Agentes Comunitárias de Saúde na pandemia de Covid-19: scoping review

Méllo, Lívia Milena Barbosa de Deus e; Santos, Romário Correia dos; Albuquerque, Paulette Cavalcanti de

doi:10.1590/0103-11042022e125

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REVISÃO • Saúde debate 46 (spe1) 11 Abr 20222022 • https://doi.org/10.1590/0103-11042022E125 copiar

Agentes Comunitárias de Saúde na pandemia de Covid-19: scoping review

Sobre os autores

RESUMO

Este artigo teve por objetivo sistematizar e analisar a literatura que aborda o trabalho das Agentes Comunitárias de Saúde (ACS) no enfrentamento da pandemia de Covid-19. Trata-se de uma revisão de escopo, realizada na Embase, Lilacs, SciELO, Medline e Cochrane Library. Envolve publicações no período de janeiro a dezembro de 2020, tendo os estudos selecionados sido submetidos à análise, considerando as seguintes categorias: práticas, formação, condições de trabalho e legitimidade. Foram incluídos 29 estudos na revisão cujo cenário de atuação das ACS foram países da África, América do Sul, América do Norte, Ásia e Europa. Os resultados revelaram enfoques diversificados de práticas nos países estudados que envolvem ações de cuidado, vigilância, comunicação e educação em saúde, práticas administrativas, articulação intersetorial e mobilização social. A formação recebida parece não corresponder ao rol de práticas e impacto esperado do trabalho das ACS. As condições de trabalho continuam precarizadas com alguns incentivos extras sendo ofertados em diferentes cenários. O reconhecimento e a legitimidade perante as autoridades sanitárias revelam a disputa em torno do próprio rumo dos modelos de atenção à saúde e abrangência dos sistemas de proteção social nos diversos países.

PALAVRAS-CHAVE
Agentes Comunitários de Saúde; Infecções por coronavírus; Saúde pública; Saúde global

Introdução

Segundo a Organização Internacional do Trabalho (OIT), as Agentes Comunitárias de Saúde (ACS) são profissionais que oferecem educação em saúde e encaminhamentos para uma ampla gama de serviços, fornecendo apoio e assistência a comunidades, famílias e indivíduos com medidas preventivas e de acesso a serviços sociais e de saúde adequados^{¹1 International Labour Office. International Standard Classification of Occupations 2008 (ISCO-08): structure, group definitions and correspondence tables. [Local desconhecido]: International Labour Office; 2012.}.

Muitas evidências demonstraram resultados positivos do trabalho que estas desenvolvem em países de baixa, média e alta renda, assim como as lacunas e barreiras que permanecem e precisam ser superadas quanto aos rumos dessas trabalhadoras nos diversos sistemas de saúde^{²2 Perry H. Health for the people: National community health worker programs from Afghanistan to Zimbabwe. Washington, DC: USAID; 2020.

3 Lu C, Palazuelos D, Luan Y, et al. Development assistance for community health workers in 114 low- and middle-income countries, 2007-2017. Bull World Health Organ. 2020 [acesso em 2021 fev 2]; 98(1):30-39. Disponível em: doi: 10.2471/BLT.19.235499.
https://doi.org/10.2471/BLT.19.235499... -⁴4 Najafizada SA, Bourgeault IL, Labonte R, et al. Community health workers in Canada and other high-income countries: A scoping review and research gaps. Can J Public Health. 2015 [acesso em 2021 fev 2]; 106(3):e157-64. Disponível em: https://pubmed.ncbi.nlm.nih.gov/26125243/
https://pubmed.ncbi.nlm.nih.gov/26125243... .}

No que diz respeito à atuação em resposta aos contextos de crises sanitárias, a literatura elucida que elas trazem contribuições eficientes e efetivas, a exemplo da atuação nas epidemias de HIV, dengue, zika e ebola^{⁵5 Silva NHLP, Cardoso CL. Agentes comunitários de saúde: sentidos acerca do trabalho em HIV/AIDS. Psicol. Soc. 2008 [acesso em 2021 fev 2]; 20(2):257-266. Disponível em: https://www.scielo.br/j/psoc/a/PtFfb38XDv7jnZThz3qgdDP/?lang=pt
https://www.scielo.br/j/psoc/a/PtFfb38XD... ,⁶6 Boyce MR, Katz R. Community Health Workers and Pandemic Preparedness: Current and Prospective Roles. Front Public Health. 2019 [acesso em 2021 fev 2]; 7:62. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443984/
https://www.ncbi.nlm.nih.gov/pmc/article...}.

O Regulamento Sanitário Internacional (2005), as Diretrizes para otimização de programas de ACS (2018) e a Estratégia Global para Influenza 2019-2030 (2019), publicados pela Organização Mundial da Saúde (OMS), são acúmulos e orientações aos países para melhor prevenir, proteger e controlar a propagação internacional de doenças, considerando a importância do envolvimento de ACS e das comunidades^{⁷7 World Health Organization. International health regulations (2005). [Local desconhecido]: World Health Organization; 2005.

8 World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. [Local desconhecido]: World Health Organization; 2018.-⁹9 World Health Organization. Global influenza strategy 2019-2030. [Local desconhecido]: World Health Organization; 2019.}.

Na pandemia de Covid-19, entendida como um evento crítico de saúde, faz-se fundamental colocar no centro da análise não apenas o corpo orgânico, mas também o sujeito humano, a sociedade, o ambiente e a cultura. Assim, desvela-se a importância de respostas que envolvem tanto fármacos e serviços hospitalares quanto medidas complexas, que têm a Atenção Primária à Saúde (APS) integrada à Vigilância Epidemiológica, lugar de destaque^{¹⁰10 Almeida Filho ND. Modelagem da pandemia Covid-19 como objeto complexo (notas samajianas). Estud. Av. 2020 [acesso em 2021 fev 2]; 34(99),97-118. Disponível em: https://www.scielo.br/j/ea/a/PYKMh83rMm77yFnjxCWzLMy/?lang=pt
https://www.scielo.br/j/ea/a/PYKMh83rMm7... ,¹¹11 Giovanella L, Vega R, Tejerina-Silva H, et al. ¿Es la atención primaria de salud integral parte de la respuesta a la pandemia de Covid-19 en Latinoamérica? Trab. Educ. Saúde. 2021 [acesso em 2021 fev 2]; 19:e00310142. Disponível em: https://www.scielo.br/j/tes/a/CJX9Rs5gSBJmsMrfwhkdJrL/
https://www.scielo.br/j/tes/a/CJX9Rs5gSB...}. Nessa perspectiva, as ACS estão em posição estratégica, promovendo reorientação de práticas para enfrentamento e mitigação dos efeitos da pandemia.

