O agente comunitário de saúde (ACS) é um ator social fundamental nas ações de controle da tuberculose (TB). Nesse estudo considerou-se à micro política voltada para prática do ACS. Objetivo do estudo: analisar segundo a visão do ACS a Busca de Sintomático Respiratório (BSR). Estudo descritivo do tipo inquérito, de forma transversal realizado em Natal, junho a setembro de 2009. População: 646 ACS do Programa de Agentes Comunitário de Saúde (PACS) / Estratégia Saúde da Família (ESF). Critérios de seleção: ACS trabalhando no período de coleta. Foram excluídos aqueles que estavam de férias, licença ou com atestados médicos. Utilizou-se amostragem de múltiplas etapas: cálculo da amostra baseado na população, partilha proporcional de acordo com a quantidade de ACS por distrito sanitário (DS) e amostragem casual simples. Prevendo-se uma taxa de não resposta de 10%, calculouse um n=108. Para coleta de dados utilizou-se um formulário aplicado aos ACS. Este compreendeu um total de 28 questões, divididas em três seções: caracterização dos ACS (08 questões), dados sobre a Estrutura das unidades de saúde (07 questões), dados sobre o Processo de atenção (13 questões). Os ACS responderam cada pergunta segundo diferentes escalas variadas de respostas: dicotômicas, de múltipla escolha com resposta única e uma escala de possibilidades preestabelecida (escala Likert) à qual foi atribuído um valor entre \"um\" e \"cinco\". A resposta mais favorável recebeu o valor mais alto da escala e a mais desfavorável recebeu o valor mais baixo. Os dados sobre Resultado (01 questão) foram coletados através de dados secundários. Para analisar os componentes Estrutura e Processo os valores próximos de 1 e 2 foram estipulados a classificação insatisfatória ,próximo de 3, regular e próximo de 4 e 5, satisfatória.Para analisar o componente Resultado da BSR, considerou-se à proporção de sintomático respiratório examinados. A maioria do ACS era do sexo feminino, nível médio e trabalhavam em unidades saúde da família com tempo médio de atuação de 122 (±47,4) meses. Consideraram como bom o trabalho na comunidade, julgaram regular a remuneração, sempre/quase sempre recebem capacitação em TB. Com relação à Estrutura das unidades de saúde apresentaram condições satisfatórias para formulários ( x = 4,90) e potes ( x = 4,25), e, no entanto apresentaram deficiências (regular) em geladeira ou caixa térmica ( x = 3,73), para armazenar o material coletado (escarro). Em relação ao ACS sentir-se preparado para identificar o suspeito de TB ( x = 4,4), orientar sobre TB ( x = 4,7) e baciloscopia ( x = 4,2), contudo muitas vezes não suspeita que a tosse possa ser TB ( x = 3,4). Foram insatisfatórias no componente Processo as ações de BSR ( x = 2,7) e levar pedido de baciloscopia para o usuário ( x = 2,2). Apenas 11% das baciloscopias esperadas foram solicitadas. A ação de BSR pelo ACS no território torna-se complexa por envolver a sua formação, a Estrutura e a organização do serviço de saúde sendo importante a supervisão do enfermeiro com foco nos mais diversos ângulos do seu trabalho ,desde as visitas domiciliares até as atividades comunitárias. / The community health agent (CHA) is a fundamental social actor in strategies for tuberculosis control (TB). This study considered the micro policy towards CHA practice. Aim of the study: to analyze, according to the CHA\'s view, the Respiratory Symptomatic Search (RSS). It is a cross-sectional descriptive study, a survey conducted in Natal, from June to September 2009. Population: 646 CHAs employed at the Community Health Agents Program (CHAP) / Family Health Strategy (FHS). Selection criteria: CHA employed at the data collection period. Those on vacation, absence or medical leave were excluded. Sample was calculated using multiple steps: sample calculation based on population, proportional division according to the number of CHAs by sanitary district (SD) and simple casual sampling. As a 10% loss rate of was expected, n = 108. Data was collected using a questionnaire completed by the CHAs. There were 28 questions, sorted into three sections: CHAs\' profile (08 questions), data about health centers Structure (07 questions), data about the caring Process (13 questions). Each question was answered according to different answering scales: dichotomous, multiple answers with single option and a Likert scale ranging from \"one\" to \"five\". The most favorable answer was given the highest score and the most unfavorable was given the lowest score. Data about Result (01 question) was collected using secondary data. To analyze the Structure and Process components, scores similar to 1 and 2 were set as a dissatisfying, similar to 3 as regular and similar to 4 and 5 as satisfying. To analyze the RSS\'s Result component the proportion of respiratory symptomatic was