Contribution of community health workers to primary health care performance in Brazil

Santos, Alaneir de Fátima dos; Rocha, Hugo André da; Lima, Ângela Maria de Lourdes Dayrell de; Abreu, Daisy Maria Xavier de; Silva, Érica Araújo; Araújo, Lucas Henrique Lobato de; Cavalcante, Isabela Cristina Carreiro; Matta-Machado, Antônio Thomaz Gonzaga da

doi:10.11606/s1518-8787.2020054002327

Alaneir de Fátima dos Santos

Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brasil

https://orcid.org/0000-0002-7674-0449

Hugo André da Rocha

Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil

https://orcid.org/0000-0001-6433-0568

Ângela Maria de Lourdes Dayrell de Lima

Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil

https://orcid.org/0000-0003-3437-5399

Daisy Maria Xavier de Abreu

Universidade Federal de Minas Gerais. Faculdade de Medicina. Núcleo de Educação em Saúde Coletiva. Belo Horizonte, MG, Brasil

https://orcid.org/0000-0002-6855-8612

Érica Araújo Silva

Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil

https://orcid.org/0000-0002-3183-5102

Lucas Henrique Lobato de Araújo

Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil

https://orcid.org/0000-0001-8528-3166

Isabela Cristina Carreiro Cavalcante

Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil

https://orcid.org/0000-0003-4530-6954

Antônio Thomaz Gonzaga da Matta-Machado

Universidade Federal de Minas Gerais. Faculdade de Medicina. Departamento de Medicina Preventiva e Social. Belo Horizonte, MG, Brasil

https://orcid.org/0000-0002-0516-8529

Correspondence: Antônio Thomaz Gonzaga da Matta-Machado Avenida Prof. Alfredo Balena, 190 30130-100 Belo Horizonte, MG, Brasil E-mail: thomaz@medicina.ufmg.br

Authors’ Contribution: Conception and planning of the work: AFS, DMXA, ATGMM. Data collection, analysis, and interpretation: AFS, HAR, AMLDL, DMXA, EAS, LHLA, ICCC. Drafting or revision of the manuscript: AFS, HAR, AMLDL, DMXA, EAS, LHLA, ICCC, ATGMM. Final approval: AFS, HAR, AMLDL, DMXA, EAS, LHLA, ICCC, ATGMM. Public responsibility for the article content: all authors.

Conflict of Interest: The authors declare no conflict of interest.

Type of professional	2013		2014

	n	%	n	%
CHW	343,023,069	92.3	318,000,654	92.4
Doctors	4,549,350	1.2	4,139,077	1.2
Nurses	7,441,938	2.0	6,658,291	1.9
Other undergraduate-degree professionals	1,974,242	0.5	2,115,596	0.6
Mid-level professionals	14,825,448	4.0	13,413,350	3.9

Total	371,814,047	100.0	344,326,968	100.0

Regions	Level of activity

	Low		Medium		High

	n	%	n	%	n	%
North	564	26.1	589	27.3	1,007	46.6
Northeast	2,813	26.1	2,510	23.3	5,445	50.6
Southeast	3,036	30.1	2,359	23.4	4,705	46.6
South	1,216	27.0	1,252	27.8	2,041	45.3
Midwest	437	19.5	551	24.6	1,253	55.9

Total	8,066	27.1	7,261	24.4	14,451	48.5

Regions	Healthcare strategies	Level of Practice

		Low		Medium-high

		n	%	n	%
North	HTN	912	42.2	1,248	57.8
	DM	659	30.5	1,501	69.5
	Women	1,449	67.1	711	32.9
	Children	1,279	59.2	881	40.8

Northeast	HTN	2,820	26.2	7,948	73.8
	DM	1,887	17.5	8,881	82.5
	Women	5,247	48.7	5,521	51.3
	Children	4,050	37.6	6,718	62.4

Southeast	HTN	2,492	24.7	7,608	75.3
	DM	1,662	16.5	8,438	83.5
	Women	4,079	40.4	6,021	59.6
	Children	3,053	30.2	7,047	69.8

South	HTN	1,562	34.6	2,947	65.4
	DM	1,171	26.0	3,338	74.0
	Women	2,033	45.1	2,476	54.9
	Children	1,501	33.3	3,008	66.7

