RESUMO
Nota técnica sobre recomendações do trabalho de combate ao Aedes Aegypt pelos Agentes Comunitários de Saúde (ACS) e Agentes de Combate à Endemias (ACE), que foi elaborada em razão do cenário epidemiológico de Doenças Infecciosas Virais - Arboviroses no Estado de Goiás 3 PÁGINAS
Nota técnica sobre recomendações do trabalho de combate ao Aedes Aegypt pelos Agentes Comunitários de Saúde (ACS) e Agentes de Combate à Endemias (ACE), que foi elaborada em razão do cenário epidemiológico de Doenças Infecciosas Virais - Arboviroses no Estado de Goiás
Assuntos
Humanos , Agentes Comunitários de Saúde/normas , Infecções por Arbovirus/prevenção & controle , Dengue/prevenção & controleRESUMO
BACKGROUND: Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort. CASE PRESENTATION: In this article, we describe the process of unifying the two major CHW workforces in Arizona, promotoras de salud in US-Mexico border communities and community health representatives (CHRs) serving American Indian communities. Differences in the origins, financing, and even language of the population-served contributed to historically divergent interests between CHRs and promotoras. In order to move forward as a collective workforce, it was imperative to integrate the perspectives of CHRs, who have a regular funding stream and work closely through the Indian Health Services, with those of promotoras, who are more likely to be grant-funded in community-based efforts. As a unified workforce, CHWs were better positioned to gain advocacy support from key health care providers and health insurance companies with policy influence. We seek to elucidate the lessons learned in our process that may be relevant to CHWs representing diverse communities across the US and internationally. CONCLUSIONS: Legislated voluntary certification provides a pathway for further professionalization of the CHW workforce by establishing a standard definition and set of core competencies. Voluntary certification also provides guidance to organizations in developing appropriate training and job activities, as well as ongoing professional development opportunities. In developing certification with CHWs representing different populations, and in particular Tribal Nations, it is essential to assure that the CHW definition is in alignment with all groups and that the scope of practice reflects CHW roles in both clinic and community-based settings. The Arizona experience underscores the benefits of a flexible approach that leverages existing strengths in organizations and the population served.
Assuntos
Certificação/normas , Agentes Comunitários de Saúde/organização & administração , Serviços de Saúde do Indígena/organização & administração , Arizona , Fortalecimento Institucional/organização & administração , Certificação/legislação & jurisprudência , Agentes Comunitários de Saúde/economia , Agentes Comunitários de Saúde/legislação & jurisprudência , Agentes Comunitários de Saúde/normas , Tomada de Decisões , Política de Saúde , Serviços de Saúde do Indígena/economia , Humanos , México , Estudos de Casos Organizacionais , Recursos Humanos/organização & administraçãoRESUMO
Apresenta medidas preventivas para atuação do agente de saúde no enfrentamento a COVID-19. Nele são compartilhados os cuidados importantes durante esse período, sugestões de organização do trabalho, experiências exitosas e materiais de referência para que se possam utilizar.
It presents preventive measures for the action of the health agent in confronting COVID-19. It shares important care during this period, suggestions for work organization, successful experiences and reference materials for use.
Assuntos
Humanos , Pneumonia Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Agentes Comunitários de Saúde/normas , Pandemias , Promoção da Saúde , Características de Residência , BetacoronavirusRESUMO
BACKGROUND: Access to surgical care is a pressing challenge, particularly for vulnerable populations. Informal and formal community health workers (CHWs), including lay people, increasingly function in pivotal roles in primary care, however, remain disconnected from surgical care in most environments. This study examined the degree to which CHW understanding of surgical conditions could be improved through the use of a pictorially based manual. METHODS: A manual and associated situational problem-solving questionnaire instrument were developed and contextualized through focus groups in Central America. A baseline assessment was obtained. In the program implementation, cohorts of formal and informal CHWs were introduced and trained to use the manual through a short curriculum. Assessment was repeated in program implementation, first with access to relevant manual content only, and then after the teaching session. Participants were also surveyed about manual scheme, usability, and utility. RESULTS: A total of 100 subjects (67% female) participated in baseline assessment, and 403 subjects (68% female) were assessed through the program implementation. Baseline problem-solving averaged 11.8 (SD 2.46) out of a possible 20 points. Mean score increased to 15.4 (SD 3.10) when participants had access to relevant surgical manual content and again to 15.9 (SD 3.09, p < 0.0001) following participation with an instructive curriculum. Participant score while utilizing the manual correlated with amount of education completed (r = 0.26), but baseline score did not. High readability 389 (96%) and high self-reported willingness for use 398 (96%) were noted. CONCLUSION: Baseline familiarity with surgically treatable conditions appears modest among rural Central American populations, and improves with access to a contextualized, pictorial manual focused on recognizing and appropriately referring surgical conditions.
