO ACOMPANHAMENTO DE PACIENTES COM SÍNDROME METABÓLICA

Metabolic syndrome (MS) is a series of metabolic disorders or abnormalities that together are considered risk factors in the same individual for the development of diabetes and cardiovascular diseases. artery, with the dietary plan being the treatment of first choice. Community health agents play an important role in helping to promote health and prevent diseases through home care, in addition to creating links with the community, promoting humanization, acceptance and accountability. They also provide guidance to the population on the use of and access to health system services. They have great responsibility in educating patients, enhancing health care actions. Community health agents encounter difficulties in carrying out educational work, often caused by the community due to the culture of medicalization, in addition to there being people in the community without comorbidity repressing the capacity of health education to carry out prevention. Therefore, the importance of educational practices is undeniable, as from them society obtains sufficient information to opt for healthier choices and modify their risk behaviors, resulting in a reduction in cases of metabolic syndrome.

COMMUNITY INTERVENTIONS TO REDUCE MATERNAL MORTALITY IN LOW-RESOURCE AREAS

Maternal mortality, defined as the death of women during pregnancy, childbirth or in the postpartum period, continues to be a serious public health problem, especially in low-resource areas. Factors such as limited access to quality healthcare, lack of infrastructure, shortage of qualified professionals and socio-economic inequalities contribute to high mortality rates. In many of these regions, community interventions have been key to reducing maternal mortality by providing direct assistance to pregnant women, promoting health care education and strengthening the link between communities and medical services. This study seeks to analyze community interventions implemented in low-resource areas to reduce maternal mortality, evaluating their strategies, challenges and the results obtained in improving maternal survival rates. This study is a systematic review that investigates the effectiveness of maternal health interventions in low- and middle-income countries, focusing on skilled birth attendant programs, community transport, and technological innovations. The analyses were carried out in databases such as PubMed, BMC Pregnancy and Childbirth and African Journal of Reproductive Health, using data from articles published between 2015 and 2021. Community interventions to reduce maternal mortality range from health education programs, training traditional birth attendants and strengthening maternal and child support networks. One of the main approaches involves training community health agents, who work directly in communities, providing basic prenatal care, referral to medical services in cases of risk and promoting knowledge about signs of pregnancy complications. These actions are especially important in remote areas, where access to health facilities is limited. Another key aspect of these interventions is the promotion of safe practices during childbirth and the strengthening of emergency transport systems, ensuring that pregnant women at risk can be transferred to health centers equipped to deal with complications. The introduction of simple technologies, such as clean delivery kits and essential medicines, has shown promising results in reducing infections and hemorrhages, which are primary causes of maternal mortality. Awareness campaigns also play a crucial role, educating the population about the importance of prenatal care, proper nutrition and birth assistance in controlled environments. These initiatives aim not only to improve knowledge about maternal health, but also to combat cultural and social barriers that can prevent pregnant women from seeking medical care in a timely manner. It is concluded that community interventions have proven to be an effective approach to reducing maternal mortality in low-resource areas. Training health workers, implementing safe delivery practices and raising awareness about antenatal care are strategies that have contributed significantly to improving maternal health outcomes. However, for these interventions to be sustainable and scaled up, continued public policy support, adequate funding and the integration of these actions with formal health systems are essential.

Effectiveness of Antileishmanial Treatments in Three Endemic Areas of Colombia: A Community-Based Cohort Study.

