<p>In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the&nbsp / human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR&nbsp / odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and&nbsp / proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas) / researchers / academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government&rsquo / s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category&nbsp / has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical&nbsp / health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system.</p>

<p>This study investigated the challenges facing a category of community health workers (Health Surveillance Assistants) in rural Malawi district of Nkhatabay following the expansion of their programme funding from the Global Funding to fight AIDS, Tuberculosis and Malaria (GFATM). The study has noted that HSAs are facing serious accommodation problems due to the lack of involvement of communities in their selection and that many HSAs are recruited from outside their catchment areas. The study has put forward some recommendations to the Ministry of Health and other stakeholders like United Nations Children&rsquo / s Fund (UNICEF) and the World Health Organization (WHO) to consider in making the HSAs programme in Nkhatabay district effective. Some of the recommendations made are that supervision of the HSAs by the EHOs and the ECHNs should be intensified and that infrastructure support should be provided to the HSAs for them to be able to deliver the EHP. Infrastructure like buildings and equipment like refrigerators and bicycles should be provided to HSAs and ensure that there is a plan for their maintenance.</p>

<p>Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens &amp / Zupan, 2005). Early&nbsp / detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing&nbsp / countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking&nbsp / behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home&nbsp / visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit,&nbsp / community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing&nbsp / community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured&nbsp / questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers&rsquo / home or at the study&nbsp / offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis.&nbsp / Descriptive analysis was&nbsp / conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant&nbsp / associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were&nbsp / enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the&nbsp / highest number of which occurred within&nbsp / the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking&nbsp / their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW.&nbsp / Conclusion: This study found&nbsp / high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South&nbsp / African National Department of Health (SANDOH) which will involve the establishment of family health worker teams&nbsp / including community health workers. A key function of these workers will&nbsp / be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with&nbsp / non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by&nbsp / community health workers. Most of the referrals in this study were&nbsp / neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal&nbsp / and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater&nbsp / realization of a team approach to PHC.</p>

<p>In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the&nbsp / human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR&nbsp / odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and&nbsp / proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas) / researchers / academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government&rsquo / s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category&nbsp / has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical&nbsp / health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system.</p>

Early diagnosis and prompt treatment is one of the malaria control strategies used to minimize malaria morbidity and mortality. One of the mechanisms to implement early diagnosis and prompt treatment is community access to diagnostic services and effective antimalarial drugs. However, in Ethiopia the health system is underdeveloped and much of the rural population has limited access to modern health services. Therefore, the Ethiopian government introduced the Health Extension Programme(HEP) which is a community-based health care delivery system aimed at accessing essential health services through its health extension workers (HEWs). Involvement of the HEWs in prescribing and dispensing antimalarial drugs is shown to have improved community access to antimalarial drugs. However, there is insufficient knowledge of HEWs compliance to malaria treatment guidelines and patient adherence of patients treated by HEWs. The objectives of this study has been to describe the HEWs practice in malaria treatment, to evaluate adherence of patients to antimalarial drugs, to explore the factors influencing the HEWs malaria treatment practice and patient adherence, and to develop the guidelines to support the HEWs in malaria treatment practice. A qualitative study design was used to study the HEWs practice in malaria treatment along with patient adherence. Data were collected using in-depth face-to-face interviews, focus group discussion and patient medical record review and were analysed according to Tesch’s steps. The study revealed that the HEWs adequately comply with malaria treatment guidelines