Este artigo tem como objetivo sistematizar e analisar a literatura que aborda o trabalho das ACS no enfrentamento da pandemia de Covid- 19, considerando recomendações, práticas, formação, condições de trabalho e legitimidade.

Material e métodos

Trata-se de um Scoping Review, conforme o método de revisão proposto pelo Joana Briggs Institute (JBI). Esse método permite mapear os principais conceitos, clarificar áreas de pesquisa e lacunas do conhecimento, além de sintetizar diferentes tipos de estudos sobre políticas para melhorar resultados de saúde^{¹²12 Joanna Briggs Institute. Methodology for JBI Scoping Reviews - Joanna Briggs 2015. Australia: JBI; c2015. [acesso em 2021 jul 11]. Disponível em: https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdf
https://nursing.lsuhsc.edu/JBI/docs/Revi...}.

Para a construção da pergunta de pesquisa, utilizou-se a estratégia Population, Concept e Context (PCC)^{¹²12 Joanna Briggs Institute. Methodology for JBI Scoping Reviews - Joanna Briggs 2015. Australia: JBI; c2015. [acesso em 2021 jul 11]. Disponível em: https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdf
https://nursing.lsuhsc.edu/JBI/docs/Revi...}, sendo: P - ACS; C - trabalho; e C - pandemia de Covid-19. Com base nessas definições, a questão norteadora desta revisão foi assim definida: como as ACS trabalharam no enfrentamento da pandemia de Covid-19, considerando recomendações, práticas, formação, condições de trabalho e legitimidade?

Foi realizada uma pesquisa eletrônica, entre 1º e 20 de fevereiro de 2021, nas Bibliotecas Virtuais Bireme, para acesso à Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs) e Scientific Electronic Library Online (SciELO); PubMed, para acesso aos estudos publicados na Medical Literature Analysis and Retrievel System Online (Medline); Cochrane Library/Cochrane Database of Systematic Reviews; e na base de dados Excerpta Medica Database (Embase).

Na estratégia de busca, foram utilizados os descritores e operadores booleanos^{¹³13 Santos CM, Pimenta CA, Nobre MR. A estratégia PICO para construção da pergunta de pesquisa e busca de evidências. Rev Lat Am Enfermagem. 2007 [acesso em 2021 fev 2]; 15(3):508-11. Disponível em: https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdfhttps://www.scielo.br/j/rlae/a/CfKNnz8mvSqVjZ37Z77pFsy/?lang=pt
https://nursing.lsuhsc.edu/JBI/docs/Revi...} “Agente Comunitário de Saúde” AND “Infecções por coronavírus”, cadastrados nos Descritores em Ciências da Saúde (DeCS) e Medical Subject Headings (MeSH). Foram identificados os termos relacionados com “Agente Comunitário de Saúde” na literatura^{⁴4 Najafizada SA, Bourgeault IL, Labonte R, et al. Community health workers in Canada and other high-income countries: A scoping review and research gaps. Can J Public Health. 2015 [acesso em 2021 fev 2]; 106(3):e157-64. Disponível em: https://pubmed.ncbi.nlm.nih.gov/26125243/
https://pubmed.ncbi.nlm.nih.gov/26125243... ,¹⁴14 Queiros AALD. A prática dos agentes comunitários de saúde na América Latina: origem, contradições e desafios para o cuidado em saúde no começo do século XXI. [tese]. São Paulo: Universidade de São Paulo; 2015. 143 p.

15 Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014 [acesso em 2021 fev 2]; 35:399-421. Disponível em: https://pubmed.ncbi.nlm.nih.gov/24387091/
https://pubmed.ncbi.nlm.nih.gov/24387091...

16 Mallari E, Lasco G, Sayman DJ, et al. Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines. BMC Health Serv Res. 2020 [acesso em 2021 fev 2]; 20(1):860. Disponível em: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05699-0
https://bmchealthservres.biomedcentral.c... -¹⁷17 Henderson S, Kendall E. ‘Community navigators’: making a difference by promoting health in culturally and linguistically diverse (CALD) communities in Logan, Queensland. Aust J Prim Health. 2011 [acesso em 2021 fev 2]; 17(4):347-54. Disponível em: https://www.publish.csiro.au/py/py11053
https://www.publish.csiro.au/py/py11053...} que também foram buscados a partir da utilização dos operadores booleanos AND e OR, um a um, conforme detalhado no exemplo abaixo.

