Saúde materno-infantil: saberes e práticas do agente comunitário de saúde na visita domiciliar no âmbito do Programa de Agentes Comunitários de Saúde

Abstract

Public Health Policies (PPS) play a central role in promoting maternal and child health, aiming to reduce morbidity and mortality and ensure comprehensive care for women and children. In Brazil, Primary Health Care (APS), through the Family Health Strategy (ESF) and the Community Health Agents Program (PACS), serves as the main setting for the implementation of these policies, especially in vulnerable communities. Community Health Agents (ACS) are key players in this process, conducting home visits for prevention, health promotion, and monitoring of pregnant women and children. However, gaps persist in the knowledge and practices of these professionals regarding maternal and child care, which may compromise the quality of assistance. This study aims to evaluate the knowledge and practices of community health agents in maternal and child care during home visits within primary health care. It is therefore a qualitative study, guided by an interpretive framework in the field of social research. The study was conducted in the municipality of Itaitinga, Ceará, involving 14 community health agents working in six Family Health teams selected based on geographic location and presence of social vulnerabilities. The qualitative data were collected through focus groups, in which community health agents discussed their experiences and knowledge. The qualitative materials were analyzed using Thematic Analysis, aiming to identify patterns and relevant themes. The focus group analysis revealed that Community Health Agents (ACS) play a crucial role in the early identification of pregnant women, guidance on prenatal care, and ongoing monitoring of both the mother and child. Practices such as verifying the maternal health card, promoting vaccination, encouraging breastfeeding, and tracking child development were frequently mentioned in participants' accounts. However, several challenges were also identified, including the absence of scales for weighing, users' lack of interest in educational activities that offer no material benefit, resistance to sexually transmitted infection diagnoses, and workload overload. Other aspects observed include low adherence among adolescent pregnant women, limited paternal involvement, fragility in ACS mental health, and the devaluation of service quality in favor of meeting quantitative targets. The results highlighted the complexity of ACS work in maternal and child care and pointed to the need for institutional recognition of their contributions. Active listening, strengthening family support networks, and revaluing educational initiatives emerge as fundamental strategies to improve care quality. Moreover, investment in continuing education and basic infrastructure, such as materials and working tools, is essential to ensure that implemented actions are sustainable and effective. The research reinforces the role of ACS as a bridge between the community and health services, emphasizing that maternal and child health care must take into account users’ territorial, sociocultural, and emotional specificities, promoting more humanized, comprehensive, and effective care.