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Community health workers reveal COVID-19 disaster in Brazil

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Lotta, Gabriela, Wenham, Clare, Nunes, João, Pimenta, Denise Nacif·2020·The Lancet

DOI 10.1016/s0140-6736(20)31521-xPMC PMC7351420

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COVID-19 in Latin America
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“The epidemic situation in severe countries such as the US, Brazil, Russia is mainly caused by the lack of attention to epidemic by the government, the unimplemented stringent control measures timely, or the inadequacy of medical facilities (van Dorn et al., 2020; Lancet, 2020; Lotta et al., 2020).”
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“, 2020) • Expansion of telehealth services, including for vulnerable populations and in remote areas (Ariadne Labs, 2020; Giannopoulou and Tsobanoglou, 2020) • Lack of nation-wide guidelines for PHC services relating to the COVID-19 response (Lotta et al., 2020; Souza et al., 2020) • Rapid deployment of frontline ment…”
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“Consequently, while it had been provided all around the country during ordinary times, community healthcare services, and CHWs as its frontline workforce, were marked as unimportant and irrelevant to the pandemic response (Lotta et al., 2020a).”
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“16,21 Political instability added to the disorder in the Health Ministry, which spent three months without a Heath Minister.”
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“On the other hand, as they are connected to the territory, it was expected that they would be better able to use their discretion in adapting the recommendations for citizens locally (Lotta et al. 2020a).”
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“Only one document ( “ Recommendations for Community Health Workers During the Pandemic ” ) proposed changes in the work of CHWs during the pandemic [40,11].”
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“These critical challenges have been noted in the Philippines,(12) just as in some well-resourced health systems;(13) and have already contributed to the loss of at least 50 CHWs in Brazil.(14) Crucially, CHWs in LMICs must be supported to continue their normal duties to minimise the negative A cc ep te d A rt ic le”
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“For example, in Brazil, Bolsonaro’s government took no direct actions during the early stage of the pandemic, although Congress did pass some social benefit packages (Lotta et al. 2020; Rozell and Wilcox 2020).”
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Mishra, B. K., Kanungo, S., Patel, K., Swain, S. P., Dwivedy, S., Panda, S., Karna, S., Bhuyan, D., Som, M., Merta, B. R., et al. (2022) · Healthcare · doi:10.3390/healthcare10010088 · Cited by 16
“Similar to our study findings, other studies have revealed that CHWs encountered threats and hostility in their field areas [17,18].”
Result
Populist government support and frontline workers' self‐efficacy during crisis
Lotta, G., Thomann, E., Fernández, M., Vogler, J. P., Leandro, A., & Corrêa, M. (2024) · Governance · doi:10.1111/gove.12851 · Cited by 14
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“Surveys carried out in April 2021 showed that more than 50% of the HCWs did not receive adequate PPE, 70% did not receive training, 65% did not feel supported by the government, and 80% had mental health issues [13,14].”
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Background
Resilience in interconnected community and formal health (and connected) systems
Fortnam, M., Hailey, P., Witter, S., & Balfour, N. (2024) · SSM - Health Systems · doi:10.1016/j.ssmhs.2024.100027 · Cited by 26
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Raven, J., Arjyal, A., Baral, S., Chand, O., Hawkins, K., Kallon, L. H., Mansour, W., Parajuli, A., Than, K. K., Wurie, H. R., et al. (2022) · Social Sciences · doi:10.3390/socsci11090415 · Cited by 11
“This resonates with findings from other settings such as Brazil where community health workers experienced threats and aggression (Lotta et al. 2020) and in India where harassment and disrespect fuelled by fears of COVID‑19 have been reported (Nanda et al. 2020).”
Result
Desigualdades e subjetividade: construção da práxis no contexto da pandemia de covid-19 em território vulnerável
Silva, C. R. D. C. E., Ianni, Á. M. Z., & Forte, E. C. N. (2021) · Saúde e Sociedade · doi:10.1590/s0104-12902021210029 · Cited by 11
Inequality in the middle of a crisis: an analysis of health workers during the COVID-19 pandemic from the profession, race, and gender perspectives.
Magri, G., Fernandez, M., & Lotta, G. (2022) · Ciência & Saúde Coletiva · doi:10.1590/1413-812320222711.01992022 · Cited by 12
Self-citation
Enhancing the capacity of community health workers in prevention and control of epidemics and pandemics in Wakiso district, Uganda: evaluation of a pilot project