Na Medline, por meio da PubMed, a busca ocorreu no dia 20 de fevereiro de 2020 seguindo a estratégia: “Community Health Workers” AND “Coronavirus Infections”; “Frontline health workers” AND “Coronavirus Infections”; “Lay Health Workers” AND “Coronavirus Infections”; “Close-to-community providers” AND “Coronavirus Infections”; “Anganwadi Worker” OR “Accredited Social Health Activist” OR “Auxiliary Nurse Midwife” AND “Coronavirus Infections”; “Gizi” OR “Kesehatan” OR “KB” AND “Coronavirus Infections”; “Community Health Agent” AND “Coronavirus Infections”; “Family Welfare Assistant” AND “Coronavirus Infections”; “Shasthya Shebika” AND “Coronavirus Infections”; “Health Assistant” AND “coronavirus infections”; “Community-Based Skilled Birth Attendant” AND “coronavirus infections”; “Community Health Care Provider” AND “Coronavirus Infections”; “Health Extension Worker” AND “coronavirus Infections”; “Health Development Army Teams” AND “Coronavirus Infections”; “Lady Health Worker” AND “Coronavirus Infections”; “Village Health Worker” AND “Coronavirus Infections”; “Village Health Teams” AND “Coronavirus Infections”; “Village Health Volunteer” AND “Coronavirus Infections”; “Home-Based Carer” AND “Coronavirus Infections”; “Lay Counselor” OR “Adherence Counselor” AND “Coronavirus Infections”; “Female Community Health Volunteer” AND “Coronavirus Infections”; “Maternal Child Health Worker” AND “Coronavirus Infections”; “Behvarz” AND “Coronavirus Infections”; “Brigadista” AND “Coronavirus Infections”; “Volunteer Midwives” OR “Volunteer Collaborators” AND “Coronavirus Infections”; “Health Promoters” AND “Coronavirus Infections”; “Community Health Volunteer” AND “Coronavirus Infections”; “Community Health Assistant” AND “Coronavirus Infections”; “Community Based Agent” AND “Coronavirus Infections”; “Health Surveillance Assistant” AND “Coronavirus Infections”; “Agentes Polivalentes Elementares” AND “Coronavirus Infections”; “Community health representatives” AND “Coronavirus Infections”; “Aboriginal health workers” AND “Coronavirus Infections”; “Community health aides” AND “Coronavirus Infections”; “Community navigators” AND “Coronavirus Infections”; “Health trainers” AND “Coronavirus Infections”; “Paraprofessional home visitors” AND “Coronavirus Infections”; “Community nutrition workers” AND “Coronavirus Infections”; “Barangay Health Workers” AND “Coronavirus Infections”.

Posteriormente, filtraram-se os estudos em línguas inglesa, espanhola e portuguesa, publicados entre 1º de janeiro de 2020 e 31 de dezembro de 2020.

As estratégias de busca foram efetuadas individualmente pelos revisores, tendo como critérios de inclusão: estudos com foco principal no trabalho das ACS na pandemia de Covid-19; estudos publicados no ano de 2020; estudos nos idiomas português, espanhol ou inglês. Já os critérios de exclusão: estudos que não citam objetivamente a atuação das ACS na pandemia; estudos que, embora mencionem as ACS, não trazem qualquer informação que responda à pergunta condutora e às categorias analíticas; estudos cujo descritor é sinônimo para ACS, mas o profissional objeto do estudo é outro ator.

A pesquisa foi realizada em três fases por dois avaliadores (L.M e R.C), sendo os desacordos de inclusão ou exclusão dos estudos resolvidos com discussão e busca de consenso. Caso os desacordos não fossem resolvidos, uma terceira revisora foi consultada (P.C). A primeira etapa de identificação dos estudos foi realizada por intermédio da busca nas bases de dados utilizando os descritores e operadores booleanos já mencionados, seguido de busca de estudos nas suas referências bibliográficas, para novas inclusões, com posterior eliminação dos duplicados. A segunda etapa consistiu na seleção dos estudos após avaliação dos títulos e resumos, chegando à definição dos estudos para leitura na íntegra. A terceira etapa envolveu análise dos textos completos e eleição dos que seriam incluídos na revisão, a partir dos critérios de inclusão e exclusão.

Após a formação do corpus desta revisão, todos os estudos incluídos foram sistematizados em um formulário padrão no Excel^®, estratificando-os em categorias predefinidas de forma indutiva^{¹⁸18 Galiazzi MC, Sousa RS. A dialética na categorização da análise textual discursiva: o movimento recursivo entre palavra e conceito. Rev. Pesquisa Qualit. 2019 [acesso em 2021 fev 2]; 7(13):1-22. Disponível em: https://editora.sepq.org.br/rpq/article/view/227
https://editora.sepq.org.br/rpq/article/...}, quais sejam: práticas, formação, condições de trabalho e legitimidade. Ao longo do processo de leitura e sistematização, foram sendo delimitadas subcategorias que são apresentadas nos quadros 2 to 3.

Resultados

O processo de busca e seleção dos estudos seguiu as recomendações da JBI e checklist adaptado do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma)^{¹²12 Joanna Briggs Institute. Methodology for JBI Scoping Reviews - Joanna Briggs 2015. Australia: JBI; c2015. [acesso em 2021 jul 11]. Disponível em: https://nursing.lsuhsc.edu/JBI/docs/ReviewersManuals/Scoping-.pdf
https://nursing.lsuhsc.edu/JBI/docs/Revi...}. Foram identificados 326 estudos, sendo 4 indexados na SciELO, 270 na Medline, 7 na Lilacs, 8 na Embase e 37 na Cochrane. Uma nova inclusão foi realizada a partir da triagem manual da lista de referências nos estudos eleitos (1), seguida de eliminação dos estudos duplicados (9). Foram selecionados 318 estudos para leitura de títulos e resumos, a partir da qual foram eliminados 238 estudos, ficando 35 estudos para leitura na íntegra. Foram eliminados 6 estudos por não atenderem aos critérios de inclusão, apresentando as devidas justificativas. Por fim, foram incluídos 29 estudos nesta revisão de escopo (figura 1).

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Figura 1
Fluxograma indicando o processo de seleção dos estudos adaptado do Prisma

O quadro 1 apresenta o resumo das informações dos 29 estudos incluídos, em que se verificou a seguinte distribuição quantos aos países/cenário de atuação das ACS: sete na África (África do Sul, Libéria, Nigéria e Zâmbia), quatro na América do Sul (Brasil e Peru), nove na América do Norte (Estados Unidos da América - EUA), quatro na Ásia (Índia, Filipinas e Vietnã), um na Europa (Inglaterra) e quatro sem cenário especificado.