considered. Most CHAs were female, with middle education level and employed at a health center for an average of 122 (±47.4) months. They rated community work as good, wages as regular, and reported education formation in TB always or almost always present. In the Structure component health centers met satisfying conditions regarding forms ( x = 4.90) and containers ( x = 4.25), despite some shortages (rated as regular) in refrigerators or thermal boxes ( x = 3.73) used to store collected material (sputum). The CHA\'s sense of preparedness to identify a TB suspect ( x = 4.4), to give orientations about TB ( x = 4.7) and about bacilloscopy ( x = 4.2), alghough in many occasions they don\'t suspect cough is a TB symptom ( x = 3.4). RSS\'s Process component was rated as unsatisfying ( x = 2.7) along with taking the bacilloscopy exam form to the patient ( x = 2.2). Only 11% of expected bacilloscopies were requested. The act of RSS by CHAs in the territory becomes complex because it involves education, health centers Structure and health care service organization. Nurse\'s supervision is important to focus on different views of the work process, from home visits to community activities.

A busca de sintomáticos respiratórios (BSR) é uma ação programática para detecção precoce de casos de tuberculose. O Agente Comunitário de Saúde (ACS) favorece a ação na atenção básica (AB) pelas peculiaridades de seu trabalho na família e comunidade. O objetivo foi avaliar a BSR desempenhada pelo ACS nos serviços de AB, João Pessoa/PB. Estudo epidemiológico descritivo tipo inquérito, realizado nas 53 unidades de saúde da família que compõem o DSIII com uma população de 635 ACS. O cálculo amostral considerou uma variância (Sd2=1); diferença entre a média amostral simples e a média da população (B = 0,2); e probabilidade do erro tipo I igual a (Z? = 1,96) resultando em 108 ACS. Utilizou-se 3 fontes de coleta de dados: Check list (material, insumos e logística para a BSR); entrevista estruturada para os ACS e dados secundários (resultados das baciloscopias). O estudo obedeceu aos preceitos éticos envolvendo seres humanos. Os resultados do desempenho do ACS, relacionado aos componentes da avaliação dos serviços de saúde, revelaram Estrutura quantitativa de recursos humanos (ACS) e materiais suficientes; O Desempenho limitado e deficiente dos ACS que realizaram capacitação em TB foi atribuído à falta de envolvimento da gestão, supervisão e organização do serviço para BSR como trabalho em equipe e formação profissional; e no Resultado: laboratório, baixa cobertura de SR examinados e inexpressivo número de casos de TB identificados pela AB, 3(2009 ) e 1(2010). Ressalta-se que os resultados não são homogêneos, quando se analisam as unidades isoladamente. Sugere-se estudos individualizados considerando a micro-gestão das unidades e maiores investimentos na reorientação das práticas da AB para o controle da tuberculose aliado a um forte processo de educação permanente em saúde, que envolva profissionais e gestores. / The search for respiratory symptomatic people (RSS) is a programmatic action to detect early tuberculosis cases. The community health aid (CHA) promotes action in primary health care (PHC) through the peculiarities of his/her work with families and communities. The goal was to assess RSS performed by CHAs in PHC services in J Pessoa/Pb. Descriptive epidemiologic study, inquest-type, accomplished in the 53 family health units that make up Sanitary District (SD III) with a population of 635 CHAs. The sampling calculus considered a variance (Sd2=1); a difference between the simple sampling mean and population mean (B=0,2); and error probability I equal to (Z?= 1,96) totaling 108 CHAs. Three sources of data collecting were used: checklist (material, input and logistic to RSS); structured interview for CHAs as well as secondary data (bacilloscopy results). The study followed ethic principles involving human beings. The results of CHAs\' performance, related to health services evaluation components showed quantitative structure of human resources (CHA) as well as sufficient materials. Limited and defective performance, by CHAs qualified in TB, due to the lack of involvement in management, supervision and organization of RSS services as a teamwork and professional qualification; and the results: laboratory, poor cover of examined RS and inexpressive number of TB cases, identified by Primary care, 3 (2009) and 1 (2010). We point out that results are not homogeneous as units are individually analyzed. We suggest separate studies when considering units micro-management, as well as more investment in reorienting Primary care practices, with a view to control TB, associated to a major process of permanent Health education which should involve both professionals and managers.