The effectiveness of treatment of cutaneous leishmaniasis (CL) in rural settings remains underexplored. This study assessed the effectiveness of standard antileishmanial treatments using a community-based approach supported by mobile health (mHealth) in three rural areas of Colombia. From January 2018 to September 2021, we assessed treatment outcomes, adherence, and adverse drug reactions in CL patients, with the support of the Guaral+ST app. Treatment decisions were made by providers at health facilities at each site in accordance with national guidelines, whereas treatment follow-up and presumptive case identification were made by trained community leaders and health agents at the community level. In total, 231 participants received antileishmanial treatment (63 received miltefosine, 110 meglumine antimoniate, and 58 pentamidine). Disease presentation was mild (median number of lesions = 1, interquartile range [IQR]: 1-2) and of short duration (1.5 months, IQR: 1-3). The strategy yielded information on the therapeutic outcomes in 81% of study participants. Effectiveness, measured as the proportion of cure at 90 to 180 days, was 86.3% (95% CI: 73.3-93.48) for miltefosine; 77.6% (67.5-85.3) for meglumine antimoniate, and 73.1% (59.0-83.6) for pentamidine. The effectiveness of pentamidine in children ≤10 years old was 79.4% (61.6-90.3). This is one of the few reports of effectiveness of pentamidine in children with prospective data collection in the Americas. Adverse drug reactions occurred in 32% of patients, most frequently with meglumine antimoniate. Our findings demonstrate that standard antileishmanial treatments are effective in rural areas where the disease is endemic and that mHealth has a pivotal role in improving patient follow-up and data collection on therapeutic outcomes.

Access to primary healthcare services among adults with disabilities in Brazil.

To investigate perspectives of people with disabilities in Brazil regarding the access to primary healthcare. In-depth interviews were conducted with 44 individuals with disabilities in Pernambuco, Distrito Federal, and São Paulo between March 2020 and November 2021. These interviews were transcribed, coded, and analysed thematically, using the Levesque framework to identify healthcare access barriers. Participants expressed a solid understanding of their healthcare needs and existing obstacles. However, individuals with hearing and visual impairments experience challenges because of communication barriers. In Pernambuco, the Community Health Agent was often the initial point of contact for primary care services. Public transportation lacked accessibility, from buses to driver attitudes, posing difficulties for people with disabilities. More accessible transportation and improved urban infrastructure could enhance service access. High medication costs were reported due to limited healthcare unit availability. Communication accessibility issues, inadequate audio-visual resources and equipment were also identified as barriers. Attitudinal barriers among healthcare professionals and subpar home visit services further hinder access. To address these challenges and improve the well-being of individuals with disabilities in Brazil, comprehensive action is essential. This includes leadership, governance, and resource allocation reforms to meet healthcare needs. Initiatives like disability-focused training for service providers, enhanced transportation options, improved information accessibility, and increased support from community healthcare workers can collectively enhance the lives of people with disabilities.

O PAPEL DO AGENTE COMUNITÁRIO DE SAÚDE NA MELHORIA DOS DADOS EPIDEMIOLÓGICOS COMO REDUÇÃO DE ÓBITOS SENSÍVEIS À ATENÇÃO BÁSICA

Introduction: The Community Health Agent (CHA) is responsible for working in the prevention and promotion of health by informing the Family Health Strategy (FHS) team of the population’s needs. Objective: To analyze the responsibilities of CHAs in the care of patients with certain conditions sensitive to primary healthcare, such as Diabetes Mellitus (DM), hypertension (HTN), and acute myocardial infarction (AMI) in the municipality of São João Del Rei/MG (SJDR) in the year 2020. Methodology: A quantitative study was conducted using data from the Department of Informatics of the Unified Health System (DATASUS), gathering the number of deaths from certain preventable causes due to the performance of Primary Health Care (PHC), alongside a literature review. Results: The municipality of SJDR reported deaths from causes sensitive to PHC interventions, such as DM, HTN, and AMI in 2020. When compared to the state of Minas Gerais, the municipality had nearly twice the number of deaths from HTN and AMI, highlighting the need for patient engagement with PHC, as the high mortality rates from these causes negatively impacted the state’s data. Conclusion: It is concluded that the municipality of SJDR had higher mortality rates from DM, HTN, and AMI compared to the state of Minas Gerais in 2020. These data suggest the need for more effective and targeted interventions to prevent the worsening of these conditions, with the role of CHAs becoming crucial in this contexto.

