Complexity and potentiality of the Community Health Workers' labor in contemporary Brazil

ABSTRACT The aim of this article was to analyze the Community Health Worker' (CHW) scope of practices, relating it to the social and health situation faced, as well as with facilitating and limiting elements of their practice. This is a cross-sectional study utilizing a mixed approach, including sequential explanatory strategy, carried out in four municipalities of Ceará. In the quantitative study, the sample of 160 CHW was randomized, and a structured instrument was used to collect data. In the qualitative study, six focal groups and interviews were carried out. We mainly found women (139; 86.9%), married (111; 69.4%), with a family income greater than or equal to 2 minumm wages (102; 63.7%), incomplete professional trainning (68; 42.5 %), from the urban area (114, 71.3%), acting as CHW for less than 10 years (93, 58.2%). The main activities were home visitation of priority groups and families registration. The complexity of the work was evidenced, which includes actions of health promotion and surveillance, such as prenatal care, immunizations, hypertension, diabetes, care for the elderly, among others. As limitations of their practices, we identified: deficiency of technical/professional training, reduced work support, and violence. As facilitators, we observed: permanent education and participatory management practices. The scope of CHW practices is complex and broad, including the articulation of public policies in the territory, which constitutes a potential for health promotion of vulnerable communities.