during diagnosis of malaria, as well as during the prescribing and dispensing of antimalarial drugs. However, there are some factors influencing the performance of HEWs. These are: shortage of diagnostic kit/RDT, shortage of antimalarial drugs, patient pressure to obtain coartem, work load, and community beliefs with regard to antimalarial drugs effectiveness. This study also revealed that the HEWs follow up after treatment of patients and good community support systems improved patient adherence to antimalarial drug use. Factors negatively influencing patient adherence were identified to include: forgetfulness, fear of shortage of drugs, adverse drug effects, duration of treatment, rapid relief of malaria symptoms and inadequate awareness of the consequence of incomplete dosage. Guidelines were developed to support the HEWs in malaria treatment practice with the aim to improve patient adherence to antimalarial drugs / Health Studies / D. Litt. et Phil. (Health Studies)

Submitted by Mario Mesquita (mbarroso@fiocruz.br) on 2014-10-15T12:15:16Z No. of bitstreams: 1 Amanda de Andrade Mendonça.pdf: 746625 bytes, checksum: d92fdc86b3542f68861a2838fbabe06a (MD5) / Approved for entry into archive by Mario Mesquita (mbarroso@fiocruz.br) on 2014-10-15T12:56:51Z (GMT) No. of bitstreams: 1 Amanda de Andrade Mendonça.pdf: 746625 bytes, checksum: d92fdc86b3542f68861a2838fbabe06a (MD5) / Made available in DSpace on 2014-10-15T12:56:51Z (GMT). No. of bitstreams: 1 Amanda de Andrade Mendonça.pdf: 746625 bytes, checksum: d92fdc86b3542f68861a2838fbabe06a (MD5) Previous issue date: 2013 / Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Programa de Pós-Graduação em Educação Profissional em Saúde. / A pesquisa apresentada desenhou-se a partir de minha inquietação quanto ao formato de qualificação do Agente Comunitário de Saúde (ACS), sendo este simplificado e aligeirado, restrito até o período em que eu atuava como ACS, a formações fragmentadas oferecidas na própria unidade de saúde ou em locais no entorno da comunidade onde atuava. Esta tem como objetivo analisar de que forma o Curso Técnico de Agente Comunitário de Saúde (CTACS) oferecido pela Escola Politécnica de Saúde Joaquim Venâncio (EPSJV/FIOCRUZ) pode contribuir para a formação e o trabalho do ACS. E procura entender ainda, se a proposta de formação tem proximidade com o cotidiano da prática do ACS e em que sentido articula o conteúdo desenvolvido ao saber comunitário e popular. A pesquisa foi desenvolvida a partir um resgate bibliográfico utilizando as bases de dados de Saúde Pública, SCIELO e LILACS, além de artigos científicos que abordavam o processo de formação dos Agentes Comunitários de Saúde. Concomitantemente, foi realizada uma análise documental (fontes do Ministério da Saúde, Escola Politécnica de saúde Joaquim Venâncio/ Fiocruz, além de leis, decretos e portarias da Saúde, Educação para a formação profissional), foram analisados documentos de avaliação do CTACS da EPSJV com intuito de contribuir para análise e reflexão a cerca dos objetivos do curso e sua contribuição para a formação crítica do ACS. Considerando a análise dos documentos do curso foi possível perceber que a proposta curricular do CTACS da EPSJV busca contribuir para a formação profissional desses trabalhadores, por meio da realização de uma experiência de formação técnica completa, realizada a partir dos princípios da politecnia e tomando o trabalho como princípio educativo. Entretanto, ainda se tem muitos desafios após esta formação crítica, pois a maioria dos ACS relatam a falta de reconhecimento enquanto categoria profissional por parte da equipe a qual estão inseridos, o que os impossibilita de colocar em prática os conhecimentos adquiridos ao longo do curso. / The research presented was drawn from my concern about the format of qualification of Community Health Agents ( ACS ) , which is simplified and streamlined , restricted to the period I served as ACS , the training offered at the very fragmented drive health or the environment of the local community where he worked. This aims to analyze how the Technical Course Community Health Agent ( CTACS ) offered by the Polytechnic School of Health Joaquim Venancio ( EPSJV / FIOCRUZ ) may contribute to the formation and work of the ACS . And still trying to understand if the proposed training has proximity to the everyday practice of the ACS and in what sense articulates content developed and popular community know . The survey was developed from a rescue literature using the databases of Public Health , SciELO and LILACS , and scientific articles that addressed the process of training of Community Health Agents Concurrently , we conducted an analysis of documents ( Ministry sources health , Polytechnic School of health Joaquim Venancio / Fiocruz , in addition to laws , decrees and orders of the health , Education training) , were analyzed to assess the documents CTACS EPSJV aiming to contribute to the analysis and reflection about the goals of course and their critical contribution to the formation of the ACS . Considering the analysis of the documents of the course was possible to notice that the proposed curriculum CTACS EPSJV seeks to contribute to the training of these workers , by conducting a complete technical training experience , made from the principles of polytechnic and taking work as an educational principle . Nevertheless, it still has many challenges after this critical training , since most ACS report a lack of recognition as an occupational category by the team to which they belong , what makes it impossible to put into practice the knowledge acquired during the course.