Dengue In Brazil: Challenges And Strategies For Public Health Management

This academic essay explores the complex landscape of dengue in Brazil, a viral arbovirus transmitted by the Aedesaegypti mosquito, with significant impacts due to its high incidence and frequent epidemic outbreaks, especially during warm and rainy periods conducive to vector reproduction. The symptoms range from high fever and muscle pain to severe forms such as dengue hemorrhagic fever, requiring urgent medical intervention. The country's dengue control strategies include eliminating breeding sites, using insecticides, and conducting public awareness campaigns. The disease not only strains healthcare services but also adversely affects the economy and social well-being, underscoring the importance of robust epidemiological surveillance systems and coordinated responses. Initiatives such as the Health in Schools Program (PSE) and the roles played by Community Health Agents (ACS) and Endemic Disease Control Agents (ACE) are crucial in prevention and control efforts. Collaborative efforts across health, education, and community sectors are essential to address the challenges of dengue comprehensively. Therefore, Brazil must continue investing in research, vaccines, and innovative strategies to sustainably and effectively reduce the burden of dengue and safeguard public health.

Spatial pattern of congenital toxoplasmosis incidence and its relationship with vulnerability and national health indicators in Brazil

There is a gap in evidence regarding spatial clusters of the congenital toxoplasmosis (CT) and its association with social and health indicators in the Brazilian territory. Thus, we aimed herein to identify CT risk areas in Brazil and its association with social vulnerability and health indicators. An ecological and population-based study was conducted. The CT incidence coefficient was calculated and smoothed using the Local Empirical Bayesian method. Global regression models and local spatial regression model were applied. High-incidence clusters of the disease were identified throughout the country. Additionally, a positive association was observed between the incidence of congenital toxoplasmosis and the Social Vulnerability Index, coverage of community health agents, and the percentage of prenatal consultations. This association was stronger the further south in the country. Herewith, the implementation and strengthening of public strategies, with focus on priority intersectoral actions for prevention, early diagnosis, and prompt treatment, is urgently required for the effective control of CT in Brazilian municipalities.

Knowledge of community health agents about stroke

The aim of this study was to measure the knowledge of community health agents (CHA) about stroke. This is a cross-sectional study carried out by applying a validated questionnaire to 235 CHAs from 16 basic health units from June to July 2023. The data were analyzed using descriptive and inferential statistics techniques. Women predominated, the majority were brown/yellow and aged 40-49 years. The average age of the CHAs was 44.49 ± 8.55 years; more than 80% had worked for more than five years, 50% had primary education and 66.4% had no training in health. Knowledge ranged from poor (36.2%), bad (29.8%), regular (13.2%), good (17.9%), very good (2.1%), and excellent (0. 9%). The variables that demonstrated the highest number of correct answers were: married participants (p=0.048), with higher education (p<0.001), health training (p=0.02), and less than five years as a CHA (p<0.001) and stocking time (p=0.029). The section on treatment performed less well. The CHWs' knowledge about stroke was predominantly poor and bad, with a lower percentage of correct answers for those with longer professional experience.

Environmental and Life Conditions Associated with Childhood Diarrhea in the Rural Area in Southern Brazil: an Exploratory Study

Objective: The objective of this study is to investigate the conditions of basic sanitation and its association with the prevalence of cases of childhood diarrhea in the rural area of the municipality of Alpestre (Brazil). Method: The methodology adopted for this research comprises a cross-sectional epidemiological study. Data collection was carried out through a survey of information conducted through home interviews. Socioeconomic conditions and basic sanitation were investigated, in addition to caregiver-reported diarrhea in children. For data alnalysis, the information contained in the questionnaires was entered into a database in the Epi InfoTM software. Results and Discussion: This study can be an example of the one health concept approach. The results obtained revealed the prevalence of 13.4% of diarrhea had been associated with factors of the peri-domiciliary environment such as the quality of the water consumed and its storage, sewage treatment, the presence of domestic animals on the rural property, solid waste destination, and socioeconomic conditions. Research Implications: Social and economic policies in favor of environmental health are essential, especially for the health of children. Community health agents are important to the application of public policies related to health education, aiming to expand access to sanitation services and improve conditions in rural areas with a focus on the most vulnerable families. Originality/Value: The relevance of this research is its contribution to the literature by showing tha rural areas have difficult socio-economic conditions, the prevalence of diarrhea was associated with poor sanitation, and public policies related to health education for rural population are needed.

