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RESEARCH ARTICLES

 


Role of the community health agent: user’s knowledge

 

Andreia Souza de JesusI; Flavia Pedro dos Anjos SantosII; Vanda Palmarella RodriguesIII; Adriana Alves NeryIV; Juliana Costa MachadoV; Tatiana Almeida CoutoVI

ISpecialist in Public Health. Master's Program Graduate Nursing and Health, State University of Southwest Bahia. Substitute Professor, Jequié Campus, Department of Health, Jequié, Bahia, Brasil. E-mail: andreiasouzad@yahoo.com.br
IIMaster in Nursing and Health. Assistant Professor, State University of Southwest Bahia, Jequié Campus, Department of Health. Jequié, Bahia, Brasil. E-mail: fpasantos@uesb.edu.br
IIIMaster in Public Health. Assistant Professor, State University of Southwest Bahia, Jequié Campus, Department of Health. Jequié, Bahia, Brasil. E-mail: vprodrigues@uesb.edu.br
IVPhD in Nursing. Professor, State University of Southwest Bahia, Campus Jequié, Department of Health. Jequié, Bahia, Brasil. E-mail: aanery@gmail.com.
VMaster in Nursing and Health. Assistant Professor of UESB, Jequié Campus, Department of Health. Jequié, Bahia, Brasil. E-mail: julicmachado@hotmail.com
VISpecialist in Public Health. Master's Program Graduate Nursing and Health, State University of Southwest Bahia, Campus Jequié, Department of Health. Jequié, Bahia, Brasil. E-mail: tatiana_almeidacouto@hotmail.com


ABSTRACT: This study aimed to analyze the knowledge of users about the performance of community health agents of family health strategy teams and to describe their actions. A descriptive and qualitative study performed in family health units of a municipality in Bahia. Data collection was carried out between May and June of 2012, it has used semi-structured interviews with 17 users. It was evidenced the lack of knowledge about community health agent work and limitations in the actions developed by this professional, weakening the relationship between community health agent and community. It was also highlighted the integration established among users, community health agent and nurse and home visit as the main community health agent action. It is needed to develop strategies that increase the link between community health agent and users.       

Keywords: Family health; community health agent; health care; nursing.
 


 

INTRODUCTION

The family health is considered as a priority strategy of primary health care, seeks to reorient the model of health care, to bring health professionals to the community, using a new dynamic organization of health services and actions, in which the home visits should be conducted by all professional health team1.

Among the professionals who work in the Family Health Strategy (FHS) the community health agent (CHA) is highlighted, who develops his work closer to the users, by residing in the area of ​​performance and conducting home visits daily.

The CHA develops several actions in order to facilitate the integration between the family and the health care team and it is responsible for specific activities such as ascription of families, registration of people in their micro area guidance on the use of health services, conducting scheduled activities, educational activities, among others2.

The proximity of the CHA gives users a trust relationship, favoring the development of their duties in a more effective and affective way, highlighting the wake of the construction of the citizenship3.

It is evident in the work of the nurse by his relationship with the CHA and the community where they both work, because in addition to activities that develops in the clinic, it also conducts home visits, which allows the knowledge of the reality of families together, encourages programming and development of health practices4. Thus, it becomes essential to provide users of listening to know the local situation and plan the actions to be undertaken by the FHS team.

The health care in the context of FHS should include users as participating subjects, it is necessary that the team will facilitate their access to health systems, providing a warm, humane and care-free discrimination5.

The relevance of this research is the possibility of professionals from FHS teams, especially the CHA and the nurse to reassess their practice in order to give visibility to the community about the responsibilities inherent in each professional. In addition, they will resize care produced the users perspective contemplating completeness and empowerment of individuals to exercise citizenship by participating effectively be questioning the difficulties experienced in health services.

This study aimed to analyze the user's knowledge about the performance of the CHA in the FHS teams and describe the actions carried out by him.

LITERATURE REVIEW

The CHA enters the Brazilian scenario with the implementation of Community Agents Program (PACS) in Ceará in 1987; PACS was extended to the North and Northeast, and in 1991, presents significantly in Brazil. Since then, the CHA began to reveal itself as a health worker, evidencing as a mediator between the community and health staff6.