Introdução: O uso de substâncias psicoativas têm se evidenciado como um grave problema de saúde pública no Brasil e no mundo, gerando custos sociais, econômicos e individuais. O reconhecimento e acompanhamento dos usuários requer equipe multiprofissional capacitada com conhecimentos técnicos para ter maior efetividade. A Estratégia Saúde da Família, por ser a porta de entrada dos usuários no sistema de saúde, e por incluir a atuação do agente comunitário de saúde (ACS) como mediador entre o serviço e a comunidade, pode oferecer uma abordagem mais integral e longitudinal. Nesse contexto, esta pesquisa teve o objetivo de identificar os conhecimentos dos ACS sobre crack e outras drogas e descrever o seu perfil sóciodemográfico e de saúde. Metodologia: Estudo descritivo, desenvolvido no período de maio a dezembro de 2012, realizado com 78 ACS do município de Passo Fundo/Rio Grande do Sul. A coleta de dados ocorreu por meio da aplicação de um questionário estruturado e autoaplicável sobre dados demográficos dos ACS e um questionário de investigação dos conhecimentos sobre crack e outras drogas. Foi realizada estatística descritiva, teste de Tukey, correlação linear de Pearson e correlação de Spearman. Resultados: Todos os 78 ACS eram do sexo feminino, com idade média de 41,1 ± 9,6 anos, 57,7% com ensino médio completo, 69,2% casadas e 98,7% pertencentes as classe social C e D. Metade dessas profissionais relatou ser sedentária, 11,5% eram tabagistas, 93,6% negaram dependência ao álcool, mas referiram ter contato com drogadição; 98,7% tinham dependentes químicos em sua área de abrangência e 59% admitiram ter familiares com problemas relacionados ao uso de drogas. Em relação à saúde das ACS, 29,5% obtiveram SRQ com pontuação elevada, sugerindo possibilidade de transtornos mentais comuns e 51,3% afirmaram ser portadoras de doenças crônicas. A prova de conhecimentos prévios sobre crack e outras drogas obteve 34,5% de média de acertos, sendo o maior número de respostas corretas entre ACS com maior escolaridade (P=0,006). Conclusão: O baixo número de acertos em teste de conhecimento evidencia uma necessidade urgente de melhor formação das ACS em relação ao crack e outras drogas, especialmente pelo frequente contato das profissionais com dependentes químicos. O perfil específico dessas profissionais, com ocorrência significativa de problemas psiquiátricos e doenças crônicas, suscita a necessidade de maior atenção à sua saúde, bem como novas pesquisas na área. / Introduction: The use of psychoactive substances has been regarded as a relevant public health problem not only in Brazil but also worldwide, as well as its social, economic and individual costs. Recognition and tracking of users require multidisciplinary teams trained with technical knowledge to achieve more effective results. The Community Health Workers (CHWs), who represent a gateway for health system users, and who represent the team's link with the community can offer a more comprehensive and longitudinal performance. In such a context, this research aimed to identify the CHW´ knowledge about crack and other drugs and to describe their health and sociodemographic profile. Methodology: This is a descriptive study, performed from May to December 2012; involving 78 CHWs in Passo Fundo Rio Grande do Sul, Brazil. Data collection was achieved through the application of a guided questionnaire, structured with CHWs´ demographic information and a research survey on the workers´ knowledge about crack and other drugs. Data descriptive statistics, Tukey test, Pearson´s linear correlative and Spearman´s correlation were performed. Results: All 78 CHWs were women aged 41.1±9.6, 57.7% had finished high school, 69.2% were married and 98.7% were from lower social classes. Half of CHWs were sedentary, 11.5% were smokers, 93.6% denied having alcohol addiction although some admitted having contact with drug users, 98.7% have contact with chemical dependents and 59% reported relatives who deal with drug use. There are 29.5% of CHWs who had a high SRQ score indicating common mental disorders and 51.3% admitted having chronic diseases. The previous knowledge about crack and other drugs presented an average of 34.5%, the highest scores being related to those with higher educational levels. Conclusion: The low score on knowledge tests identifies the urgent need to invest in training programs for CHWs about the use of crack and other drugs, especially considering the frequent contact these agents have with people who show dependency on these drugs. These professionals´ specific profile - high levels of psychiatric problems and chronic diseases - indicates the need for more attention with their health and new researches about CHWs´ health conditions.