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Quadro 1
Características gerais dos estudos incluídos na revisão sistemática da literatura

A revisão de escopo incluiu estudos de revisão de literatura (3), pesquisas qualitativas (13), estudos transversais (1), assim como artigos de opinião em revistas acadêmicas (12).

Práticas abrangentes e diversificadas na pandemia de Covid-19

Segundo a literatura aqui revisada, as ACS realizaram práticas diversificadas, variando de acordo com os cenários e perfis profissionais preexistentes (quadro 2). As práticas de cuidado na pandemia envolveram a continuidade ou o restabelecimento de programas de apoio à saúde sexual e reprodutiva, assim como aos cuidados materno-infantis^{¹⁹19 Akseer N, Kandru G, Keats EC, et al. Covid-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 [acesso em 2021 fev 2]; 12(2):251-256. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32559276/
https://pubmed.ncbi.nlm.nih.gov/32559276... ,²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10.... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...}.

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Quadro 2
Práticas desenvolvidas pelas ACS na pandemia de Covid-19, 2020

A gestão integrada de casos de doenças infecciosas como malária e tuberculose, assim como de condições crônicas preexistentes como hipertensão, diabetes, HIV, epilepsia e deficiências, foram registradas na literatura, sendo muitas destas consideradas fatores de risco para o agravamento da Covid-19^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... ,³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...}. Nesse sentido, a entrega de medicamentos em domicílio passou a ser uma prática das ACS em alguns países, minimizando o deslocamento desses grupos aos serviços e o risco de contrair o novo coronavírus^{²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,²⁷27 Brey Z, Mash R, Goliath C, et al. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32501022/
https://pubmed.ncbi.nlm.nih.gov/32501022... ,²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... ,³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...}.

O monitoramento e o apoio em saúde mental àqueles que sofrem de transtornos por abusos de substâncias, depressão, ansiedade e sofrimento em decorrência do luto envolveram ações como facilitação para renovação de prescrição, agendamento de consultas com prestadores de cuidados primários e de saúde mental, assim como visitas domiciliares, monitoramento telefônico e uso da cura tradicional, no caso das comunidades indígenas^{²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.

24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189
https://www.tandfonline.com/doi/full/10.... -²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729... ,⁴⁶41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...}.

As visitas domiciliares ou peridomiciliares, para acompanhamento de doentes, foram interpretadas como um dilema, com alguns países mantendo-as, outros reduzindo-as ou interrompendo-as, com substituição por tele monitoramento^{²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,³²32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance... ,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0...}.

Intervenções de apoio diagnóstico com aferição de temperatura, pressão arterial e oximetria foram sugeridas na Inglaterra^{²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30...}, que vem discutindo uma proposta de implantação de ACS no seu sistema de saúde. No Brasil, apesar de tais práticas serem previstas, só serão implantadas mediante treinamento, disponibilidade de Equipamentos de Proteção Individual (EPI) e de equipamentos^{²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.}.

No que diz respeito à introdução de vacinas e aos eventuais tratamentos que surjam para Covid-19, a literatura recomenda que as ACS contribuam na preparação dos sistemas de saúde e das comunidades^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...}.

As práticas de vigilância em saúde envolveram realização de rastreamento de contato, isolamento, quarentena e toques de recolher, a partir de mandatos tribais^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550...

21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...

22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... -²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... ,²⁹29 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499
https://phcfm.org/index.php/PHCFM/articl... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...

42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10.... -⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... ,⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf
https://www.jogh.org/documents/issue2020... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...}, assim como o monitoramento de pacientes e cuidadores quanto à deterioração clínica da Covid-19^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100...

23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.

24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189
https://www.tandfonline.com/doi/full/10.... -²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...}. Não foi relatado em nenhum estudo a realização de testes por parte das ACS.

A vigilância ambiental, utilizando abordagens de saúde única^{²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...}, foi recomendada, com relatos de rastreamento de icterícia, aconselhamento sobre água potável e distribuição de solução de cloro^{⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...}, além do apoio à desinfecção de superfícies em comunidades^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...} e atuação em barreiras sanitárias^{⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...}.

Vários estudos também mencionaram o papel das ACS na coleta de dados, visando compreender o impacto da pandemia^{²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... ,⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...}, o que sugere a importância, de magnitude local e nacional, dessas trabalhadoras para diagnósticos mais próximos da realidade.

Outro papel de grande destaque diz respeito às práticas de educação e comunicação em saúde sobre sinais, sintomas e rotas de transmissão do vírus^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10.... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... ,⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...}, agindo como ponte para acesso ao sistema formal de saúde e à telemedicina^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...}.

No âmbito da comunicação social, muitos estudos mencionaram a importância no combate à desinformação, às fake news, ao medo, estigma com pessoas adoecidas e desconfiança em relação ao sistema de saúde e às vacinas^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....

43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... -⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...}. Foram desenvolvidas estratégias, tanto em áreas urbanas como nas áreas rurais, incluindo impressão de folhetos educativos e disponibilização em locais de permanente circulação, grafia de instruções sobre lavagem das mãos nas paredes, postagens nas redes sociais, veiculação de informações em bicicleta ou carros de som, rádios e jornais comunitários^{²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...}.

Um papel diferenciado na dimensão comunicativa diz respeito à tradução linguística e cultural de protocolos da saúde e seu papel de intérprete para médicos em países com grande quantidade de imigrantes^{³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...} ou grande diversidade de dialetos^{³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529...}. Internamente aos serviços de APS, organizaram fluxos de atendimento de modo a evitar aglomerações^{²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.}.

Muitos estudos descreveram o papel de ações intersetoriais e mobilização social, tais como entrega de alimentos, material de limpeza, EPI e apoio social para acesso a renda, moradia e emprego^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100...

23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.

24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189
https://www.tandfonline.com/doi/full/10.... -²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10.... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...

44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre... -⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf
https://www.jogh.org/documents/issue2020...}.