Musoke, D., Lubega, G. B., Twesigye, B., Nakachwa, B., Brown, M. O., & Gibson, L. M. (2024) · BMC Family Practice · doi:10.1186/s12875-024-02522-1 · Cited by 14
“This training was conducted due to the vital role played by CHWs in supporting health systems at the grassroots, particularly during epidemics and pandemics [22, 27].”
Background
Pandemic-Related Impairment in the Monitoring of Patients With Hypertension and Diabetes and the Development of a Digital Solution for the Community Health Worker: Quasiexperimental and Implementation Study
Cimini, C. C. R., Maia, J. X., Pires, M. C., Ribeiro, L. B., Pinto, V. S. D. O. E. A., Batchelor, J., Ribeiro, A. L. P., & Marcolino, M. S. (2022) · JMIR Medical Informatics · doi:10.2196/35216 · Cited by 10
Características do trabalho do agente comunitário de saúde na pandemia de COVID-19 em municípios do Nordeste brasileiro
França, C. D. J., Nunes, C. A., Vilasbôas, A. L. Q., Aleluia, Í. R. S., Aquino, R., Nunes, F. G. D. S., & Prado, N. M. D. B. L. (2023) · Ciência & Saúde Coletiva · doi:10.1590/1413-81232023285.18422022 · Cited by 9
“É necessário acompanhar as mudanças efeti-vas provocadas nas práticas reais de trabalho, as exigências geradas, as construções sociotécnicas que as materializam, seus efeitos sobre a saúde e as dimensões do trabalho 30 .”
Background
Hear my voice: understanding how community health workers in the Peruvian Amazon expanded their roles to mitigate the impact of the COVID-19 pandemic through community-based participatory research
Samsamshariat, T., Madhivanan, P., Prada, A. R. F., Moya, E. M., Meza, G., Reinders, S., & Blas, M. M. (2023) · BMJ Global Health · doi:10.1136/bmjgh-2023-012727 · Cited by 8
A scoping review of the roles, challenges, and strategies for enhancing the performance of community health workers in the response against COVID-19 in low- and middle-income countries
Zulu, J. M., Silumbwe, A., Munakampe, M. N., Chavula, M. P., Mulubwa, C., Sirili, N. S., Zulu, W., Michelo, C., & Tetui, M. (2025) · BMC Family Practice · doi:10.1186/s12875-025-02853-7 · Cited by 9
“This gap hinders the development of resilient CHSs for future infectious outbreaks [19].”
Breastfeeding Practices Before and During the COVID-19 Pandemic in Fortaleza, Northeastern Brazil
Farías-Antúnez, S., Correia, L. L., Araújo, D. A. B. S., Penna, A. L., de Sousa, G. D. S., Silva, A. C. E., Campos, J. S., Rocha, H. A. L., de Aquino, C. M., Castro, M. C., et al. (2022) · Journal of Human Lactation · doi:10.1177/08903344221101874 · Cited by 8
“, 2021), disruption of primary care (Lotta et al. 2020), deterioration of health conditions (Barone et al.”
Background
COVID-19, Older Adults and the Ageing Society
Chatterjee, S. C., & Chatterjee, D. (2022) · Routledge eBooks · doi:10.4324/9781003286936 · Cited by 7
Medos, desejos e preocupações acerca da sindemia de Covid-19 e sofrimento psíquico: experiências extensionistas no sul da Bahia, Brasil
Cardoso, A. J. C., & da Silva, G. A. (2022) · Interface - Comunicação Saúde Educação · doi:10.1590/interface.210675 · Cited by 7
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Authors: Lotta, G., Wenham, C., Nunes, J., & Pimenta, D. N.
Affiliations: Fundação Getulio Vargas (BR)
London School of Economics and Political Science (GB)
University of York (GB)
Fiocruz Minas (BR)
Corresponding author: Lotta, Gabriela
ORCID: Lotta, Gabriela
Wenham, Clare
Nunes, João
Pimenta, Denise Nacif
Venue: The Lancet
Publisher: Elsevier BV
Published: 2020-08
Volume: 396
Issue: 10248
Pages: 365-366
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(20)31521-x
PMC: PMC7351420
OpenAlex: W3041305424
Cited by: 153
References: 6
Citations by year: 2026: 7 · 2025: 12 · 2024: 22 · 2023: 17 · 2022: 48 · 2021: 37 · 2020: 9
FWCI: 28.98
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
doi.org/10.15223/policy-017 (stm-asf)
doi.org/10.15223/policy-037 (stm-asf)
doi.org/10.15223/policy-012 (stm-asf)
doi.org/10.15223/policy-029 (stm-asf)
doi.org/10.15223/policy-004 (stm-asf)
Locations: The Lancet (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Arca - Repositório Institucional da Fiocruz (submittedVersion, other-oa)
LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
Topics: Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Challenges
Health Sciences › Health Professions › Emergency Medical Services › Disaster Response and Management
Health Sciences › Health Professions › General Health Professions › Health, Nursing, Elderly Care
Keywords: community health workers, COVID-19 pandemic, Brazil, primary care, infection control training, personal protective equipment
MeSH terms: Personal Protective Equipment, Betacoronavirus, COVID-19, SARS-CoV-2, Brazil, Community Health Workers, Health Policy, Humans, Leadership, Pneumonia, Viral, Politics, Infectious Disease Transmission, Patient-to-Professional, Coronavirus Infections, Pandemics

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