Starting in 1994, they began to form the first FHS at first deployed as a program and subsequently expanded as a strategy, prioritizing prevention, promotion and restoration of health of individuals and communities in a full and continuous way2.

In 2006, the profession of the CHA was regulated under the primary care, supporting its performance backed by Law No. 11,350 that recognized as a health professional, attributing the exercise of activities to promote health and disease prevention, through home or community, individual or collective actions, developed according to the guidelines of the Unified Health System (SUS)7.

The CHA is the professional staff that manages the FHS while being inserted into the team and the community. Moreover, it is this peculiarity that allows these professionals to act as a facilitator of links, enabling community access to health services and communication between them8.

Thus, it strengthens the ability of the CHA to establish a relationship and bond with the host families with whom acts and from that bond becomes possible to create a link between the community and health staff, this being generally recognized by the community9.

The closeness that the CNA has with local reality and the importance of their work with the team for the planning of health, justify the importance of this professional qualification in risk identification, damage and health needs of the population. Moreover, their work involves actions as a measure of weight, height and control vaccination status of children10.

This close relationship between the health service and community enables sensitive listening users to feel welcomed and included proactively in the care production.

It is believed that from the strengthening of the bond the co-responsibility of the users will be established in health care by facilitating the consolidation of SUS principles and promote a humane and comprehensive care5.

METHODOLOGY

Descriptive study with a qualitative approach, carried out in three teams of family health units (FHU) in the urban area of a State of Bahia, in the period May-June 2012, with 17 members, selected from the following inclusion criteria: registered users and accompanied by FHS teams for a minimum of one year and chosen by lot by micro area.

Data were collected through semi-structured interviews using a script with the following questions: What is your understanding of the performance of the CHA of FHS teams, including the actions taken by CHA from the FHS teams? The interviews were recorded at FHU and at home, taking an average of 25 minutes duration, considering the most suitable for the users location.

For data processing it was proceeded to the technique of content analysis thematic method11, contemplating three stages: the first was the pre-analysis, where all materials were chosen to be analyzed, based on the objectives of the study, which constituted the whole of the transcribed interviews of 17 participants.

Going forward, there was a brief reading of the material collected for constituting the corpus, that is, the search for the organization of the material. A brief reading allowed to infer that the content of the material obtained contemplate homogeneity, completeness and relevance therefore, it could be considered representative.

The second phase referred to the exploration of the material with the cutting of the text into units of categorization and coding for recording such data.

In the third step the treatment results and their interpretation were performed. Finally, two categories were identified: performance of the CHA in the view of users and actions developed by CHA: users´ view.

The identification of respondents in the text was represented by the letter I of interviewed, followed by the number corresponding to the ascending order of the interview number.

The study was submitted to the Ethics Committee in Research of the State University of Southwest Bahia and approved by the opinion in paragraph 7.905, and interviewees signed a consent form, fulfilling the ethical principles set out in Resolution 196/96 National Health Council, applies to the period of the research.

RESULTS AND DISCUSSION

The study participants had 20-70 years old, 16 females and one male, with elementary to higher education. Most respondents exercised the profession/occupation of home chores and the other, general services, teacher, assistant secretary and retired. With regard to the time of residence in the area of the FHU was 2-30 years with time Registration of 1-8 years.

The following results are analyzed according to the identified categories.

Performance of the CHA in the view of users

Respondents noted that they had little knowledge about the work of the CHA, a fact that seems to be related to the lack of monitoring of registered families.

[...] I know little about the work of the agent [...]. (I8)

[...] Here he never comes, I do not quite know how it works [...] I signed up [...] in the square, when I came from work [...] in my house never came to know and Iam pregnant, he never came here. (I10)

The CHA must be attentive to the needs identified in the community health and daily life of health services, so as to provide that the community recognizes as professionals working in the community, working with the FHU.

In addition, it was observed misconceptions about the actions developed by the CHA as described in lines explained below.

[...] To measure our blood pressure [...] to bring the medicine [...]. (I1)

[...] To measure the blood pressure. (I6)

[...] To go to the health center to take the medication for diabetics. (I7)

He has to check the exams, measuring our blood pressure, if it is needed, to bring a remedy or take a person to take the exam [...]. (I16)

These interviewees relate the actions of CHA with the performance of procedures and dispensing drugs, showing ignorance about this professional, which can result in dissatisfaction with the work of these professionals, a fact that provides reflection on the need for strategies that can best clarify the professional performance of the CHA in the community, in order to equip users for responsibility in the production of comprehensive care.