Assuntos
Agentes Comunitários de Saúde/educação , Cirurgia Geral/educação , Manuais como Assunto , Encaminhamento e Consulta/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica , Serviços de Saúde Comunitária/normas , Agentes Comunitários de Saúde/normas , Currículo , Avaliação Educacional/métodos , Feminino , Grupos Focais , Honduras , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Atenção Primária à Saúde/normas , Resolução de Problemas , População Rural , Populações Vulneráveis , Adulto JovemRESUMO
This article analyzes the feasibility of implementing a program that monitors the hearing and language development in the first year of life. It is a prospective longitudinal study, in which 41 community health workers were invited to monitor, on a monthly basis, by means of a questionnaire validated earlier, the hearing and language of children born in their micro areas of expertise. Thirty-nine community health workers agreed to participate, with only two refusals. Five gave up participating. Twenty-six (66.66%) did not perform monitoring, seven (17.94%) monitored improperly and only six (15.38%) monitored properly. Just one child failed the quiz, who was forwarded to the hospital that conducted the auditory screening for retesting. These professionals' high activity demand was considered the main reason for the difficulties encountered in this project. In addition, there is the difficulty to have contact with the Family Health Strategy teams, as well as the impossibility of permanent face-to-face discussions and the influence of the community health agents' supervisors.
Este artigo analisa a viabilidade da implantação de um programa de monitoramento do desenvolvimento auditivo e de linguagem no primeiro ano de vida. Trata-se de um estudo longitudinal prospectivo, no qual quarenta e um agentes comunitários de saúde foram convidados a monitorar mensalmente, por meio de um questionário já validado, a audição e a linguagem de crianças nascidos nas suas microáreas de atuação. Trinta e nove agentes comunitários de saúde aceitaram participar, havendo apenas duas recusas. Cinco desistiram da participação. Vinte e seis (66,66%) não realizaram o monitoramento, sete (17,94%) monitoraram de forma inadequada e apenas seis (15,38%) monitoraram adequadamente. Apenas uma criança falhou no questionário, a qual foi reencaminhada ao hospital em que realizou a triagem auditiva para reteste. Acredita-se que a elevada demanda de atividades destes profissionais foi o principal motivo para as dificuldades observadas neste projeto. Além disso, destaca-se a dificuldade no contato com as equipes de Estratégia Saúde da Família, bem como a inviabilidade de discussões presenciais permanentes e a influência dos supervisores dos agentes comunitários de saúde.
Assuntos
Agentes Comunitários de Saúde/estatística & dados numéricos , Testes Auditivos/métodos , Desenvolvimento da Linguagem , Programas de Rastreamento/métodos , Agentes Comunitários de Saúde/normas , Audição/fisiologia , Humanos , Lactente , Estudos Longitudinais , Projetos Piloto , Atenção Primária à Saúde/métodos , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
Resumo Este artigo analisa a viabilidade da implantação de um programa de monitoramento do desenvolvimento auditivo e de linguagem no primeiro ano de vida. Trata-se de um estudo longitudinal prospectivo, no qual quarenta e um agentes comunitários de saúde foram convidados a monitorar mensalmente, por meio de um questionário já validado, a audição e a linguagem de crianças nascidos nas suas microáreas de atuação. Trinta e nove agentes comunitários de saúde aceitaram participar, havendo apenas duas recusas. Cinco desistiram da participação. Vinte e seis (66,66%) não realizaram o monitoramento, sete (17,94%) monitoraram de forma inadequada e apenas seis (15,38%) monitoraram adequadamente. Apenas uma criança falhou no questionário, a qual foi reencaminhada ao hospital em que realizou a triagem auditiva para reteste. Acredita-se que a elevada demanda de atividades destes profissionais foi o principal motivo para as dificuldades observadas neste projeto. Além disso, destaca-se a dificuldade no contato com as equipes de Estratégia Saúde da Família, bem como a inviabilidade de discussões presenciais permanentes e a influência dos supervisores dos agentes comunitários de saúde.
Abstract This article analyzes the feasibility of implementing a program that monitors the hearing and language development in the first year of life. It is a prospective longitudinal study, in which 41 community health workers were invited to monitor, on a monthly basis, by means of a questionnaire validated earlier, the hearing and language of children born in their micro areas of expertise. Thirty-nine community health workers agreed to participate, with only two refusals. Five gave up participating. Twenty-six (66.66%) did not perform monitoring, seven (17.94%) monitored improperly and only six (15.38%) monitored properly. Just one child failed the quiz, who was forwarded to the hospital that conducted the auditory screening for retesting. These professionals' high activity demand was considered the main reason for the difficulties encountered in this project. In addition, there is the difficulty to have contact with the Family Health Strategy teams, as well as the impossibility of permanent face-to-face discussions and the influence of the community health agents' supervisors.