Identificar e articular apoio em situações de violência doméstica também foi registrado nos estudos revisados, visto que, comumente, a ACS é o primeiro contato em casos de assédio no lar^{³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...}. Nos EUA, conectaram clientes com assistência jurídica, incluindo serviços de assessoria para regularizar a situação de imigração, além de explicarem requisitos complexos de elegibilidade para vários programas governamentais, ressaltando a advocacy como uma prática essencial das ACS^{³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20...}.

Qualificação profissional para novas necessidades sociossanitárias

Nove estudos recomendaram formação para qualificar a atuação das ACS na pandemia de Covid-19^{¹⁹19 Akseer N, Kandru G, Keats EC, et al. Covid-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 [acesso em 2021 fev 2]; 12(2):251-256. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32559276/
https://pubmed.ncbi.nlm.nih.gov/32559276...

20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550...

21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...

22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100...

23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.

24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189
https://www.tandfonline.com/doi/full/10.... -²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf
https://www.jogh.org/documents/issue2020... ,⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024...}, 16 mencionam experiências concretas de qualificação realizadas nos diversos países^{²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,²⁷27 Brey Z, Mash R, Goliath C, et al. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32501022/
https://pubmed.ncbi.nlm.nih.gov/32501022... ,³⁰30 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177...

31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529...

32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance...

33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.

34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0...

35 Mayfield-Johnson S, Smith DO, Crosby SA, et al. Insights on Covid-19 From Community Health Worker State Leaders. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):268-277. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858726/
https://pubmed.ncbi.nlm.nih.gov/32858726...

36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... -³⁷37 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/
https://pubmed.ncbi.nlm.nih.gov/33216679... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137...

41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...

42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....

43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236... -⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...}, enquanto 4 estudos não mencionaram qualquer tipo de formação ofertada^{²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... ,²⁹29 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499
https://phcfm.org/index.php/PHCFM/articl... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl...} (quadro 3).

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Quadro 3
Características da formação, condições de trabalho e legitimidade das ACS na pandemia de Covid-19, 2020

Um estudo sugere treinamento contínuo, compartilhamento de informações e atualizações, mediante meios diversos, considerando mudanças frequentes dos protocolos no decorrer da pandemia^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550...}. A formação em serviço envolveu profissionais da APS na Índia, no Brasil e no Peru^{³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...}, assim como treinadores locais e nacionais no Vietnã^{⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf
https://www.jogh.org/documents/issue2020...}. A oferta de cursos por instituições de ensino especializadas na área foi recomendada na Inglaterra^{²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30...} e realizada pela Universidade do Novo México nos EUA^{³⁷37 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/
https://pubmed.ncbi.nlm.nih.gov/33216679...}.

Grande parte dos estudos sugere o uso de ensino on-line^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30... ,³⁷37 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/
https://pubmed.ncbi.nlm.nih.gov/33216679... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} como alternativa, sendo mencionada a experiência indiana de uma nova Plataforma de Governo Integrada para treinamento on-line^{⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....}.

A literatura revisada apresenta objetivos e conteúdos a serem considerados, tais como aquisição de conhecimentos e habilidades para prevenir, detectar e controlar a infecção por coronavírus^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...}; uso da internet e aplicativos^{²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.}; avaliações de déficits cognitivos, físicos e emocionais de idosos pós-hospitalização por Covid-19^{²⁴24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189
https://www.tandfonline.com/doi/full/10....}; primeiros socorros e avaliação de emergências^{²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30...}; mitos e verdades em torno do teste e tratamento para Covid-19^{³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,³⁷37 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/
https://pubmed.ncbi.nlm.nih.gov/33216679...}; e uso adequado de EPI^{³⁷37 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/
https://pubmed.ncbi.nlm.nih.gov/33216679...}.

Uma questão importante a observar é a falta de padronização mínima quanto à formação prévia e geral dessas trabalhadoras. Na Filadélfia, EUA, exige-se diploma de ensino médio e personalidade empática, além de ofertarem um mês de treinamento em habilidades como entrevista motivacional^{⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137...}. Em Indiana, EUA, existe um curso de nove meses para se tornar uma ACS, seguida de certificação^{³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922...}. Na Nação Navajo, nos EUA, todos são auxiliares de enfermagem são certificados, sendo treinados como ACS no Departamento de Saúde do Novo México^{⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...}.

É importante ressaltar que a falta de treinamento foi apontada como uma barreira significativa para a prestação de serviços eficazes em outras epidemias^{²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...}, o que parece se repetir na pandemia atual. No Brasil, estima-se que apenas 9% das ACS tenham recebido formação após quatro meses da pandemia^{³²32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance...}, enquanto na Nigéria, uma avaliação dos conhecimentos e práticas relacionadas com a Covid-19 revelou defasagens que sugerem negligência na qualificação dessas profissionais^{³⁰30 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177...}.

Condições de trabalho na pandemia de Covid-19

Foram identificados cinco estudos (quadro 3) que mencionam a precarização das condições de trabalho das ACS no contexto da pandemia^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,³²32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance... ,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....}, incluindo insuficiência de EPI^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550... ,²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,³²32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance... ,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....}, baixos salários^{³²32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance...} ou mesmo atrasos no pagamento, preconceitos, alta carga de trabalho e falta de atenção psicossocial^{⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....}. Consequentemente, alerta-se para o fato de que muitas ACS podem não querer ou serem incapazes de assumir tarefas adicionais durante a pandemia^{⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/
https://pubmed.ncbi.nlm.nih.gov/32985024...}.

Na Índia e na África, as experiências revelaram uma infraestrutura carente e suprimentos básicos insuficientes para que as ACS atuassem de forma satisfatória na pandemia, prejudicando a segurança dessas profissionais e tornando-as vulneráveis ao contágio^{²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....}. Por outro lado, as experiências do Vietnã^{³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529...} e da Libéria^{⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...} revelam que suas ACS tiveram acesso a EPI adequados^{³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...} e treinamento para seu uso^{⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...}.

