Changes in the national primary health care policy: perceptions of community health workers in northeastern Brazil
1
Graduate Program in Public Health, Universidade Estadual do Ceará (UECE), Fortaleza, Brazil
2
Professional Master's Degree in Family Health, Universidade Federal do Tocantins, Palmas, Brazil
3
Nursing Department, Universidade Regional do Cariri, Iguatu, Brazil
4
Nursing Department, Universidade Federal do Tocantins, Palmas, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A1545
ABSTRACT
INTRODUCTION:
Community health workers play a central role in health promotion and in linking communities with primary health care services¹. The National Primary Health Care Policy, published in 2017², introduced relevant changes in the professional work process, generating challenges that affect community bonding, continuity of care, and professional identity. This study aimed to understand the perceptions of community health workers in northeastern Brazil regarding the changes resulting from the National Primary Health Care Policy.
METHODS:
This was an exploratory and descriptive study with a qualitative approach, conducted with ten community health workers working in Family Health Strategy teams in urban áreas of a municipality in northeastern Brazil. Data were collected in September 2021 through online focus groups. The narratives were analyzed using thematic content analysis. The study complied with the ethical and legal principles established by Resolution No. 466 of 2012 of the National Health Council³.
RESULTS:
Participants reported significant transformations in the work process, particularly related to the expansion of responsibilities and the intensification of administrative and bureaucratic tasks guided by performance indicators. These changes reinforce a productivist logic, perceived as dehumanizing care and undermining work quality. Role deviation weakens historically constructed practices, compromises community bonds, and delegitimizes professional identity, traditionally grounded in health education, health promotion, and mediation between communities and health services. The centrality of technicist practices was associated with feelings of distress, insecurity, and professional threat.
CONCLUSIONS:
The findings highlight the need for permanent spaces for training, dialogue, and participation of community health workers in the development and implementation of public policies, in order to reaffirm their professional identity and strengthen humanized care practices in the territories within the Brazilian national health system.
Community health workers play a central role in health promotion and in linking communities with primary health care services¹. The National Primary Health Care Policy, published in 2017², introduced relevant changes in the professional work process, generating challenges that affect community bonding, continuity of care, and professional identity. This study aimed to understand the perceptions of community health workers in northeastern Brazil regarding the changes resulting from the National Primary Health Care Policy.
METHODS:
This was an exploratory and descriptive study with a qualitative approach, conducted with ten community health workers working in Family Health Strategy teams in urban áreas of a municipality in northeastern Brazil. Data were collected in September 2021 through online focus groups. The narratives were analyzed using thematic content analysis. The study complied with the ethical and legal principles established by Resolution No. 466 of 2012 of the National Health Council³.
RESULTS:
Participants reported significant transformations in the work process, particularly related to the expansion of responsibilities and the intensification of administrative and bureaucratic tasks guided by performance indicators. These changes reinforce a productivist logic, perceived as dehumanizing care and undermining work quality. Role deviation weakens historically constructed practices, compromises community bonds, and delegitimizes professional identity, traditionally grounded in health education, health promotion, and mediation between communities and health services. The centrality of technicist practices was associated with feelings of distress, insecurity, and professional threat.
CONCLUSIONS:
The findings highlight the need for permanent spaces for training, dialogue, and participation of community health workers in the development and implementation of public policies, in order to reaffirm their professional identity and strengthen humanized care practices in the territories within the Brazilian national health system.
| eISSN: | 2654-1459 |
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