Crime in South Africa is currently a high priority topic discussed by politicians, professionals and the general public since violence has become part of everyday life. Trauma has become a fact of life. When trauma hits, it is usually sudden and unexpected. Traumatic events could include acts of human cruelty, a car or plane crash, an untimely death or natural disasters like a tornado or a flood. A traumatic incident abruptly rips a person out of their comfort zone and thrusts that person into the depths of loss and despair. Unfortunately many people live their lives under the shadows of trauma. Trauma does not have to be a life sentence, it can be healed, through intensive counselling (as the researcher experienced at the trauma centre where she is affiliated). There are individuals who are thankful that they have survived their traumatic experience. These individuals would often like to help and support others who have gone through similar experiences. These individuals are often linked to a centre or organisation that renders a service to a victim with the aim of empowering and equipping him/her if he/she was exposed to a similar situation. It was the willingness of these individuals to help and the researcher’s involvement at a trauma centre that motivated her to undertake this research study. The researcher became aware, in her everyday contact with these willing individuals who wanted to help others who were traumatised through crime, how important it was that these people should be recruited, screened and trained. These “volunteers” should be under the supervision of a manager of a victim empowerment programme. Therefore, the focus of this research study was on the volunteer who renders a service to the traumatised victim of crime. The primary goal of this study was to evaluate the impact of service rendering within the victim empowerment programmes on the victim of crime, with the emphasis on the role of the volunteer. To achieve this goal the researcher established the following objectives: • To explore the literature with regard to stress, crisis and trauma, with specific reference to the definitions of stress, crisis and trauma, as well as their related signs and symptoms, as specifically related to victims of crime • To discuss victim empowerment services in South Africa, with specific reference to Gauteng • To explore the available literature with regard to the recruiting, screening, training and supervision of volunteers in general, but with specific reference to volunteers who render a service to victims of crime • To evaluate qualitatively the recruiting, screening, training and supervision of volunteers who rendered a service to victims of crime • To evaluate quantitatively the effect of intervention by volunteers on the victims of crime, in terms of: the level of satisfaction with the victim of crime was experiencing with regard to the services rendered by the volunteer the level of satisfaction the victim of crime was experiencing with regard to the services rendered by the professional (although this aspect was included as an objective of this study, the focus of this study was on the volunteer who renders a service to the traumatised victim of crime) the symptoms the victim of crime was experiencing when the volunteers rendered trauma debriefing services • Based on the results, to formalise guidelines for the managers of the victim empowerment programmes, who manage volunteers, to improve their service rendering to victims of crime. The methodology of programme evaluation, as a combined quantitative and qualitative research approach, was implemented to achieve the goal and objectives set for this research study. The quantitative data was collected by questionnaires that were completed by victims who utilised the services rendered by various victim empowerment centres. This data was then analysed by utilising the SPSS computer programme. Frequencies between the variables was described and interpreted. The qualitative data was collected through interview schedules. Interviews were conducted with 10 management members and 10 volunteers from 10 selected centres in Gauteng, which utilised volunteers to render services to victims of crime. The qualitative data was analysed by identifying various responses and placing these responses into categories and themes. All the responses were transcribed. The main results derived from the quantitative data indicated that the victims were satisfied with the level of service rendering from the volunteers. The main results from the qualitative data indicated that volunteers who rendered services to victims of crime were recruited, screened, trained and supervised according to the requirements of the specific victim empowerment programme where this service was rendered. Victims of crime that received trauma debriefing appeared to experience less symptoms, with specific reference to physiological symptoms (reliving the trauma), than those who did not receive trauma debriefing. From the three literature chapters of this study the following main conclusions were made, namely: • Trauma (Chapter 2) It was imperative to discuss stress, crisis and trauma as they lie on a continuum of severity. The volunteer had to be aware of this and the effects thereof. Since each