Quality of life of professionals working in primary care

Objective: To analyze the factors associated with the quality of life of health professionals working in primary care. Methods: an integrative literature review was conducted using the secondary databases Virtual Health Library, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online and Online System for Search and Analysis of Medical Literature based on the specific descriptors retrieved from the Health Sciences Descriptors. Results: the following factors were identified as associated with the outcome: inadequate conditions to perform work, lack of organization and difficulty in social relationships, professional occupation, with community health agents being the professionals with the lowest quality of life, followed by mid-level professionals, in the qualitative data, the perspectives that most impact the quality of life were infrastructure and salary deficits, Regarding the quality of life domains, there was great variation in the findings of the various studies. Conclusion: the data of the study indicate that the factors that influence the quality of life of professionals working in primary care are complex and multifaceted, ranging from individual variables or to the work environment.

Abstract PO5-21-02: Breast cancer screening based on physical breast examination: ITABERAÍ randomized trial

Abstract Introduction: Approximately 70% of the Brazilian population depends on the public healthcare system (Sistema Único de Saúde - SUS). However, only 16% of SUS users have access to mammography for breast cancer screening, which necessitates the evaluation of new strategies to reduce mortality from the disease, including expanding physical breast examination (PBE) by non-medical professionals. Within the primary healthcare network, the Community Health Agent (CHA) is a technical-level professional who performs activities through home visits. The primary objective of this study is to evaluate the effectiveness of screening actions based on PBE performed by CHA in reducing advanced tumors (Stage III and IV) and breast cancer mortality rates. Secondary objectives include comparing the number of breast cancer diagnoses between the groups, establishing the overdiagnosis rate, comparing cancer-specific survival, comparing overall survival, comparing the number of diagnostic procedures, assessing the interval between the first symptom and diagnosis, evaluating the interval between diagnosis and the start of treatment, and comparing the financial cost of diagnosis and treatment for breast cancer patients. Trial design: Multicenter, phase III, prospective, randomized clinical trial. The target population comprises women aged 40 years or older and users of SUS. The randomization process will be carried out based on the spatial analysis of each participating center, using sociodemographic information on women from each macroregion to verify the homogeneity of data between groups. Intervention: After randomization, CHA in each group underwent training at different times. CHA in the CG received guidance on breast cancer screening and prevention according to Ministry of Health recommendations, while CHA in the IG received the same guidance and participated in theoretical and practical training for PBE (only female professionals). Variables and data collection: An application was developed to be installed on mobile devices, which the CHA used during home visits. The graphical interface of the application was developed in Dart/Flutter. For the backend, Python programming language was used along with the Flask framework to create the Application Programming Interface (API) responsible for the communication between the database and the application. The MySQL software was used for the relational database. The variables used for building the application included sociodemographic data, lifestyle habits, medical history, information on previous examinations, and physical breast examination. Statistical analysis: For the analyses, the database will be exported to the REDCap (Research Electronic Data Capture) platform. The calculations were defined to detect a reduction in severe cases and mortality (10% and 20%, respectively). For this purpose, a sample power of 80% and a Type I error of 5% were adopted after adjusting for intraclass correlation and sampling effect (0.032 and 1.892, respectively). The calculations were estimated using nQuery software (version 9.1). For the city of Itaberaí, a population of 1,894 women was estimated in each group, resulting in a total of 3,788. Present and target accrual: The trial was activated in December 2022, and as of June 30th, 2023, 2,467 patients had been accrued. The study will last for 16 years, and the first data analyses will be conducted in 2024. Registration and ethical aspects: The trial is registered in ReBEC (Brazilian register): RBR-39vm2nd. Contact information: Prof. Dr. Ruffo Freitas-Junior, Federal University of Goiás, ruffojr@terra.com.br. Citation Format: Ruffo Freitas-Junior, Danielle Rodrigues, Rosangela Corrêa, Leonardo Soares. Breast cancer screening based on physical breast examination: ITABERAÍ randomized trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-21-02.