A forma de pagamento ao redor do mundo variou de bolsistas^{³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl...}, salários^{⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....}, pagamento por desempenho^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550
https://gh.bmj.com/content/5/6/e002550...}, a voluntariado^{¹⁹19 Akseer N, Kandru G, Keats EC, et al. Covid-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 [acesso em 2021 fev 2]; 12(2):251-256. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32559276/
https://pubmed.ncbi.nlm.nih.gov/32559276... ,²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...}. A literatura sugere que a remuneração deve ser implementada^{¹⁹19 Akseer N, Kandru G, Keats EC, et al. Covid-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 [acesso em 2021 fev 2]; 12(2):251-256. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32559276/
https://pubmed.ncbi.nlm.nih.gov/32559276... ,³⁵35 Mayfield-Johnson S, Smith DO, Crosby SA, et al. Insights on Covid-19 From Community Health Worker State Leaders. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):268-277. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858726/
https://pubmed.ncbi.nlm.nih.gov/32858726...} e que outros benefícios devem ser considerados, como fornecimento de subsídios à moradia, treinamentos^{²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769...}, transporte para áreas remotas^{²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,³⁰30 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177...}, sendo fundamental que as ACS, durante a pandemia, tenham flexibilidade para atender às suas necessidades pessoais e folga remunerada^{³⁵35 Mayfield-Johnson S, Smith DO, Crosby SA, et al. Insights on Covid-19 From Community Health Worker State Leaders. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):268-277. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858726/
https://pubmed.ncbi.nlm.nih.gov/32858726...}.

As más condições de trabalho das mulheres também foram descritas e analisadas como um problema preexistente e intensificado. Por tratar-se de uma categoria feminilizada, fica sujeita a um maior volume de trabalho doméstico na pandemia e às violências de gênero^{²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,³⁰30 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....}, como sequestros e estupros registrados em áreas rurais da Nigéria^{³⁰30 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177...} e outros preconceitos de gênero na Índia^{⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....}.

A institucionalização das ACS no mundo é variável e inespecífica segundo os resultados desta revisão, podendo estar vinculadas às Organizações Não Governamentais (ONG) na África do Sul^{²⁹29 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499
https://phcfm.org/index.php/PHCFM/articl...}, aos hospitais, clínicas, organizações comunitárias ou serviços de saúde indígena nos EUA^{³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...}, aos sistemas locais ou nacionais de saúde na África do Sul^{²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl...}, Brasil^{³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.}, Índia^{⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...} e Vietnã^{⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf
https://www.jogh.org/documents/issue2020...}.

O processo de trabalho pode ser multiprofissional em âmbito hospitalar^{³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20...} ou de APS^{³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...}. Podem acompanhar quantidades de famílias que variam de 40 na Zâmbia^{³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529...}, 60-100 na Índia^{⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/
https://pubmed.ncbi.nlm.nih.gov/32496236...}, a 250 domicílios na África do Sul^{²⁷27 Brey Z, Mash R, Goliath C, et al. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32501022/
https://pubmed.ncbi.nlm.nih.gov/32501022...}. A coordenação e/ou supervisão desses profissionais pode ser realizada por meio de lideranças tribais locais^{⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...}, enfermeiros^{²⁷27 Brey Z, Mash R, Goliath C, et al. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32501022/
https://pubmed.ncbi.nlm.nih.gov/32501022...

28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607
https://phcfm.org/index.php/PHCFM/articl... -²⁹29 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499
https://phcfm.org/index.php/PHCFM/articl... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...} ou assistentes sociais^{³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137...}.

Legitimidade ante as comunidades, equipes de saúde e autoridades nacionais e internacionais

A confiança na atuação e nas práticas das ACS nos territórios, nas comunidades e na sua interlocução com os sistemas nacionais, subnacionais e serviços de saúde foi a principal característica de legitimidade evidenciada nos estudos encontrados^{²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769
https://gh.bmj.com/content/5/6/e002769... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,³⁵35 Mayfield-Johnson S, Smith DO, Crosby SA, et al. Insights on Covid-19 From Community Health Worker State Leaders. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):268-277. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858726/
https://pubmed.ncbi.nlm.nih.gov/32858726... ,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641
https://www.nejm.org/doi/10.1056/NEJMp20... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10.... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...}. Isso torna a ACS uma trabalhadora importante na construção de estratégias de enfrentamento da Covid-19, sobretudo em regiões de vulnerabilização social^{²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11.
https://link.springer.com/article/10.100... ,²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/
https://pubmed.ncbi.nlm.nih.gov/32467431...} (quadro 3).

No entanto, identificam-se desafios na legitimidade das ACS em contextos de oposição política de autoridades nacionais às recomendações da OMS, como é o caso do presidente da república do Brasil^{³²32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext
https://www.thelancet.com/journals/lance...}. Além disso, há registros de assaltos às ACS na África do Sul, devido à crescente falta de renda e à insegurança alimentar da população^{²⁹29 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499
https://phcfm.org/index.php/PHCFM/articl...}.

A isso, somam-se os temores de que os profissionais de saúde estejam espalhando Covid-19^{²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext
https://www.thelancet.com/journals/lance... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....} e outros estigmas sociais como conhecimentos limitados das ACS na Zâmbia^{³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529...}. Na Índia, há registros de reconhecimento das autoridades de saúde, seja com felicitações públicas, seja com aprovação de legislação contra atos de violência aos profissionais de saúde e campanhas antiestigma^{⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413
https://www.tandfonline.com/doi/full/10....}.

Outro aspecto que interfere na legitimação das ACS diz respeito aos diferentes sistemas de crença na qual estão inseridas, incluindo cenários de atenção às populações indígenas, rurais e imigrantes^{³⁰30 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/
https://pubmed.ncbi.nlm.nih.gov/33209177... ,³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/
https://pubmed.ncbi.nlm.nih.gov/33110529... ,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197
https://bmjopen.bmj.com/content/10/12/e0... ,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/
https://pubmed.ncbi.nlm.nih.gov/32858729...}, o que sugere levar em conta uma identidade cultural prévia no momento da seleção e qualificação profissional para uma melhor aceitabilidade da comunidade. Em países de alta renda, com crescente imigração, como é o caso dos EUA, fica evidente a importância do domínio da língua e origem étnica das ACS, tendo sido relatados casos de maior confiança e vínculo com ACS que dominam o espanhol e reconhecem os problemas decorrentes da imigração pela população latina atendida^{³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223
https://www.mdpi.com/1660-4601/17/24/922... ,³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400
https://journals.plos.org/plosone/articl...}.