In addition, respondents were not presented as proactive subjects in the care of his own health process.
It is highlighted the need for the FHS team include users in the process of care, awakening them to their responsibility in the prevention, treatment and healing process and these should be active in the construction of knowledge that underpin their actions process, considering health and social production as a citizen's right12.

It is important that the team at FHS and especially the CHA to develop their activities in order to promote the acceptance, respect and link users to develop promising modes of care in health services, in order to improve the resolution of needs health identified by the community, minimizing the dissatisfaction of users5.

The performance of the CHA involves actions for health promotion and disease prevention and provides the approach with families to hold them accountable. It is necessary to establish new ways of caring for the health of conjoint-professional/family way that constitutes a priority action in the FHS4.

It is emphasized that there is still a gap in how the activities of the CHA in the community are developed, showing little resolution at their actions.

Study in Picos (PI), the FHS has demonstrated the need for knowledge about the doubts and the risk situations that identify CHA in their daily work routine in order to support the nurse in planning effective actions aimed at families13.

In FHS, the health care must transcend centered practices in standards and procedures, focusing on the establishment of a connection between the health team and community and encouraging autonomy of users14.

In the study, we identified the appreciation of the link between users and the CHA.

 [...] The agent is the friend of the family [...]. (I7)

The welcoming attitude and sensitive listening are potential actions to build commitment and responsibility among professional and user perspective in a climate of mutual trust and respect15.

Actions developed by CHA: user´s view
           
In the FHS, a home visit is considered a tool for team performance by providing the resumption of personal autonomy and establish care at the closest to the user at their home site, enabling the development of effective actions16.

In the study, respondents identified the home visit as the main action taken by the CHA.

 [...] The community agent has to be in the neighborhood, visiting [...] the sick people, those who can not afford to go to the PSF [Family Health Program] [...]. (I6)

[...] Visit the population of their area [...] give information that he needs something, exam [...]. (I14)

Visiting families, pass the information on health, weigh children and look vaccine card [...] give some information, ask if I take the child to the health center [...]. (I17)

Although users have evidenced a home visit as a monitoring tool for families, these statements showed some specifics about the work of the CHA restricted to those who cannot travel to FHU, the transfer of information on the examinations and targeted actions child health. Such responses visions reaffirm a biologist vision by reducing the actions of the CHA to technicist and limited actions.

Respondents signaled that the performance of CHA is related to the family environment.

He has to follow the family, the pregnant women [...]. (I7)

[...] It has to come to the houses, to know what the family is [...] to have the knowledge of what is happening in the house. (I10)

Although users have targeted monitoring of the CHA to specific groups, they seem to recognize that their role involves the individual in the family context, outlining a broader view that considers not only the individual aspect, but considering the other family members.

Respondents also indicated that the CHA establishes communication between the community and the staff of FHS, highlighting the participation of nurses in home visits, and routing the user this professional whenever necessary.

 [...] The agent was always there, he took the nurses [...]. (I6)

[...] Forward to the nurse [...]. (I15)

It is the perspective of integration among the members of the FHS team that activities should be carried out and the nurse stands out in his involvement with the CHA, for developing actions in the unit, and especially in the community.

The home support for families should be performed monthly by the CHA, that are responsible for all the families of their micro area and home care nurse accomplishes that, where necessary, prioritizing users with health needs4.

It is understood that the nurse should not develop his powers being restricted to the FHU area, without prioritizing contact with other professionals and the community, considering that configures the opportunity to seize the health needs of the population so closer the local reality.

It is expected that many situations identified in the community are brought to the team of FHS through the CHA, especially for nurse accompanying the health situation of the families of the area covered by the FHU and oversees the work of the agent17.

However, reports of respondents indicated that the work of the CHA has no visibility to the community, either by not carrying out home visits, or by insufficient number of visits to contemplate the demands presented by the families.