individual experienced the effects differently, knowledge of the effects would determine the volunteers’ level of service delivery to the victims of crime. • Victim Empowerment (Chapter 3) The victim empowerment literature for this study was relevant, since victim empowerment programmes are seen as the “umbrella” of the services rendered to victims of crime. • Volunteers (Chapter 4) The researcher wanted to highlight that the research results proved that volunteers played an imperative role in service delivery to victims of crime. The lack of relevant literature and research that has been completed with specific reference to the recruitment, screening, training and supervision of volunteers who rendered a service to victims of crime limited the study, especially with regard to the compilation of the guidelines for the managers of the victim empowerment programmes. These guidelines include advice on the recruitment, screening, training and supervision of volunteers who render a victim empowerment service to victims of crime. This advice is focussed on the mangers of the victim empowerment programmes that were responsible for the volunteers who rendered a service to victims of crime. With the completion of the guidelines, the researcher added value to the social work profession, since this profession increasingly utilises volunteers in their service rendering to victims of crime. / Prof. J.B.S. Nel Dr. E. Oliphant

M.Cur. (Nursing Management) / Motivation is a process that influence and directs behaviour in order to satisfy a need. Motivation of nurses is important in the primary health care environment since low levels of motivation among Primary Health Care (PHC) nurses; who are in a critical position in health service delivery; could have a negative impact on the achievement of high standards in the nursing profession. This situation is also relevant in a mine clinic setting. The main factor in motivating nurses may be a sense of success. However, levels of stimulation and individual requirements also significantly influence the motivation of a person. As a manager at a mine clinic setting, the researcher became aware; by means of staff progress reports and performance appraisals; that PHC nurses (professional nurses) were demotivated. The research questions were therefore posed: - What are the motivational needs of PHC nurses in the workplace at mine clinic settings? - What should be done to assist these nurses to acquire motivation in the work place? Therefore, it was imperative to explore and describe the motivational needs of PHC nurses in their work place and to describe recommendations for nurse managers at a mine clinic setting to motivate PHC nurses. The study was conducted within the theoretical framework of McClelland’s Acquired Motivation Theory that consists of three basic needs, i.e. the need for achievement, the need for power, and the need for affiliation. A quantitative, explorative, descriptive design was followed and the researcher used a structured questionnaire to explore the perceptions of PHC nurses about their needs to acquire motivation in their workplace. The accessible population in this study was PHC nurses (N = 30) working at the 13 mine clinics. The accessible population served as the total sample.

Submitted in fulfillment of the requirements for the Master of Health Sciences in Nursing, Durban University of Technology, Durban, South Africa, 2017. / Background Human immunodeficiency virus (HIV) testing, treatment and prevention programmes have been initiated and implemented, but nearly 19 million of the 35 million people globally who are living with HIV do not know they have it. A new and powerful movement called 90-90-90 has been set in motion where the target is that by the year 2020, 90% of all people should know their HIV status, 90% of those testing HIV positive should be commenced on lifelong antiretroviral treatment and 90% of the people receiving treatment should be virally suppressed. It is argued the new innovative HIV self-testing strategy can increase the uptake of HIV testing among key populations and the general public. Aim of the study The aim of the study was to assess health care users’ knowledge, attitudes and perceptions towards HIV self-testing at selected Gateway clinics in eThekwini District, KwaZulu-Natal. Methodology A quantitative, non-experimental descriptive design was used to determine knowledge, attitudes and perceptions of health care users at three selected Gateway clinics in eThekwini Health District. The researcher requested permission and was granted to conduct the study from all the relevant stakeholders. Human rights were protected and ethical considerations were adhered to throughout the research process. The convenience sample was 442 participants with a minimum of 98 and a maximum of 246 participants sampled from each of the three study sites. A survey questionnaire was used to collect data. Version 23 of SPSS was used to analyse data. Graphs and tables were used to represent frequencies. Inferential statistical were used to test whether any of the response options were selected significantly more or less than others Results Results of the study revealed that health care users had a reasonable knowledge of HIV self-testing and there were indications that they would use it if it was made freely available to the public and was properly regulated. Generally, there were indications that health care users had positive attitudes towards HIV self-testing. It was seen as a good idea as it can be performed in the privacy of one’s home and the person would be first to know about the results. Results also revealed that there could be more people who would know their HIV status and people could test more frequently. There were perceptions that there would be no difficulty in performing an HIV self-test. The lack of pre-test counselling, false negative results, possible coercion and sale of unregulated testing kits seemed to be issues of concern that require addressing if HIV self-testing is to be promulgated. / M

