Effects of Urban Violence on Primary Healthcare: The Challenges of Community Health Workers in Performing House Calls in Dangerous Areas
Community health workers in developing countries usually perform house calls in degraded and violent territories. Thus, in this paper we study the effects of urban violence in the performance of CHWs in poorly developed territories, in order to understand the challenges of delivering care to dangerous communities in developing countries. We conducted telephone surveys for 5 months in 2017, within a systematic sample of 2.000 CHWs based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. We completed 766 interviews, approximately 40% of the sample, 86% man and 14% women. Most participants are 30 to 39 years old (35%), followed by 27% of 40 to 49 years old participants. As CHWs 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.
KeywordsCommunity health workers Primary health care House calls Exposure to violence
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflicts of interest.
Research Involving Human Participants/Informed Consent
Regarding scientific research involving human beings, this study was conducted in accordance with the ethical principles of the Resolution No. 466/2012 of the Brazilian National Council of Health Care/Brazilian Ministry of Health and approved by ethics committees. Therefore, all participants had to express their agreement with to informed consent terms read by the telephone interviewer. In addition, participants had the option of receiving a copy of the informed consent terms by email. Moreover, participants’ confidentiality was ensured as their responses were not identified.
- 2.Declaration of Alma-Ata (1978). Alma-Ata, USSR: World Health Organization.Google Scholar
- 4.Rosenthal, E.L., Lacey, Y., Blondet, L., et al. (1998) A summary of the National Community health advisor study: Weaving the future—A policy research project of the University of Arizona. Tucson Univ Ariz Rural Health Office of the Mel Enid Zuckerman Ariz College Public Health, 14, 2005.Google Scholar
- 6.Singh, P., & Sullivan, S. (2011). One million community health workers: Technical task force report (pp. 304–310). New York: Earth Inst Columbia University.Google Scholar
- 20.Morosini, M., & Fonseca, A. F. (2018). Configurações do trabalho dos Agentes Comunitários na Atenção Primária à Saúde entre normas e práticas. Atenção Primária à saúde no Brasil: conceitos, práticas e pesquisa (pp. 369–406). Fiocruz: Rio de Janeiro.Google Scholar
- 23.Ospina, S.T. (2013) Uncovering the role of community health worker/lay health worker programs in addressing health equity for immigrant and refugee women in Canada: An instrumental and embedded qualitative case study Google Scholar
- 29.Brazilian Ministry of Health (2006). Brazilian Primary Health Care National Policy. http://bvsms.saude.gov.br/bvs/saudelegis/gm/2006/prt0648_28_03_2006.html
- 32.de Coriolano, M. W. L., & de Lima, L. S. (2010). Focus groups with community health agents: Subsidies for understanding these social actors. Revista Enfermagem UERJ, 18, 92–96.Google Scholar