 [...] I don´t see neither working [...] we do not even see the agents here [...] [only] from year to year [...]. (I7)

I rarely have accompanied the presence of the agent, here in my house [...]. (I8)

[...] I have no assistance [...] in my house hedoes not come [...]. (I14)

The ethical commitment to life pervades the overcoming of the mechanical and fragmented way of producing care and is essential to the conduct of a professional staff of FHS is driven by humanitarian, solidarity and citizenship values​15.

Therefore, respondents emphasized that the CHA is limited to the care of sick people or prioritizes the health of the child.

 [...] He just asks if anyone got sick [...]. (I5)

[...] The service of the community agent who comes here in my house is very restricted [...] aimed just right for [...] children's health [...]. (I11)
           
Despite the importance of the CHA direct their actions to priority population groups, it is understood that comprehensive care is to contemplate the ramifications inherent in the analysis, health, political, economic, socio-cultural and spiritual context that permeate the way of life of families in which acts of permanent and not just during registration family way.

[...] Just even when I registered, he asked me if I had sewage here att home, how many people lived here. (I10)

The socially naturalized idea that the CHA is the link between the community and health services, is incorporated in such a way that at times these professional activities occur without more careful follow than the nurse and without a reflection on the CHA itself relevance to their role as driving social transformation.

Despite the importance and impact that the work of the CHA provides users and FHU, it is believed that it is sometimes still possible to perceive obstacles in solving their actions.

In this direction, there are many factors that can lead to the impoverishment of the actions developed by the CHA in the community, may well be considered salary dissatisfaction, difficulty in meeting the goals, difficulty in accepting families in relation to their work, indifference of users in relation to their guidelines, among others17.

We should also stress the importance of being listening to the community, to understand and monitor how all professional of FHS, proceeding to review and redirect them, is developing these actions.

In the study, statements that point to the need of the CHA periodically conduct home visits to families emerged.

I think we need more attention, more visits. (I4)

[...] Assistance should be greater [...] they have to do constant visits. (I11)

Check out more [...] being present in the homes of the families [...]. (I17)

It is worth remembering that some people in the community do not see the activity of CHA even when developed satisfactorily, since they spend most of the day working outside the home.

Respondents' expectations about the performance of the CHA refers to the monitoring, identification of needs, guidance and emotional support to families of his micro area.

[...]they have to follow [...] seeing the needs of these residents [...] guiding. (I9)

[...] Bring words of comfort and inquiring whether he had been hospitalized. (I12)

Respondents highlighted the need for a more participatory monitoring in relation to the work of the CHA in community with guidance and referral to the nurse.

I think it should [...] participate more [...] more guidance. (I13)

Having more guidance [...] forwarding to a nurse [...]. (I15)

The social knowledge that the CHA has the community in which it operates directly interferes in the activities developed by the FHS team. In this context, the visit of the CHA seeks to identify health demands, conduct health education and follow other professionals to households; now the nurse aims to further health education, research health needs of families and conducting welfare nursing activities4.

It is realized the importance of the interaction between the nurse and the CHA so that they can develop their actions in a more resolute manner and produced with quality care for users, taking into account the knowledge of both professionals.

Thus, it is urgent to motivate the CHA to rescue the essence of their mission, which is to prioritize actions to promote health. However, when faced with more complex health needs, it is imperative that seeks to ensure the fulfillment of these needs through teamwork and ensure the way of the user through the service network, with involvement of the FHS staff in the production of comprehensive care.

CONCLUSION

The results revealed ignorance of the work of the CHA by some users, and dissatisfaction with the actions developed by them. Some users have associated assignments for the CHA mistakenly, for example the execution of procedures and marking exams.

While viewing the home visit as the main action performed by the CHA sometimes reducing their actions to biologicist character by emphasizing the monitoring of the sick and bedridden.

They highlighted the integration of the CHA, the community and the nurse as well as the need to monitor the CHA, through periodic home visits, identifying the health needs of the community and involvement with the health situation of the user.

It is fundamental to develop actions by FHS staff that give visibility to the community about the work of the CHA, and the creation of strategies to encourage these professionals to develop their activities in the context of achieving a comprehensive care, prioritizing the responsibility for transformation of health practices.

The study met the proposed objectives, however, had some limitations related to the reality of a State of Bahia, preventing the generalization of results to other settings, which raises the need for further research to explore the topic, revealing other perspectives not covered by the study.

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