Magazine article Nursing Economics

Brazilian Nurses' Perception of the Role of Community Health Agents in Preventive Care

Magazine article Nursing Economics

Brazilian Nurses' Perception of the Role of Community Health Agents in Preventive Care

Article excerpt

The adoption of the Affordable Care Act (ACA) in 2010 placed great emphasis on developing and providing effective preventive care to healthcare consumers. Regardless of future changes to the ACA, this new emphasis on disease prevention and illness management will remain as a cost savings element of U.S. healthcare delivery. The present and future role of nursing in how preventive care is delivered to patients is of utmost concern. According to Cogan (2011), perhaps the ACA's most important public health feature is the preventive service mandate. This mandate continues to change the way evidence-based preventive care is provided and paid for by private health insurances as well as Medicare and Medicaid. By mandating evidence-based preventive care with little out-ofpocket costs to consumers, the ACA dramatically changed the way health care is provided in the United States. During the last 50 years, separate goals, methods, and resources have divided public health and healthcare services. This development has created an expensive and poorly performing healthcare system that privileges curative medicine and lacks meaningful preventive healthcare measures (Cogan, 2011). With the implementation of the ACA preventive services mandate, the U.S. healthcare system moved away from a strictly curative healthcare model and adopted a comprehensive model that embraces preventive, as well as curative healthcare services. Even with the Trump Administration's promise to "repeal and replace" the ACA, little evidence exists to support the reversal of the cost-effective and outcomes-driven preventive services mandate.

Among other things, the ACA preventive services mandate increased the demand for community health and community-based nursing care. The Bureau of Labor Statistics estimates registered nurses (RN) employment in home health care alone will increase by 55% between 2010 and 2020 and account for about 230,000 of the 3.5 million RN jobs by the year 2020 (Spetz, 2014). Community health and community-based nurses will be responsible for coordinating care and supervising lowskilled healthcare workers. Consequently, it is important to conduct research on new and existing roles and to increase knowledge and understanding concerning the role of ancillary healthcare workers (such as the Brazilian agente comunitário de saúde - community health agent). In doing so, evidence helps develop programs and policies to provide evidence-based health care to populations. Looking to other countries and other systems of healthcare delivery is one way of expanding our knowledge base in new and different models of providing preventive healthcare services.

During an academic study partnership exchange with Brazilian nurses in late 2014, members of the nursing program from the University of Hartford (West Hartford, CT) visited academic nursing programs and healthcare facilities connected to the Federal University of Santa Catarina (Universidade Federal de Santa Catarina) in Florianópolis, Brazil, and the Rio de Janeiro State University (Universidade do Estado do Rio de Janeiro) in Rio de Janiero, Brazil. During the visit, the nursing group was impressed with the figure of the community health agent (CHA) (agente comunitário de saúde) and the inclusion of this figure into the Family Health Program (Programa de Saúde da Família) of the Brazilian National Unified Health System (Sistema Único de Saúde). The inclusion of the CHA was perceived to be a positive factor in providing preventive care to the community and more information was desired about the role.

CHAs are lay healthcare workers who are members of an interprofessional healthcare team of nurses, physicians, and other healthcare professionals. CHAs live in the community or neighborhood where they work, and they are the liaison or link between the community and healthcare professionals in the Family Health Program. As integral members of the healthcare team, CHAs promote preventive health care in neighborhoods and strengthen links between the community and the unified health services. …

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