Thesis (PhD)--University of Stellenbosch, 2005. / ENGLISH ABSTRACT: The South African primary health care (PHC)system is in a period of transition. This, and the growing HIV epidemic, place tremendous strain on PHCworkers in public health services. Staff morale is low and this results in turnover and poor quality of care. Therefore, staff need to be supported, so that they are better equipped to provide quality care for patients. This dissertation describes a process of action research that aimed to explore possibilities for staff-support interventions to health teams in the public PHCsector. Data were collected through in-depth interviews, group interviews, focus group discussions and consultation sessions, with health staff and middle managers. Data were analysed using a grounded theory approach, with the assistance of the Atlas.ti 4.1 software package.The interpretation of data was informed by psychoanalytic and open systems theories. Four cycles of action research were conducted. The first action stage involved a qualitative assessment of the nature of stressors in the PHC system. The second action stage describes the experiences of two staff teams from a health prevention clinic and a day hospital (curative service) as they prepared to merge and integrate aspects of service delivery. In the third action stage the research team explored the feasibility of a short programme aimed at building capacity amongst middle and facility level managers to act as containers for staff stresses. However, due to external factors the programme was not completed. The final action stage describes interviews with selected participants to reflect on the effects of the current action research process on them and their work. The current research suggests that a psychodynamic approach may be a useful component of action research in health settings. This approach makes room for interpretation of unconscious processes in the stress experiences of health workers, and has the potential to move health staff and management to alternative modes of functioning and coping. / AFRIKAANSE OPSOMMING: Primêre gesondheidsdienste in Suid Afrika is tans in 'n proses van transisie. Die toenemende druk wat die VIGS-epidemie op gesondheidsdienste plaas, maak dit eweneens moeilik vir gesondheidswerkersom aan te pas by 'n gedurig-veranderende stelsel. Dit bring mee dat moraal laag is, baie werkers die publieke sektor verlaat en gehalte van dienslewering verswak. Hierdie situasie noodsaak dat programme ontwikkel moet word om gesondheidswerkerste ondersteun in hul werk, sodat hulle beter toegerus is om kwaliteit sorg aan pasiënte te verleen. Hierdie proefskrif beskryf aksienavorsing wat gedoen is met die doelom ondersteuningsprogramme vir gesondheidswerkers en hulpwerkers in openbare primêre gesondheidsdienste te ontwikkel. Individuele en in-groepsverband in-diepte onderhoude, asook fokusgroepbesprekings en konsultasies met gesondheidswerkers en middelvlak-bestuurders is gevoer om data in te samel. Data-ontleding was gedoen volgens die gegronde teorie aanslag en die Atlas.ti 4.1 sagteware pakket Is vir hierdie doel gebruik. Teorieë van psigoanalise en oop stelsels is deurgans geraadpleeg met die interpretasie van bevindinge. Die navorsingsproses bestaan uit vier siklusse van aksienavorsing. In die eerste navorsingsiklus is ~ie aard van stress in the publieke primêre gesondheidstelsel ondersoek. Die tweede siklus behels 'n beskrywing van die ervaringe van twee personeelgroepe soos hulle gereed gemaak het om aspekte van hulonderskeie dienslewering te integreer met die oprigting van 'n gemeenskaplike gesondheidsentrum. Die derde siklus beskryf die implementering van 'n kort program wat gerig is daarop om middel-vlak en diens-bestuurdersvaardighede aan te leer om personeel beter te ondersteun. Eksterne invloede het meegebring dat hierdie opleidingsprogram nie ten volle uitgevoer kon word nie. In die finale siklus is onderhoude met geselekteerde deelnemers gevoer om te bepaal hoe deelname aan die aksienavorsingsproses hulle in hul persoonlike hoedanigheid asook In die uitvoering van hul pligte beïnvloed het. Die huidige navorsing stel voor dat die psigodinamiese benadering 'n gepaste komponent van aksienavorsing in publieke gesondheidsomgewingskan wees, omdat hierdie benadering Insig kan verleen tot die onbewuste prosesse wat gesondheidswerkersse belewenis van stres beïnvloed, en verder ook die potensiaal het om gesondheidswerkers en bestuurders tot alternatiewe funksionering en hantering van stres te motiveer.

