Our global health experts are working with communities across Brazil to understand how the country manages major health challenges, including the recent outbreak of Zika virus.
At the heart of the research, led by Dr João Nunes from our Department of Politics, is the vital role played by Brazil's network of Community Health Workers (CHWs). This community-based, mostly female workforce of over 280,000 people acts as the bridge between residents and local primary care services in the country's universal public health system.
CHWs have no formal medical training and they do not prescribe medication. What they do is visit people in their homes where they advise on women’s reproductive health, make sure that diabetes patients are taking their medication and check up on elderly or disabled people. They offer exercise and healthy eating advice and sometimes work with victims of domestic violence.
CHWs are also pivotal in community activities including organising social events or activities for elderly people to tackle loneliness.
Their work has contributed to health improvements including reduced infant mortality and increased uptake of vaccines.
“It’s fair to say that without CHWs, the health of some of the poorest communities in Brazil would be a lot worse with many health problems going undetected,” says Dr Nunes, an expert in the politics of global health. “They know their local communities, they know who the vulnerable people are and they know how to work with them.”
At the height of the Zika virus, CHWs acted as the eyes and ears of the public health service, spotting symptoms, flagging up possible cases and giving advice to families about how to control mosquitoes – the source of the virus. “The Zika outbreak underscored the importance of CHWs,” says Dr Nunes.
The world’s attention may have moved on from Zika – but small pockets of the virus still remain. Other mosquito-borne diseases including dengue, yellow fever and chikungunya are also endemic among the population.
“Health-related problems in Brazil are not just medical," says Dr Nunes. “They are rooted in political and cultural issues linked to poverty, society and lack of investment in basic infrastructure such as sanitation. Community Health Workers have a key role in helping to tackle the health problems which are often related to these wider political and infrastructure issues.”
But despite the benefits of CHWs, economic difficulties and political upheaval in Brazil means that politicians and policy makers are questioning the value of the CHW programme and the public health system.
"CHWs do invaluable work," says Dr Nunes, "but they are easy targets for budget cuts. Low pay and the fact they are not clinically trained means they are often seen as dispensable."
Dr Nunes is collaborating with Dr Alexander Medcalf, based in our Centre for Global Health Histories, who is exploring the history of CHWs and how their roles have evolved in response to changing health needs.
His focus is the period leading up to and immediately after the 1978 International Conference on Primary Health Care when the World Health Organisation (WHO) sought to put CHWs at the centre of delivering health for all.
WHO officials recommended the creation of more national CHW programmes and the expansion of others, but they also identified many weaknesses and challenges to overcome. Dr Medcalf’s research tracks strategies for action, including the use of extensive media campaigns to garner support for the programmes.
Dr Nunes and Dr Medcalf recently met officials from WHO at their HQ in Geneva to discuss some of the project findings.
Support and training
Now, following further funding for his work, Dr Nunes is collaborating with researchers at the Fiocruz scientific foundation and the João Pinheiro Foundation in Brazil to develop support programmes and training to help CHWs working in the Minas Gerais state in south-eastern Brazil. Training films are planned in partnership with a regional TV company. Dr Nunes is also collaborating with regional government and scientific institutions to draw up policy recommendations.
Interviews are already underway with women’s social movement groups in Minas Gerais, including trade union representatives and rural workers, to understand the health needs of women and the impact of ill health on their families.
“Our research highlights the enduring value of CHWs. In Minas Gerais, our work will also establish what support they need to help them do their jobs – and then provide training programmes to help them overcome some of the challenges they face on a daily basis.”
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