Evaluation by Community Health Agents of the attributes of Primary Health Care for fighting leprosy

Objective: To evaluate whether the attributes of Primary Healthcare are present in leprosy control actions in Londrina from Community Health Workers (CHW) perspectives. Methods: Observational and evaluative study. Data collection took place between January and March 2020 in Londrina, Paraná, using the questionnaire "Primary Care Assessment Tool (PCATool) - Hansen's disease - CHW version" and a population-based census of 246 CHWs from 52 Primary Healthcare Units. The analyses used a cutoff point (≥ 6.6), central tendency, and dispersion measures. One-way ANOVA and Tukey's post hoc tests were used to analyze differences. Results: The general performance towards the primary healthcare attributes were evaluated as strong (mean = 6.95 / SD = 1.08) and the essential score (mean = 7.39 / SD = 1.0). On the other hand, the derived score was evaluated as poor (mean = 6.07 / sd = 1.06). Concerning the Access attribute, the rural zone had a lower score than the urban (mean = 4.47 / SD = 1.63). As for the Comprehensiveness attribute of services provided to leprosy patients, the central region had a lower mean (mean = 4.87 / SD = 3.44) than the south region (mean = 6.76 / SD = 2, 24). Concerning the Integrality, the rural region presented a higher score (mean = 8.15 / SD = 1.22) than the western (mean = 6.16 / SD = 2.91) and central regions (mean = 6.13 / SD = 3.27). As for Community Orientation, the western region had a lower mean than the others (mean = 5.04 / SD = 2.44). The vocational guidance attribute had a higher average in the rural region (mean = 4.14 / SD = 2.62). Final Considerations: The study highlights issues that can be improved, such as first contact access, catalog of services offered to leprosy patients, information provided to the community, professional training, and differences in PHC performance between urban and rural regions.

Home Care for the Elderly: An Integrated Approach to Perception, Quality of Life, and Cognition.

This study investigated the impact of home care, health status, and cognition. A qualitative and quantitative approach was employed through a cross-sectional study with a sample of 60 elderly individuals in need of home care in the municipality of Itatiba, São Paulo, Brazil. The analysis utilized the Discourse of the Collective Subject (DCS), EQ-5D, EQ VAS, and Mini-Mental State Examination (MMSE). The sample consisted of 40.0% male and 60.0% female individuals. The majority (61.6%) received weekly visits, mainly from community health agents, who were responsible for the majority of the care (45%). Positive considerations were highlighted, with 36.6% emphasizing the contribution to treatment continuity. The EQ VAS assessment indicated a moderately good perception of health. The EQ-5D analysis revealed significant differences between genders in personal care (p = 0.04). There were significant differences between clinical characteristics and EQ-5D dimensions, such as neoplasia and reduced mobility (p = 0.04), and arthritis/osteoarthritis/rheumatism and a limitation in common activities (p = 0.01). The presence of anxiety/depression was significant in cases of neoplasia (p = 0.006), arthritis/osteoarthritis/rheumatism (p = 0.01), and stroke (p = 0.04). The logistic regression analysis showed associations between usual activities and arthritis, osteoarthritis, rheumatism (p = 0.034), pain/malaise and arthritis, osteoarthritis, rheumatism (p = 0.038), and anxiety/depression and stroke (p= 0.028). The average MMSE scores (17.52) suggested a mild cognitive impairment, with no statistical differences between genders. Based on these results, it can be concluded that home care can provide a comprehensive approach and continuous assistance, emphasizing the importance of personalized care based on perceived and clinical differences.