Thesis (MA)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: HIV/AIDS places much stress on those living with the disease. An understanding of the processes of stress and coping and how these relate to people living with HIV/AIDS (PLWHA) can inform the nature of services we offer to PLWHAs. Social support has been shown to playa mediatory role in the stress response and is also considered to be a problem-focused coping strategy. This paper presents an overview of the literature on stress, coping and social support with the aim of assisting healthcare workers to understand how these issues relate to HIV/AIDS and to show how healthcare workers, and, specifically psychologists can use their unique competencies and skills to enhance the quality of life of PLWHAs. / AFRIKAANSE OPSOMMING: MIVNIGS plaas baie druk op mense wat met die siekte moet saamleef. Insig rakende die prosesse van spanning en hantering daarvan en hoe dit verband hou met mense wat met MIVNIGS moet saamleef, het die potensiaal om die aard van die dienste wat aan die spesifieke populasie gelewer word, in te lig. Sosiale ondersteuning blyk 'n bemiddelende rol te speel in spanningsresponse en word ook beskou as 'n probleemgefokusde hanteringsmeganisme. Die betrokke werkstuk bied 'n oorsig van die literatuur rakende spanning, hantering en sosiale ondersteuning. Dit is gefokus daarop om bystand te verleen aan gesondheidsorg werkers om hulle insig te gee hoe hierdie kwessies met MIVNIGS verband hou. Dit poog ook om aan te toon hoe gesondheidsorgwerkers en spesifiek sielkundiges, hul unieke bevoegdhede en vaardighede kan benut om die wat met MIVNIGS moet saamleef, se kwaliteit van lewe te verryk.

Thesis (MBA.) --University of Limpopo, 2016 / The Ward Based Outreach Teams (WBOT) Programme is established in South Africa as part of a series of strategies to strengthen Primary Health Care (PHC) and to improve service delivery in the country. The purpose of the study was to gain an understanding of the experiences of Community Health Workers (CHW) in the implementation of the WBOT programme. The objectives of the study were to evaluate the experiences of CHWs in the WBOT, to evaluate factors that facilitate the implementation and to make recommendations and strategies on what can be done to improve the WBOT programme. A quantitative research design was used where self-administered questionnaires were provided to respondents for data collection. Respondents were asked to complete the questionnaires; completed questionnaires were returned by only 12 of the 27 respondents, resulting in a 44% response rate. The study’s findings indicate that the Community Health Workers (CHWs) regarded the WBOT as helping the community in many ways such reducing the long queues at the clinic and providing the care of the patients in their own homes, although concerns about poor participation by the community structures and nurses in the health facilities were expressed. CHWs expressed experiences that were positive and negative when conducting their work in the community. The results from the study have shown that there are successes, challenges and lesson learned. The results of the study further indicated that the programme is being implemented well even though it is still in a pilot phase in the sub-district. The programme has managed to improve and save many lives in the communities of Kgetleng Sub-district. Despite the level of depth in this study, there is a crucial need for more for more in-depth research regarding the experiences of users of the WBOT services and to conduct similar studies looking into urban areas and to compare and contrast the rural and urban findings.