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta pesquisa teve como objetivo geral, analisar as práticas de saúde desenvolvidas por ACS, em consonância com os documentos determinados pelo Ministério da Saúde, na ESF na Região do Médio Paraíba, Estado do Rio de Janeiro. Este estudo corresponde ao desdobramento da pesquisa Perfil dos agentes comunitários de saúde do Estado do Rio de Janeiro: análise comparativa entre municípios e regiões em articulação com o estudo Saberes e Práticas na Atenção Primária à Saúde: diálogos entre usuários e profissionais de saúde no Estado do Rio de Janeiro. Trata-se de um estudo descritivo, de natureza qualitativa e teve como abordagem teórico-filosófico, a hermenêutica-dialética. Teve como cenários os municípios de Piraí, Porto Real, Pinheiral, Rio Claro e Rio das Flores. Os sujeitos corresponderam a 53 ACS atuantes nas UBSF dos municípios selecionados. Os instrumentos utilizados para a coleta de dados foram: a observação assistemática, o questionário semiestruturado e o grupo focal. Para a análise dos dados foi utilizada a hermenêutica-dialética proposta por Minayo. Através dos resultados alcançados foi possível realizar uma breve caracterização dos sujeitos provenientes do questionário e a análise do grupo focal desdobrando-se em três categorias. A primeira categoria focou nas práticas de saúde dos ACS que colaboram com a gestão do cuidado. A segunda buscou analisar as práticas de atenção à saúde dos ACS. E a terceira categoria direcionou-se para as práticas educativas dos ACS. Entendemos as práticas de saúde dos ACS acontecem de forma conectada. Pois no cotidiano das práticas não percebemos que as mesmas são realizadas concomitantemente preservando a ideologia da integralidade do cuidado aos usuários da ESF. Encontramos que a maioria dessas práticas de saúde está de acordo com o preconizado pelo MS, porém, identificamos no cotidiano das práticas dos ACS, as que não são abordadas pelos respectivos documentos, como a entrega de recados, a entrega de medicamentos e a atuação na farmácia e recepção das unidades. Assim, podemos afirmar de antemão, que as práticas de saúde dos ACS dos municípios estudados contribuem para a consolidação da Estratégia Saúde da Família no interior do Estado do Rio de janeiro. E além do mais, indicam possíveis desdobramentos para a firmação do modelo da Vigilância da Saúde na Atenção Básica à Saúde. / The general objective of this research was to analyze the health practices developed by CHW, in line with the documents determined by the Brazilian Ministry of Health, in the FHS in the Médio Paraíba Region, State of Rio de Janeiro. This study corresponds to the outcome of the research Profile of community health workers of the State of Rio de Janeiro: comparative analysis between municipalities and regions in articulation with the study Skills and Practices in Primary Health Care: dialogues between users and health professionals in the State of Rio de Janeiro. This is a descriptive study, with qualitative nature, that had the hermeneutics-dialectics as theoretical-philosophical approach. The study scenarios were the cities of Piraí, Porto Real, Pinheiral, Rio Claro and Rio das Flores. The subjects corresponded to 53 CHW who worked in BFHU of the chosen cities. The tools used for data collection were: unsystematic observation, semi-structured questionnaire and focus group. In order to analyze data, we used the hermeneutics-dialectics proposed by Minayo. Through the achieved results, it was possible to perform a short description of the subjects stemming from the questionnaire, and the analysis of the focus group, thereby generating three categories. The first category was focused on the health practices of CHW who collaborate with the care management. The second sought to analyze the health care practices