Breastfeeding in primary health care: weaknesses and potentialities of nursing care

Objective: To identify the weaknesses and potentialities of nursing care for breastfeeding in Primary Health Care (PHC). Methods: A qualitative study developed through workshops held in September 2021 with 43 nursing professionals. Results: Two categories emerged: “Weaknesses of breastfeeding nursing care in PHC” and “Potentialities of breastfeeding nursing care in PHC”. Weaknesses permeate the discourse, which is often not in line with the reality of the postpartum period, lack of theoretical and practical knowledge, cultural influences, short maternity and paternity leave, shortage of professionals, absence of meetings, inappropriate physical space, limited time for care, failure to address the issue and lack of training. Presented as potentialities are the availability of professionals for guidance in different environments, the work of community health agents, the existence of the Women’s, Children’s and Adolescents’ Health Center, the Municipal Breastfeeding Support Network, the use of technology and encouraging the participation of partners from prenatal to postpartum. Conclusion: It is necessary to consider the weaknesses identified in order to develop improvement actions focused on increasing breastfeeding indices. As for the strengths, they reflect successful practices that can support and guide other nursing services.

Perceptions of community health agents about violence against elderly of people

Violence against the elderly is a serious public health problem, which has been growing and interfering with the quality of life of this population group. In view of this, this article aims to investigate the perceptions of community health agents (CHA) about violence against elderly people and their knowledge about this topic. To this end, one exploratory and descriptive research was carried out with a qualitative approach based on interviews with seven health agents, whose contents were analyzed using the MAXQDA Analytics Pro 2020 Software. This search resulted in two categories: “weaknesses in working with violence to the elderly” and “the power of the multidisciplinary team, of home visits, qualified listening and teaching-service integration” with their respective subcategories. In speech of the CHAs, the lack of knowledge of the coping network was emphatically pointed out, which is a great weakness, proving to be a challenge to be overcome. In short, community agents are at an impasse in recognizing the Network to combat violence against the elderly, with a notable lack of training and ongoing education to deal with this social problem. It is necessary to develop qualification strategies for CHWs, and also for the institutions participating in the Network to combat the elderly to be strengthened, enhancing the monitoring of proposed actions in cases of violence.

Perspective of nurses and community health agents on directly observed treatment of tuberculosis in a capital city in northern Brazil

To understand the perspective of nurses and community health agents on Directly Observed Tuberculosis Treatment (DOT) in their professional practice in Primary Health Care in a municipality in northern Brazil. This is a qualitative, exploratory study carried out with 12 nurses and five community health workers. Data was collected through semi-structured interviews between August and November 2019 and submitted to the conventional content analysis technique. Two categories emerged: 1. "The TDO project is wonderful, the problem is that it doesn't work in practice"; 2. "We don't leave it loose, if it disappears we go after it". The results showed that both nurses and CHWs recognize the importance of DOT, but that for reasons related to operationalization, accessibility, patient peculiarities and curtailment of autonomy, DOT is not carried out. They also showed that, despite not being able to carry out the DOT, they use different strategies to ensure that TB treatment is carried out. These findings suggest the need for more in-depth reflection on the implementation of DOT and the existence of possibilities that need to be widely discussed in relation to established policies.

Sexual invisibility in individual registrations: a study with Community Health Agents

The debate on gender and sexuality is crucial in Primary Health Care (PHC), given its influence on the health-disease process. Its initial approach occurs in the Individual Registration Form, a tool used by Community Health Agents (CHAs), through optional questions about the resident's gender identity (GI) and sexual orientation (SO). In this sense, the present study aims to investigate the factors related to the act of questioning or not questioning GI and SO in a sample of CHAs. It is a cross-sectional, quantitative, and descriptive study, using a structured questionnaire directed to CHAs affiliated with Family Health Units of the Integrated Health Care Territories project in the city of Campo Grande/MS. With 118 participants, 22.9% could not indicate their GI, and 80.5% rarely inquire about GI and SO. The majority (72.8% and 61%) has limited knowledge about GI and SO. The analysis revealed a positive association between the frequent discussion of the topic with CHAs and the frequent questioning of GI and SO (OR=6.45; 95% CI: 1.33-31.21), p<0.05. Therefore, the results highlight the importance of ongoing health education to promote equity in the care of LGBTQIAP+ individuals within the scope of PHC.

Landscape analysis of healthcare workforce and resilience actions in the Sahelian context of high security challenge areas: The case of Burkina Faso.