The purpose of this study was to get a better sense of what collaborative efforts between the allopathic and indigenous health systems to address HIV/ AIDS look like 'on the ground' with the hope that revealed successes and failures could inform other initiatives. The pilot investigation took the form of a small case study of the Community Health and HIV/AIDS project at the Valley Trust in KwaZulu Natal's Valley of a Thousand Hills where HIV/AIDS collaboration with traditional healers has taken primarily three forms: 1) incorporation in the formal primary health care system as CHWs (TH/CHWs); 2) formal short-term HIV/AIDS training (Trained); and 3) informal second-hand HIV/AIDS training or information sharing (Untrained). The investigation focused primarily on how the indigenous healers' involvement in the Valley Trust's varying training programs affected their knowledge ofthe disease, their engagement in HIV/ AIDS awareness and prevention efforts, their treatment of HIV/AIDS patients, and their perception and relationship with the formal medical system. The findings show that collaboration between traditional and formal health services, in the form of the Valley Trust's training, results in 'better' HIV/AIDS work by participating traditional healers through enhanced performance on HIV/AIDS knowledge tests. As indicated by their superior performance on correlating knowledge indices, TH/CHWs engaged in the most effectual community prevention activities of the three groups. Additionally, the TH/CHW group appeared to have the most confidence and experience in treating patients with HIV/AIDS. Additionally as compared to the other two groups, their treatment methods were more varied, induding psycho-spiritual ceremonies, diet, traditional medicinal herbs, and support of biomedical efforts. Given the comparative success of TH/CHWs, it was ironic that only the healers' themselves indicated wanting more izangomas to serve as Community Health Workers. As leaders among participating healers, TH/CHWs were critical to the success of the Valley Trust's collaborative project. The findings of this case study suggest that the nature of the varying trainings offered by the Valley Trust accounted for the primary difference in the effectiveness of the healers' subsequent HIV/AIDS work. The study implies that both the skills-based nature and long-term supervision of the CHW training were instrumental in their superior performance. These findings point to the fact that indigenous healers can not function effectively as extension services without investment in infrastructure development and ongoing support. In terms of the collaboration between biomedical and indigenous health systems operating at the Valley Trust, the primary point of contention between the participating parties was the collaboration's unidirectional referral system (healers would refer patients to the clinic and not vice versa). Discrepancies in the collaborative partners' perceptions of one another, which were revealed in the study, point to the need for greater dialogue and formal linkages between participating groups. A referral system of some content and magnitude appears to be the most critical and pressing issue the new structure needs to address. / Thesis (M.Dev. Studies)-University of Natal, Durban, 2002.

O objetivo deste trabalho foi analisar as características das visitas domiciliares nos programas Agentes Comunitários de Saúde e Saúde da Família e sua possível contribuição para o alcance da integralidade. Em ambos os programas, a visita domiciliar apresenta-se como uma ação emblemática, como evidenciado pela designação de um profissional específico para essa atividade (o agente comunitário de saúde), embora se recomende que seja realizada por todos os profissionais de saúde. A integralidade foi buscada como representando um norte para a atenção primária, através de características do processo de trabalho em saúde. A metodologia adotada foi a pesquisa de tipo qualitativo, sendo os dados empíricos obtidos por meio de entrevistas com profissionais e usuários e pela observação do cotidiano de três equipes de agentes comunitários de saúde e três equipes de Saúde da Família em Campo Grande, MS, de novembro de 2005 a julho de 2006. A análise dos dados aponta que as coordenações estadual e municipal dos programas incentivam as visitas, mas consideram serem necessários critérios para as solicitações de visitas, definição do profissional que as realizará e mecanismos de avaliação, especialmente no que se refere às visitas feitas por profissionais com formação universitária. Na dinâmica de trabalho das equipes pesquisadas, as formas de organização do trabalho são diversas, podendo favorecer ou dificultar a realização das visitas domiciliares. As visitas são solicitadas majoritariamente por agentes comunitários de saúde, respondendo a demandas de usuários, ou decorrem de demandas internas dos serviços, com variados enfoques quanto às finalidades, conteúdos e prioridades. Os profissionais apontam como aspectos positivos das visitas uma leitura ampliada da realidade, das dinâmicas familiares, das condições de vida e das necessidades dos usuários, permitindo implementação de medidas preventivas e assistenciais e o fortalecimento do vínculo entre usuários e equipe de saúde. No entanto, evidenciam-se tensões relacionadas com o tipo de solicitações dos usuários, predominantemente de caráter clínico, muitas vezes requerendo referências secundárias e terciárias, nem sempre presentes. Por outro lado, a pobreza e as precárias condições de vida dos usuários, características das populações cobertas pelos programas, geram demandas de ações de assistência social, moradia, educação e trabalho, entre outras, que muitas vezes também permanecem