Assuntos
Humanos , Lactente , Programas de Rastreamento/métodos , Testes Auditivos/métodos , Desenvolvimento da Linguagem , Atenção Primária à Saúde/métodos , Projetos Piloto , Estudos Prospectivos , Inquéritos e Questionários , Estudos Longitudinais , Agentes Comunitários de Saúde/normas , Agentes Comunitários de Saúde/estatística & dados numéricos , Audição/fisiologiaRESUMO
The 2010 earthquake resulted in the breakdown of Haiti's social, economic and health infrastructure. Over one-quarter of a million people remain internally displaced (ID). ID women experience heightened vulnerability to intimate partner violence (IPV) due to increased poverty and reduced community networks. Scant research has examined experiences of IPV among ID women in post-earthquake Haiti. We conducted a qualitative study to explore the impact of participating in Famn an Aksyon Pou Santé Yo (FASY), a small-group HIV prevention intervention, on ID women's agency in Leogane, Haiti. We conducted four focus groups with ID women, FASY participants (n = 40) and in-depth individual interviews with peer health workers (n = 7). Our study was guided by critical ethnography and paid particular attention to power relations. Findings highlighted multiple forms of IPV (e.g., physical, sexual). Participants discussed processes of intrapersonal (confidence), interpersonal (communication), relational (support) and collective (women's rights) agency. Yet structural factors, including patriarchal gender norms and poverty, silenced IPV discussions and constrained women's agency. Findings suggest that agency among ID women is a multi-level, non-linear and incremental process. To effectively address IPV among ID women in Haiti, interventions should address structural contexts of gender inequity and poverty and concurrently facilitate multi-level processes of agency.
Assuntos
Agentes Comunitários de Saúde/psicologia , Infecções por HIV/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Poder Psicológico , Refugiados/psicologia , Direitos da Mulher/normas , Adulto , Antropologia Cultural , Agentes Comunitários de Saúde/educação , Agentes Comunitários de Saúde/normas , Desastres/economia , Desastres/estatística & dados numéricos , Terremotos/economia , Terremotos/estatística & dados numéricos , Feminino , Grupos Focais , Identidade de Gênero , Haiti , Humanos , Relações Interpessoais , Entrevistas como Assunto , Violência por Parceiro Íntimo/economia , Violência por Parceiro Íntimo/prevenção & controle , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores Socioeconômicos , Direitos da Mulher/economia , Direitos da Mulher/tendênciasRESUMO
INTRODUCTION: Mid-level health workers are on the front-lines in underserved areas in many LMICs, and their performance is critical for improving the health of vulnerable populations. However, improving performance in low-resource settings is complex and highly dependent on the organizational context of local health systems. This study aims to examine the views of actors from different levels of a regional health system in Guatemala on actions to support the performance of auxiliary nurses, a cadre of mid-level health workers with a prominent role in public sector service delivery. A concept mapping study was carried out to develop an integrated view on organizational support and identify locally relevant strategies for strengthening performance. METHODS: A total of 93 regional and district managers, and primary and secondary care health workers participated in generating ideas on actions needed to support auxiliary nurses' performance. Ideas were consolidated into 30 action items, which were structured through sorting and rating exercises, involving a total of 135 of managers and health workers. Maps depicting participants' integrated views on domains of action and dynamics in sub-groups' interests were generated using a sequence of multivariate statistical analyses, and interpreted by regional managers. RESULTS: The combined input of health system actors provided a multi-faceted view of actions needed to support performance, which were organized in six domains, including: Communication and coordination, Tools to orient work, Organizational climate of support, Motivation through recognition, Professional development and Skills development. The nature of relationships across hierarchical levels was identified as a cross-cutting theme. Pattern matching and go-zone maps indicated directions for action based on areas of consensus and difference across sub-groups of actors. CONCLUSIONS: This study indicates that auxiliary nurses' performance is interconnected with the performance of other health system actors who require support, including managers and community-level collaborators. Organizational climate is critical for making auxiliary nurses feel supported, and greater attention to improving the quality of hierarchical relationships is needed in LMIC settings. The participatory nature of the concept-mapping process enabled health system actors to collaborate in co-production of context-specific knowledge needed to guide efforts to strengthen performance in a vulnerable region.