of CHW. And the third category was directed to the educational practices of CHW. We understand that the health practices of CHW take place in a connected manner, since, in the daily practices, we did not realize that they are concomitantly conducted while preserving the ideology of comprehensiveness of care for FHS users. We found that the majority of these health practices are in accordance with what is advocated by MS, but we identified, in the daily practices of CHW, those that are not approached by the respective documents, such as delivery of messages, delivery of medications, and operation in the pharmacy and reception desk of the units. Thus, we can say, in advance, that the health practices of CHW of the surveyed cities have contributed to the consolidation of the Family Health Strategy in the State of Rio de Janeiro. Furthermore, they point out possible outcomes for the consolidation of the model of Health Surveillance in Primary Health Care.

Submitted by Izabel Franco (izabel-franco@ufscar.br) on 2016-10-05T20:50:03Z No. of bitstreams: 1 DissKB.pdf: 3071596 bytes, checksum: 1bc408fa0cd26180655e5ea2862d55e6 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-20T13:43:29Z (GMT) No. of bitstreams: 1 DissKB.pdf: 3071596 bytes, checksum: 1bc408fa0cd26180655e5ea2862d55e6 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-10-20T13:43:36Z (GMT) No. of bitstreams: 1 DissKB.pdf: 3071596 bytes, checksum: 1bc408fa0cd26180655e5ea2862d55e6 (MD5) / Made available in DSpace on 2016-10-20T13:43:45Z (GMT). No. of bitstreams: 1 DissKB.pdf: 3071596 bytes, checksum: 1bc408fa0cd26180655e5ea2862d55e6 (MD5) Previous issue date: 2016-03-31 / Não recebi financiamento / The Ministry of Health's policy for integral care to drug users calls for social integration and the promotion of autonomy of these subjects through place-based approaches and community with the participation of users and families in the care process, and social control assistance. The competent care model for this is the Family Health Strategy (FHS), which includes the Community Health Workers (CHW). These CHW are professionals who mediate between the community and the health team in the care process. To support the qualification of these professionals to care for people who use licit and illicit drugs, we investigated the perceptions of the same on these users through a qualitative research previously approved by the Ethics Committee on Human Research of the Federal University of São Carlos, SP. To identify the CHW with experience in the care of people who use drugs to the interviews, the quantified experience of each one through a window specifically for this, applied to the total of 43 of these professionals working in health teams family under the single Family Health Support Centers of Rio Claro, SP, at the time of the study. Interviewing the CHW in descending order of the scores given by the experience rating indicator of each was obtained saturation of findings at the end of the tenth semi-structured interview. In light of the theoretical framework of the clinic of the subject and the integral care, we analyzed the speeches of the interviewed by thematic categories. The findings suggested a predominance of moralizing perceptions about the use and on and drug users, understanding these people as devoid of reason, requiring police intervention, legal or repressive nature of health. Against the Psychiatric Reform and social rehabilitation, there was institutionalization of expectations and an outsourcing of care, although at times the CHW own question the effectiveness of practices based on hospital-centric psychiatry. Overall, it was found that there are still actions based on common sense and lack of access to technical and scientific information that are reflected in disparaging view of the user and discomfort in dealing with them. Initiatives of a comprehensive care, which considers and promotes the autonomy of the subject were found in a few moments; significant of them understood as impact of its participation in the Care Pathways course, offered by the Ministry of Health to improve care to drug users under the ESF. Such a course has shown as the only training that CHW received on care to drug users. It was concluded that still prevails a stigmatizing