Em março de 2020, uma coalizão global de 16 organizações que trabalham com governos do Haiti, Mali e Nepal emitiu um documento de posição e oferecimento de recursos técnicos para orientar os governos que buscam envolver as ACS no combate à Covid-19^{⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/
https://blogs.bmj.com/bmj/2020/03/27/pre...}. Convergindo para o que parece ser um movimento global, senadores dos EUA propuseram a criação de uma Força Nacional de Saúde para recrutar, treinar e empregar centenas de milhares de ACS^{⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836
https://www.healthaffairs.org/doi/10.137...}, enquanto na Inglaterra, discute-se a viabilidade de implantar um programa cujo custo estimado seria de £ 2,2 bilhões por ano para 100 mil ACS^{²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2.
https://doi.org/10.1016/S0140-6736(20)30...}.

Discussão

Os estudos desta revisão apresentaram diferentes abordagens, práticas, características e desafios das ACS no contexto da pandemia de Covid-19. Porém, os resultados destacam a alta produção científica nos EUA, enquanto países de baixa e média renda, com grande tradição de programas de ACS^{¹⁵15 Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014 [acesso em 2021 fev 2]; 35:399-421. Disponível em: https://pubmed.ncbi.nlm.nih.gov/24387091/
https://pubmed.ncbi.nlm.nih.gov/24387091...}, publicaram pouco ou não publicaram, denotando uma desigualdade estrutural no desenvolvimento científico e educacional entre os países.

A pandemia reapresentou a importância das ACS na garantia de uma APS integral, de base comunitária, integrada à vigilância ativa e à proteção social abrangente, ao mesmo tempo que revelou a distância entre o ideal e o real. Isso se expressa na grande quantidade de atribuições, que deveriam ser executadas por equipes interprofissionais, nem sempre garantidas pelos sistemas de saúde, além das relações precárias de trabalho, o que revela que as ACS fazem parte de uma estratégia de APS seletiva^{⁴⁸48 Giovanella L, Mendonça MHM, Buss PM, et al. From Alma-Ata to Astana. Primary health care and universal health systems: an inseparable commitment and a fundamental human right. Cad. Saúde Pública. 2019 [acesso em 2021 fev 2]; 35(3):e00012219. Disponível em: https://www.scielo.br/j/csp/a/9rWTS9ZvcYxqdY8ZTJMmPMH/?lang=pt
https://www.scielo.br/j/csp/a/9rWTS9ZvcY...}.

Nesta revisão, chama atenção a pouca especificidade dos estudos no que diz respeito à realização de testes para Covid-19, aferição de temperatura e oximetria pelas ACS, reafirmando a centralidade de suas práticas no cuidado não biomédico, baseado na educação, promoção da saúde, articulação intra e intersetorial.

Apesar de alguns estudos mencionarem a coleta de dados como prática das ACS, estas não refletem sobre a capacidade profissional de processá-los e interpretá-los para conduzirem, com inteligência, o passo seguinte de vigilância ativa e participativa nas comunidades.

O deslocamento de ACS para atividades administrativas no interior dos serviços ou para barreiras sanitárias, fora do seu território de abrangência, precisa ser refletido criticamente na medida em que pressupõem diminuir a relação com a comunidade em tempos nos quais se espera maior contato e empatia, gerando confiança e legitimidade.

As práticas de educação e comunicação em saúde foram desafiadas a responder ao contexto de infodemia e fake news^{⁴⁹49 The Lancet Infectious Diseases. The Covid-19 infodemic. Lancet Infect Dis. 2020 [acesso em 2021 fev 2]; 20(8):875. Disponível em: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30565-X/fulltext
https://www.thelancet.com/journals/lanin...}, assim como às desigualdades de acesso às tecnologias da informação nos diversos países, singularizando as pandemias deste século e a necessidade de desenvolvimento de novas habilidades pelas ACS.

Poucos estudos desta revisão apresentaram o papel das ACS na facilitação de acesso às vacinas contra a Covid-19 ou de formações específicas para melhor atuarem diante dos movimentos antivacinas, o que se justifica pelo período do estudo que não abrangeu a fase de vacinação da população mundial, iniciada em dezembro de 2020 no Reino Unido. Da mesma forma, a abordagem às sequelas pós-covid e ao adoecimento mental também carecem de maiores investigações, especialmente sobre como podem ser realizadas pelas ACS.

É notória a quantidade de experiências de articulação intersetorial e mobilização comunitária desenvolvidas pelas ACS nos processos de enfrentamento dos determinantes do processo saúde-doença. Isso nos leva a refletir não somente sobre a solidariedade caritativa, mas também sobre a importância de pautar nos Estados nacionais e organismos internacionais políticas públicas de segurança alimentar e renda básica universal de curto, médio e longo prazo. Nesse quesito, ressaltamos as práticas de advocacy, assumida pelas ACS em alguns países, que podem ser mais bem investigadas como categoria analítica em outros estudos comparativos.

Diferentemente dos rumos de outras categorias da saúde, o trabalho das ACS, no geral, não caminhou no sentido da profissionalização, o que esbarra significativamente em baixa definição quanto aos currículos de sua formação geral^{⁸8 World Health Organization. WHO guideline on health policy and system support to optimize community health worker programmes. [Local desconhecido]: World Health Organization; 2018.}. Apesar da crise sanitária se colocar como uma oportunidade de maior abertura para tais investimentos, a literatura revisada trouxe poucos elementos quanto aos processos formativos oferecidos, carecendo de mais estudos para entender o caráter e o impacto das formações desenvolvidas nas respostas à pandemia.

