{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T12:17:11Z","timestamp":1793967431348,"version":"4.8.0"},"reference-count":31,"publisher":"FapUNIFESP (SciELO)","issue":"7","license":[{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,1,1]],"date-time":"2023-01-01T00:00:00Z","timestamp":1672531200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cad. Sa\u00fade P\u00fablica"],"abstract":"<jats:p>Abstract: This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team\u2019s work routines across a range of northeast Brazilian cities as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured questionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Cear\u00e1 State, Jo\u00e3o Pessoa - Para\u00edba State, Recife - Pernambuco State, Teresina - Piau\u00ed State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Cear\u00e1 State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25\u00b18.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46%) or weakening (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfiguration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowledged while preserving the headway made thus far.<\/jats:p>","DOI":"10.1590\/0102-311xen007223","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T11:30:52Z","timestamp":1691753452000},"source":"Crossref","is-referenced-by-count":7,"title":["Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil"],"prefix":"10.1590","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4237-8995","authenticated-orcid":false,"given":"Anya Pimentel Gomes Fernandes","family":"Vieira-Meyer","sequence":"first","affiliation":[{"name":"Funda\u00e7\u00e3o Oswaldo Cruz,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4237-0184","authenticated-orcid":false,"given":"Franklin Delano Soares","family":"Forte","sequence":"additional","affiliation":[{"name":"Universidade Federal da Para\u00edba,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5682-6106","authenticated-orcid":false,"given":"Jos\u00e9 Maria Ximenes","family":"Guimar\u00e3es","sequence":"additional","affiliation":[{"name":"Universidade Estadual do Cear\u00e1,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3650-154X","authenticated-orcid":false,"given":"Sidney Feitoza","family":"Farias","sequence":"additional","affiliation":[{"name":"Funda\u00e7\u00e3o Oswaldo Cruz,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2483-550X","authenticated-orcid":false,"given":"Andr\u00e9 Luiz S\u00e1 de","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Funda\u00e7\u00e3o Oswaldo Cruz,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7813-547X","authenticated-orcid":false,"given":"Maria Socorro de Ara\u00fajo","family":"Dias","sequence":"additional","affiliation":[{"name":"Universidade Estadual Vale do Acara\u00fa,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0902-3340","authenticated-orcid":false,"given":"Claudete Ferreira de Souza","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Universidade Federal do Piau\u00ed,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5731-632X","authenticated-orcid":false,"given":"Fernando Jos\u00e9","family":"Guedes da Silva J\u00fanior","sequence":"additional","affiliation":[{"name":"Universidade Federal do Piau\u00ed,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6188-7897","authenticated-orcid":false,"given":"Ana Patr\u00edcia Pereira","family":"Morais","sequence":"additional","affiliation":[{"name":"Universidade Estadual do Cear\u00e1,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9821-1935","authenticated-orcid":false,"given":"Maria Rosilene Candido","family":"Moreira","sequence":"additional","affiliation":[{"name":"Universidade Federal do Cariri,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4606-2795","authenticated-orcid":false,"given":"M\u00e1rcia C.","family":"Castro","sequence":"additional","affiliation":[{"name":"Harvard TH Chan School of Public Health,  U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1592-8923","authenticated-orcid":false,"given":"Aisha Khizar","family":"Yousafzai","sequence":"additional","affiliation":[{"name":"Harvard TH Chan School of Public Health,  U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2023]]},"reference":[{"key":"ref1","series-title":"A import\u00e2ncia de um sistema de sa\u00fade p\u00fablico e universal no enfrentamento \u00e0 epidemia.","author":"Guimar\u00e3es C"},{"key":"ref2","article-title":"Portaria n\u00ba 2.436, de 21 de setembro de 2017. Aprova a Pol\u00edtica Nacional de Aten\u00e7\u00e3o B\u00e1sica, estabelecendo a revis\u00e3o de diretrizes para a organiza\u00e7\u00e3o da aten\u00e7\u00e3o b\u00e1sica, no \u00e2mbito do Sistema \u00danico de Sa\u00fade (SUS).","year":"2017","journal-title":"Di\u00e1rio Oficial da Uni\u00e3o"},{"key":"ref3","article-title":"Community health workers during Covid-19 pandemic practices, legitimacy and professional education in Brazil","volume":"25","author":"M\u00e9llo LMBD","year":"2021","journal-title":"Interface (Botucatu)"},{"key":"ref4","series-title":"WHO Coronavirus (COVID-19) Dashboard."},{"key":"ref5","first-page":"4099","article-title":"COVID-19 in Northeast Brazil: achievements and limitations in the responses of the state governments.","volume":"25","author":"Kerr L","year":"2020","journal-title":"Ci\u00eanc Sa\u00fade Colet"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"bjgpopen20X101041","DOI":"10.3399\/bjgpopen20X101041","article-title":"The coronavirus outbreak the central role of primary care in emergency preparedness and response","volume":"4","author":"Dunlop C","year":"2020","journal-title":"BJGP Open"},{"key":"ref7","first-page":"657","article-title":"Violence and vulnerability of the Community Health Worker in the territory implications for tackling COVID-19","volume":"26","author":"Vieira-Meyer APGF","year":"2021","journal-title":"Ci\u00eanc Sa\u00fade Colet"},{"key":"ref8","first-page":"4185","article-title":"Community health workers reflections on the health work process in Covid-19 pandemic times","volume":"25","author":"Maciel FBM","year":"2020","journal-title":"Ci\u00eanc Sa\u00fade Colet"},{"key":"ref9","series-title":"Protocolo de manejo cl\u00ednico do coronav\u00edrus (COVID-19) na aten\u00e7\u00e3o prim\u00e1ria \u00e0 sa\u00fade.","volume":"9","year":"2020"},{"key":"ref10","article-title":"Challenges for Primary Health Care in Brazil an analysis on the labor of community health workers during a COVID-19 pandemic","volume":"19","author":"Fernandez M","year":"2021","journal-title":"Trab Educ Sa\u00fade"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1111\/1475-6773.00149","article-title":"The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998","volume":"38","author":"Macinko J","year":"2003","journal-title":"Health Serv Res"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.gaceta.2011.10.009","article-title":"Primary care an increasingly important contributor to effectiveness, equity, and efficiency of health services. 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Orienta\u00e7\u00f5es para servi\u00e7os de sa\u00fade: medidas de preven\u00e7\u00e3o e controle que devem ser adotadas durante a assist\u00eancia aos casos suspeitos ou confirmados de infec\u00e7\u00e3o pelo novo coronav\u00edrus (SARS-CoV-2)."},{"key":"ref18","article-title":"Lei n\u00ba 14.536, de 20 de janeiro de 2023. 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