Julia Neves (EPSJV/Fiocruz)
Professors-researchers of the Joaquim Venâncio Polytechnic School of Health (EPSJV/Fiocruz) have launched the first bi-monthly report of the study called Health monitoring and contributions to the work processes and professional training of Community Health Agents (CHA) in times of Covid-19. The research, coordinated by Mariana Nogueira and Camila Borges, of EPSJV/Fiocruz, includes the participation of other researchers and other Fiocruz units, such as the Institute of Scientific and Technological Information and Communication in Health (Icict/Fiocruz), Fiocruz Ceará, and the Foundation’s Social Cooperation Coordination. The initiative, financed by Fiocruz by means of its Program of Public Policies, Care Models and Management of Health System and Services, of the Foundation’s Vice-Presidency of Research and Biological Collections, has also a direct interface with the CHAs.
According to Nogueira, the main goal of the research is to analyze the impacts of the disease on the health of these workers, as well as the work conditions made available to them during the pandemic in Brazilian capitals with high number of cases, in addition to three other cities in the metropolitan areas of these capitals. According to the report, although the number of visit has dropped, 83% of the participants said the activity has continued, which, together with a deficient and inappropriate supply of personal protection equipment (PPE), helps understand the insecurity reported by such a high percentage of CHAs. “We relied on the participation of 1,978 CHAs, of which 734 from São Paulo, 116 from Guarulhos; 588 from Rio de Janeiro, 153 from São Gonçalo; 291 from Fortaleza and 96 from Maracanaú”, she mentions.
The report refers to April and May, and is organized in six parts: participants profile, figures on access to PPE, data on the work process, data on the health conditions of community agents, on the experience of loss and psychological and emotional suffering, and on the level of training to act in the pandemic. During this phase, 92.4% of the participants were women, mostly between 30 and 39 years old. Among those who responded, 52.5% declared themselves brown and 18.8% black. “The data make up a set of elements that constitute the life of working women, who, during the pandemic, in addition to dealing with a deepening social inequality, have continued to face work overload, with the expressions of sexism and the other consequences of the patriarchy, which historically leave to working women the chores of caring for others”, highlights Nogueira.
Among the most alarming results, Nogueira highlights that 47.1% of CHAs reported some health issue or problem that offers higher risk if combined with Covid-19, especially hypertension.
As for PPE, the municipalities in which the CHAs work and live have high percentags of workers who reported not having received PPE by the basic units. In Maracanaú, for instance, 52.1% of the participants reported no distribution of PPE whatsoever. From among the agents who were given surgical masks, 39.3% stated they did not receive them in sufficient amount and 45.4% said the quality was poor. In addition, about 10% of the CHAs said they do not have access to soap and water at the health units to wash their hands when needed.
Overall, 95.6% of the workers stated they showed some sign or symptom associated to Covid-19 in the months of April and May. Among these, 39.9% lost their sense of taste or smell, 31% had a fever, and 30% had difficulty breathing. “In such a context, the number of agents that were never tested was very significant (53.8%). Testing health professionals should be a priority. Failure to provide testing hampers health surveillance actions and healthcare offer. Not testing implicates higher exposure for these workers and for the population they work with”, emphasizes Nogueira.
The research also provides important data on experiencing loss and on the emotional suffering during the pandemic. 45.2% of the agents went through the death of people they had been following or of other people they knew due to Covid-19, and 96.1% reported suffering related to the context of the pandemic. “The signs and symptoms most frequently reported were insomnia, sadness, and anguish”, says Nogueira. This is because the scenario was that of absolute uncertainty, as 46.9% said that basic health units and municipal health secretaries provided no training so they could work during the pandemic, and 32.6% of the CHAs said they had insufficient training.
“It is important to consider that CHAs are not guaranteed to receive, as a public policy, safety at work, access to safety equipment, support regarding emotional suffering... Something else that is not guaranteed to them is specific technical training, which makes it even more relevant to produce research that help give visibility to these precarious conditions, in addition to the contribution of the need that the Brazilian Public Health System (SUS, in the Portuguese acronym) actually puts into practice its duty to guide and promote training and to promote safe work conditions”, Nogueira concludes.
The researcher says the team will apply the survey once again in August, to collect information on the months of June and July. All data obtained from the study will be made available in a digital panel that is expected to be ready by the end of August. “We hope the report is a good tool to help with the demands of organized agents and also with the willingness to act of the managers involved”, completed Borges.