Access to health services is a major challenge in developing countries in general, particularly those affected by insecurity. The availability of sufficient quantity and quality of equitably distributed healthcare workforce is a major obstacle, yet it is an essential pillar of an effective and efficient national health system. Burkina Faso, similar to other countries in the Sahel, has been affected by an unprecedented security crisis that has severely tested the functionality of health facilities and the availability of healthcare workforce. To describe the landscape of healthcare workforce and to analyse the actions taken by the government and other stakeholders to improve the resilience of the system and the retention of healthcare workers in the context of major security challenges. This is a transversal, descriptive and analytical study carried out in Burkina Faso in 2023 through a documentary review, analyses of databases collected from health districts and regional directorates, focus groups and a national triangulation workshop with key informants. The study shows that, with the closure and minimal functioning of certain health facilities in security-challenged areas, healthcare workforceare concentrated in the urban areas of regional and district capitals, to the detriment of rural areas. Some staff become in an irregular situation regarding the administration. To strengthen resilience to the crisis, the main solutions have been implemented: (i) enhancing the community platform with the recruitment of 15,000 community-based health volunteers, (ii) delegating tasks to community health agents, (iii) simplified approaches, (iv) advanced health posts and mobile clinics, (v) redeployment to the most stable structures, (vi) thinking about legislation in crisis situations. Community resilience through the delegation of tasks to community-based health workers and strengthening of the community health platform has helped ensure the continuity of care in insecure areas. However, the optimization of innovative and attractive strategies will further improve the retention and return of healthcare workers in rural areas affected.

Are community health agents the link to integrating care? Lesson from Brazil

Purpose This viewpoint piece will highlight the contribution of trained lay community health workers to the integrated workforce in rural, remote and island settings, drawing on experience from a system strengthening project involving community health agents (CHAs) in four municipalities in Litoral Norte, a remote coastal and island region in the state of São Paulo, Brazil.Design/methodology/approach This viewpoint reflects on experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.Findings CHAs took forward actions that touched the lives of thousands of vulnerable families with low income and complex needs in communities with high levels of social and health inequalities. They acted as a bridge between patients and families at home, primary healthcare professionals and wider community partners and services. Their valuable insight into the healthcare issues and social challenges experienced by the community informed and supported family centred practice and population health goals. The CHAs rapidly pivoted to became an essential public health workforce during the Covid-19 pandemic.Practical implications As the authors establish integrated care systems and embrace proactive care and population health, the conditions are favourable for introducing a similar role in the UK. For psychological safety and avoidance of burnout people in such new roles will require training, supervision and full integration within community teams.Originality/value This viewpoint reflects experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.

Implementing a provisional overarching intervention for COVID-19 monitoring and control in the Brazil-Colombia-Peru frontier.

he challenge was to provide comprehensive health resources to a remote and underserved population living in the Brazil-Colombia-Peru border, amid the most disruptive global crisis of the century. In August 2021, Fundação Oswaldo Cruz Amazonia (FIOCRUZ Amazônia) and partner collaborators implemented an overarching provisional program for SARS-CoV-2 detection and lineages characterization, training of laboratory personnel and healthcare providers, donation of diagnostic supplies and personal protective equipment, and COVID-19 vaccination. The expedition was conducted at the Port of Tabatinga, a busy terminal with an intense flux of people arriving and departing in boats of all sizes, located in the Amazon River basin. Local government, non-profit organizations, private companies, and other stakeholders supported the intervention. The expedition was accomplished in a convergence point, where migrant workers, traders, army personnel, people living in urban areas, and people from small villages living in riversides and indigenous territories are in close and frequent contact, with widespread cross-border movement. Using a boat as a provisional lab and storage facility, the intervention provided clinical and laboratory monitoring for 891 participants; vaccination for 536 individuals; personal protective equipment for 200 healthcare providers; diagnostic supplies for 1,000 COVID-19 rapid tests; training for 42 community health agents on personal protection, rapid test execution, and pulse oximeter management; and hands-on training for four lab technicians on molecular diagnosis. Our experience demonstrates that multilateral initiatives can counterweigh the scarcity of health resources in underserved regions. Moreover, provisional programs can have a long-lasting effect if investments are also provided for local capacity building.