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How do community health workers institutionalise: an analysis of Brazil's CHW programme

Martins Krieger, Morgana G., Wenham, Clare ORCID: 0000-0001-5378-3203, Pimenta, Denise Nacif, E. Nkya, Theresia, Schall, Brunah, Nunes, Ana Carolina, De Menezes Silva, Ana Irys and Lotta, Gabriela (2022) How do community health workers institutionalise: an analysis of Brazil's CHW programme. Global Public Health, 17 (8). 1507 - 1524. ISSN 1744-1692

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Identification Number: 10.1080/17441692.2021.1940236


Community health workers (CHWs) are framed as the link between communities and the formal health system. CHWs must establish trusting relationships with the community and with the broader health service. How to find the optimal balance between the various strands of work for CHWs, and how to formalise this, has been the focus of different studies. We performed an extensive documentary analysis of federal legislation in Brazil to understand the institutionalisation of the CHW workforce in Brazil over the last 3 decades. The paper offers three contributions to the literature: the development and application of an analytical framework to consider the institutionalisation process of CHWs; a historical analysis of the professional institutionalisation of CHW in Brazil; and the identification of the paradoxes that such institutionalisation faces: firstly, institutionalisation focused on improving CHW remuneration created difficulties in hiring and paying these professionals; when CHW are incorporated within state bureaucracy they start to lose their autonomy as community agents; and that the effectiveness of CHW programmes depends on the improvement of clinical services in the most deprived areas.

Item Type: Article
Official URL:
Additional Information: © 2021 The Authors
Divisions: Health Policy
Grantham Research Institute
IGA: Latin America and Caribbean Centre
Subjects: R Medicine > RA Public aspects of medicine
Date Deposited: 28 May 2021 17:06
Last Modified: 07 Jun 2024 01:54

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