view by CHW about who uses drugs, from a still lay understanding of the matter. However, there is provision of these professionals qualify this view and address the problem of use and drug users in the community in which they operate. Therefore, the development of matrix support spaces and regular Continuing Education projects for CHW and other Family Health Strategy professionals is appropriate to have such discussions and qualify the care of drug users. / A política do Ministério da Saúde para a atenção integral a usuários de drogas preconiza a integração social e a promoção da autonomia desses sujeitos por meio de abordagens de base territorial e comunitária com a participação de usuários e familiares no processo de cuidado, e no controle social da assistência. O modelo assistencial competente para isso é o da Estratégia Saúde da Família (ESF), o qual conta com os Agentes Comunitários de Saúde (ACS). Esses ACS são os profissionais que fazem a mediação entre a comunidade e a equipe assistencial no âmbito do processo de cuidado. Para subsidiar a qualificação desses profissionais para a atenção a pessoas que usam drogas lícitas e ilícitas, investigou-se as percepções dos mesmos sobre esses usuários por meio de uma pesquisa qualitativa previamente aprovada pelo Comitê de Ética em Pesquisa com Seres Humanos da Universidade Federal de São Carlos, SP. Para identificar os ACS com maior experiência no cuidado de pessoas que usam drogas para as entrevistas, quantificou-se a experiência de cada um por meio de um indicador especificamente criado para isso, aplicado ao total de 43 desses profissionais atuantes nas equipes de Saúde da Família cobertas pelo único Núcleo de Apoio à Saúde da Família (NASF) de Rio Claro, SP, no momento de realização do estudo. Entrevistando os ACS segundo a ordem decrescente da pontuação dada pelo indicador de classificação da experiência de cada um, obteve-se a saturação dos achados ao final da décima entrevista semiestruturada. À luz do referencial teórico da clínica do sujeito e da integralidade do cuidado, analisou-se as falas dos entrevistados por categorias temáticas. Os achados sugeriram um predomínio de percepções moralizantes sobre o uso e sobre e os usuários de drogas, entendendo essas pessoas como desprovidas de razão, que demandam intervenção policial, jurídica ou de saúde de caráter repressor. Na contramão da Reforma Psiquiátrica e da reinserção social, observou-se expectativas de institucionalização e de uma terceirização do cuidado, embora em alguns momentos os próprios ACS questionassem a efetividade de práticas manicomiais. No geral, verificouse que ainda há atuações baseadas no senso comum e na falta de acesso às informações técnico-científicas que se refletem na visão depreciativa do usuário e desconforto em lidar com os mesmos. Iniciativas de um cuidado integral, que considera e promove a autonomia do sujeito foram encontradas em alguns momentos; significativa parte delas entendidas como impacto de sua participação no curso Caminhos do Cuidado, ofertado pelo Ministério da Saúde para a qualificação da atenção aos usuários de drogas no âmbito da ESF. Tal curso se mostrou como a única formação que os ACS receberam sobre cuidado a usuários de drogas. Concluiu-se que ainda prevalece uma visão estigmatizante por parte de ACS sobre quem usa drogas, a partir de uma compreensão ainda leiga sobre a matéria. Entretanto, há disposição desses profissionais em qualificarem esse modo de ver e de enfrentar a problemática do uso e do usuário de drogas na comunidade em que atuam. Portanto, é oportuno o desenvolvimento de espaços de apoio matricial e projetos de Educação Permanente regulares para ACS e demais profissionais da ESF a fim de provocar tais discussões e qualificar o cuidado aos usuários de drogas.