sem resposta ou são tratadas de forma caritativa. Além disso, existem dificuldades relacionadas a horários, percursos, transporte e abordagem dos moradores durante as visitas, além de situações de resistência, de recusa e de contato com famílias em precárias condições de vida. Constatou-se que para atingir sua potencialidade de estimular a integralidade, a visita requer trabalho em equipe e respeito e singularização dos usuários. As visitas domiciliares constituem uma prática com potencial integrador, favorecendo o desenvolvimento de ações no domicílio, a ampliação do acesso à unidade de saúde, a adoção de medidas preventivas, a adesão ao tratamento, o apoio aos cuidadores e a longitudinalidade. No entanto, apesar de potencialmente aumentarem a visibilidade de problemas de difícil abordagem, como alcoolismo, violência doméstica ou sexualidade, as visitas domiciliares não os tomam como objetos de trabalho, geralmente evitando essas situações nos domicílios. As visitas podem colaborar com a integração com os níveis secundário e terciário, com a abordagem familiar e com o desenvolvimento de ações intersetoriais, sempre que houver incentivo e condições para isso. A atividade é, porém, permeada de tensões, por seu caráter por vezes autoritário e de intromissão na vida privada, pelas frágeis condições de trabalho e por sua utilização como atenuante de deficiências no atendimento nas unidades de saúde e na ação do poder público em problemas estruturais. / The purpose of this study was to analyze the profile of home visits in the Brazilian health care programs \'Community Health Agents\' and \'Family Health\' with regard to their potential contribution toward integrality in health services. In both programs home visits occupy a prominent position, as shown by the assignment of a specific professional to carry out this activity--the community health agent--although performance of the visit is recommended for all health professionals. Integrality was the guiding principle intended for primary care, configuring the features of the work process in the health area. The methodology adopted was that of qualitative research. Empirical data were collected by interviewing health professionals and users and by observing the daily activities of three teams of community health agents and three teams of the Family Health Program in Campo Grande, Mato Grosso do Sul, from November 2005 to July 2006. The activity is encouraged by program coordinators at the state and county level, who recognize the need for developing criteria for defining which newly detected cases should warrant the performance of home visits and which professionals should be assigned to perform them, in addition to mechanisms for evaluation of the activity, particularly in the case of home visits performed by health professionals holding higher education degrees. With regard to the operative dynamics of the teams investigated, workflow was found to be organized in various ways, which may facilitate or hinder the performance of visits. Most home visits are requested by community health agents in response to demands of users, but they can also be requested by the service itself, in response to internal demands, and the focus of the activity may vary in terms of purpose, content, and level of priority. According to the professionals interviewed, home visits have a number of positive aspects, as they provide a broader perception of reality, family dynamics, living conditions, and needs of users, in addition to facilitating the implementation of preventive and assistance measures and strengthening the connection between users and health care team. Nonetheless, the activity has inherent tensions, as those related to the type of requests placed by users, mostly of clinical nature, which may require secondary and tertiary care approaches, not always available. On the other hand, poverty and unfavorable living conditions, typical of the population assisted by the programs, generate demands for actions related to social assistance, housing, education and work, among many others, which often are not dealt with at all or are managed with a charitable focus. Additional difficulties involve schedules, transects, transportation, manner of establishing first contact and relating to residents during the visits, situations of resistance or refusal by residents, and the very contact with families living in dire conditions. It was found that in order to exert its potential for promotion of integrality, home visits require not only teamwork, by also respect for users and recognition of their singularity. Home visits have an integrative potential, facilitating the performance of health-related actions in the home setting, promoting broader access to health care units, encouraging adoption of preventive measures, adherence to treatment, and support to caretakers, and fostering the development of longitudinality. However, in spite of their potential for facilitating the perception of issues requiring a more sensitive approach, such as alcohol consumption, domestic violence, or sexuality, home visits do not take these occurrences as their object of action, but usually avoid direct contact with such situations. Visits also aid in the integration with secondary and tertiary levels, are valuable in the establishment of a family-focused approach, and are advantageous to the development of intersectoral actions whenever favorable conditions and incentive are available. The activity, however, is not without tensions. In some instances, its focus is authoritarian and intrusive into private life; working conditions are fragile; and visits play the extra role of lessening deficiencies in services and in the governmental ability to tackle structural issues.