Midwest	HTN	818	36.5	1,423	63.5
	DM	607	27.1	1,634	72.9
	Women	1,256	56.0	985	44.0
	Children	1,053	47.0	1,188	53.0

Total	HTN	8,604	28.9	21,174	71.1
	DM	5,986	20.1	23,792	79.9
	Women	14,064	47.2	15,714	52.8
	Children	10,936	36.7	18,842	63.3

Strategy	Level	B	p	OR	95%CI
HTN	Low			1	-
	Medium	1.01	0.001	2.75	2.52–3.0
	High	1.92	0.001	6.88	6.13–7.71

DM	Low			1	-
	Medium	0.77	0.001	2.16	2.01–2.32
	High	1.73	0.001	5.64	5.23–6.07

Women’s health	Low			1	-
	Medium	0.74	0.001	2.11	1.97–2.26
	High	1.82	0.001	6.21	5.84–6.59

Children’s health	Low			1	-
	Medium	0.78	0.001	2.19	2.05–2.33
	High	1.88	0.001	6.56	6.12–7.04

Strategy	Regions	Level	B	p	OR	95%CI
HTN	North	Low			1.00	-
		Medium	0.95	0.00	2.59	2.04–3.30
		High	2.00	0.00	7.41	5.88–9.33

	Northeast	Low			1.00	-
		Medium	0.67	0.00	1.95	1.74–2.19
		High	1.52	0.00	4.57	4.11–5.08

	Southeast	Low			1.00	-
		Medium	0.84	0.00	2.31	2.06–2.59
		High	2.09	0.00	8.09	7.17–9.13

	South	Low			1.00	-
		Medium	0.52	0.00	1.69	1.44–1.98
		High	1.58	0.00	4.87	4.16–5.69

	Midwest	Low			1.00	-
		Medium	0.82	0.00	2.27	1.75–2.95
		High	1.96	0.00	7.12	5.60–9.04

DM	North	Low			1,00	-
		Medium	0.77	0.00	2,16	1.70–2.73
		High	1.96	0.00	7,11	5.58–9.05

	Northeast	Low			1,00	-
		Medium	0.68	0.00	1,98	1.75–2.25
		High	1.47	0.00	4,36	3.87–4.92

	Southeast	Low			1.00	-
		Medium	0.89	0.00	2.43	2.13–2.77
		High	2.17	0.00	8.75	7.55–10.14

	South	Low			1.00	-
		Medium	0.61	0.00	1.84	1.56–2.17
		High	1.74	0.00	5,67	4.77–6.75

	Midwest	Low			1.00	-
		Medium	0.77	0.00	2.15	1.66–2.79
		High	1.74	0.00	5.71	4.48–7.26

Women	North	Low			1.00	-
		Medium	0.54	0.00	1.71	1.24–2.36
		High	2.04	0.00	7.72	5.84–10.20

	Northeast	Low			1.00	-
		Medium	0.64	0.00	1.90	1.70–2.13
		High	1.61	0.00	4.99	4.52–5.51

	Southeast	Low			1.00	-
		Medium	1.02	0.00	2.78	2..49–3.11
		High	2.31	0.00	10.12	9.10–11.26

	South	Low			1.00	-
		Medium	0.76	0.00	2.14	1.82–2.52
		High	1.82	0.00	6.17	5.28–7.22

	Midwest	Low			1.00	-
		Medium	0.59	0.00	1.80	1.34–2.42
		High	1.69	0.00	5.45	4.20–7.06

Children	North	Low			1	-
		Medium	0.51	0.00	1.66	1.27–2.17
		High	1.59	0.00	4.89	3.86–6.20

	Northeast	Low			1	-
		Medium	0.20	0.00	1.22	1.10–1.36
		High	1.14	0.00	3.12	2.83–3.43

	Southeast	Low			1	-
		Medium	0.76	0.00	2.13	1.91–2.38
		High	1.96	0.00	7.10	6.36–7.92

	South	Low			1	-
		Medium	0.47	0.00	1.59	1.36–1.87
		High	1.34	0.82	3.83	3.28–4.48

	Midwest	Low			1	-
		Medium	0.56	0.00	1.74	1.33–2.28
		High	1.67	0.00	5.33	4.19–6.77

[TFN1] CHW: community health workers.

Contribution of community health workers to primary health care performance in Brazil

ABSTRACT