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta pesquisa teve como objetivo geral, analisar as práticas de saúde desenvolvidas por ACS, em consonância com os documentos determinados pelo Ministério da Saúde, na ESF na Região do Médio Paraíba, Estado do Rio de Janeiro. Este estudo corresponde ao desdobramento da pesquisa Perfil dos agentes comunitários de saúde do Estado do Rio de Janeiro: análise comparativa entre municípios e regiões em articulação com o estudo Saberes e Práticas na Atenção Primária à Saúde: diálogos entre usuários e profissionais de saúde no Estado do Rio de Janeiro. Trata-se de um estudo descritivo, de natureza qualitativa e teve como abordagem teórico-filosófico, a hermenêutica-dialética. Teve como cenários os municípios de Piraí, Porto Real, Pinheiral, Rio Claro e Rio das Flores. Os sujeitos corresponderam a 53 ACS atuantes nas UBSF dos municípios selecionados. Os instrumentos utilizados para a coleta de dados foram: a observação assistemática, o questionário semiestruturado e o grupo focal. Para a análise dos dados foi utilizada a hermenêutica-dialética proposta por Minayo. Através dos resultados alcançados foi possível realizar uma breve caracterização dos sujeitos provenientes do questionário e a análise do grupo focal desdobrando-se em três categorias. A primeira categoria focou nas práticas de saúde dos ACS que colaboram com a gestão do cuidado. A segunda buscou analisar as práticas de atenção à saúde dos ACS. E a terceira categoria direcionou-se para as práticas educativas dos ACS. Entendemos as práticas de saúde dos ACS acontecem de forma conectada. Pois no cotidiano das práticas não percebemos que as mesmas são realizadas concomitantemente preservando a ideologia da integralidade do cuidado aos usuários da ESF. Encontramos que a maioria dessas práticas de saúde está de acordo com o preconizado pelo MS, porém, identificamos no cotidiano das práticas dos ACS, as que não são abordadas pelos respectivos documentos, como a entrega de recados, a entrega de medicamentos e a atuação na farmácia e recepção das unidades. Assim, podemos afirmar de antemão, que as práticas de saúde dos ACS dos municípios estudados contribuem para a consolidação da Estratégia Saúde da Família no interior do Estado do Rio de janeiro. E além do mais, indicam possíveis desdobramentos para a firmação do modelo da Vigilância da Saúde na Atenção Básica à Saúde. / The general objective of this research was to analyze the health practices developed by CHW, in line with the documents determined by the Brazilian Ministry of Health, in the FHS in the Médio Paraíba Region, State of Rio de Janeiro. This study corresponds to the outcome of the research Profile of community health workers of the State of Rio de Janeiro: comparative analysis between municipalities and regions in articulation with the study Skills and Practices in Primary Health Care: dialogues between users and health professionals in the State of Rio de Janeiro. This is a descriptive study, with qualitative nature, that had the hermeneutics-dialectics as theoretical-philosophical approach. The study scenarios were the cities of Piraí, Porto Real, Pinheiral, Rio Claro and Rio das Flores. The subjects corresponded to 53 CHW who worked in BFHU of the chosen cities. The tools used for data collection were: unsystematic observation, semi-structured questionnaire and focus group. In order to analyze data, we used the hermeneutics-dialectics proposed by Minayo. Through the achieved results, it was possible to perform a short description of the subjects stemming from the questionnaire, and the analysis of the focus group, thereby generating three categories. The first category was focused on the health practices of CHW who collaborate with the care management. The second sought to analyze the health care practices of CHW. And the third category was directed to the educational practices of CHW. We understand that the health practices of CHW take place in a connected manner, since, in the daily practices, we did not realize that they are concomitantly conducted while preserving the ideology of comprehensiveness of care for FHS users. We found that the majority of these health practices are in accordance with what is advocated by MS, but we identified, in the daily practices of CHW, those that are not approached by the respective documents, such as delivery of messages, delivery of medications, and operation in the pharmacy and reception desk of the units. Thus, we can say, in advance, that the health practices of CHW of the surveyed cities have contributed to the consolidation of the Family Health Strategy in the State of Rio de Janeiro. Furthermore, they point out possible outcomes for the consolidation of the model of Health Surveillance in Primary Health Care.