O trabalho dos agentes comunitários de saúde à luz da teoria das Comunidades de Prática

Abstract

Community health agents are considered as strategic workers for Brazil's main Primary Care Policy, the Family Health Strategy, dedicated to carrying out work to promote health for the populations to where they belong. The Theory of Communities of Practice proposed by Etienne Wenger argues that the active participation of people in a common project, centered on the negotiation of meanings, where they share and produce different types of repertoires, is the context where knowledge is built and shaped. Their concepts become useful as a tool of thought and can shed new light on the world of primary health care. This study sought to analyze the work of the Community Health Agents in the light of the theory of Communities of Practice, focusing on the negotiation of meanings. This is a multiple case study, with a qualitative approach, carried out in four municipalities in the State of Ceará: Cruz, Eusébio, Tauá and Fortaleza, including the community health agents involved in the Family Health Strategy. For the construction of the empirical material, documentary analysis was carried out and the focus group techniques and in-depth interviews were used, guided by a script of open questions. In total, six focal groups, with 39 participants, and six interviews, all recorded and transcribed in their entirety, were performed. The information collected was analyzed by the content analysis technique. The research was approved in the Ethics Committee of the Oswaldo Cruz Institute - FIOCRUZ. The results showed that the participation of the community health agent was marked by the experience with / in the community of their practices, mainly through the home visit, being the main focus of their work the monitoring of priority groups, children under two years, pregnant, puerperal, hypertensive, diabetic, bedridden and domiciled. These practices include health monitoring activities, orientation to prevention, collection of health information, delivery of exams and specialized consultations and identification of new demands, supporting families to obtain access to health services. They also develop roles of educator, mobilizer and articulator of the public services in the territory. The practices of these professionals put them before the demands of the most diverse and were characterized by situations of social and family complexities. In this process, the community agent was creating meanings for himself and for his work process, such as the "listening and looking of the health service directed to the communities" and being the "link" of the health team with the community, which is incorporated to the identity of this collective of professionals. The referential of Communities of Practice Theory was adequate to analyze the practices of these professionals. It was verified that the greater involvement of these professionals in the process of negotiation of meanings, the more potent the construction of new senses and new forms of participation in their practice. This study contributes to explain why, or rather, how the Family Health Strategy has such important impacts, mainly to produce equity in the access to primary health care, since it prioritizes more vulnerable groups and individuals. This result is largely explained by the participation of the Community health agent. On the other hand, it shows how the CHWs are led to try to face complex social and health situations, without the support of the team and the set of public policies. Management and family health team need to approach, in order to visualize the complexities that the CHA approach in practice, giving them support in this process, without what underutilization and wear and tear of this professional, with negative repercussions on the health of the population.