Somadas a isso, a origem popular, a feminização, e as más condições de trabalho são marcas das ACS em muitos contextos, refletindo a realidade das comunidades onde estão inseridas por um lado e a divisão social e sexual do trabalho presente no setor saúde em muitos países por outro^{⁵⁰50 Shannon G, Minckas N, Tan D, et al. Feminisation of the health workforce and wage conditions of health professions: an exploratory analysis. Hum Resour Health. 2019 [acesso em 2021 fev 2]; 17(1):72. Disponível em: https://pubmed.ncbi.nlm.nih.gov/31623619/
https://pubmed.ncbi.nlm.nih.gov/31623619...}. Tal realidade aponta a importância de conjugar lutas políticas por melhores condições de vida nas comunidades, com lutas por melhores condições trabalhistas, em especial, nos contextos pandêmicos.

Considerações finais

Os achados desta revisão apresentam-se como um subsídio aos formuladores e implementadores de políticas de saúde, mas também aos trabalhadores que precisam de evidências para melhor fundamentarem suas agendas de negociação. Apresenta relevância também aos pesquisadores da área, por apontar lacunas que precisam ser mais bem exploradas em futuros projetos de pesquisa.

Como limite deste estudo, houve pouca contextualização histórica da institucionalização das ACS e o cenário da pandemia em cada país, tendo em vista a abrangência do escopo. Sugere-se a realização de estudos avaliativos quanto à eficácia e efetividade das ACS, que poderiam melhor subsidiar os tomadores de decisão para cenários de pandemia que tendem a ser frequentes.

Em última instância, ressaltamos que o futuro das ACS está inserido na disputa de rumos do próprio modelo de atenção à saúde em cada país e abrangência dos sistemas de proteção social, na medida em que a efetividade de suas ações dependem de retaguarda econômica, social e política, conquistadas com lutas amplas e gerais no seio da sociedade.

Suporte financeiro: não houve

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⁵⁰
Shannon G, Minckas N, Tan D, et al. Feminisation of the health workforce and wage conditions of health professions: an exploratory analysis. Hum Resour Health. 2019 [acesso em 2021 fev 2]; 17(1):72. Disponível em: https://pubmed.ncbi.nlm.nih.gov/31623619/
» https://pubmed.ncbi.nlm.nih.gov/31623619/

Datas de Publicação

Publicação nesta coleção
11 Abr 2022
Data do Fascículo
2022

Histórico

Recebido
15 Abr 2021
Aceito
25 Jan 2022

Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado.

Autores	País/Cenário	Tema	Tipo de Estudo
Recomendações
Akseer et al.^{¹⁹19 Akseer N, Kandru G, Keats EC, et al. Covid-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 [acesso em 2021 fev 2]; 12(2):251-256. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32559276/ https://pubmed.ncbi.nlm.nih.gov/32559276...}	Não Especificado	Saúde materno-infantil	Revisão de literatura
Ballard et al.^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550...}	Não Especificado	Roteiro de ação rápida de enfrentamento da pandemia de Covid-19	Artigo de opinião
Bhaumik et al.^{²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769 https://gh.bmj.com/content/5/6/e002769...}	Não Especificado	Principais problemas, barreiras e facilitadores na pandemia de Covid-19	Revisão de literatura
Corburn et al.^{²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11. https://link.springer.com/article/10.100...}	Não Especificado	Atuação em populações vulneráveis	Artigo de opinião
Maciel et al.^{²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.}	Brasil	Processo de trabalho das ACS	Revisão de literatura
Naylor; Hirschman; Mccauley^{²⁴24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189 https://www.tandfonline.com/doi/full/10....}	EUA	Saúde do idoso	Artigo de opinião
Haines et al.^{²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30...}	Inglaterra	Propor um programa de ACS	Artigo de opinião
Relatos de Experiências
Nepomnyashchiy et al.^{²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext https://www.thelancet.com/journals/lance...}	África	Importância das ACS em pandemias	Artigo de opinião
Brey et al.^{²⁷27 Brey Z, Mash R, Goliath C, et al. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32501022/ https://pubmed.ncbi.nlm.nih.gov/32501022...}	África do Sul	Entrega de medicação em domicílio	Pesquisa qualitativa
Mash; Goliath; Perez^{²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607 https://phcfm.org/index.php/PHCFM/articl...}	África do Sul	Reorganização de serviços de Atenção Primária à Saúde	Pesquisa qualitativa
David; Mash^{²⁹29 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499 https://phcfm.org/index.php/PHCFM/articl...}	África do Sul	Triagem e testagem comunitária	Pesquisa qualitativa
Omoronyia et al.^{³⁰30 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/ https://pubmed.ncbi.nlm.nih.gov/33209177...}	Nigéria	Avaliação de conhecimentos e práticas	Estudo transversal
Sham; Ciccone; Patel^{³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/ https://pubmed.ncbi.nlm.nih.gov/33110529...}	Zâmbia	Cuidados de paciente com epilepsia	Pesquisa qualitativa
Lotta et al.^{³²32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext https://www.thelancet.com/journals/lance...}	Brasil	Atuação geral das ACS	Artigo de opinião
Duarte et al.^{³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.}	Brasil	Atuação com enfermeiras	Pesquisa qualitativa
Reinders et al.^{³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197 https://bmjopen.bmj.com/content/10/12/e0...}	Peru	Saúde materno-infantil	Pesquisa qualitativa
Mayfield-Johnson et al.^{³⁵35 Mayfield-Johnson S, Smith DO, Crosby SA, et al. Insights on Covid-19 From Community Health Worker State Leaders. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):268-277. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858726/ https://pubmed.ncbi.nlm.nih.gov/32858726...}	EUA	Atuação geral das ACS	Pesquisa qualitativa
Logan; Castañeda^{³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922...}	EUA	Comparar atuação das ACS	Pesquisa Qualitativa
Katzman et al.^{³⁷37 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/ https://pubmed.ncbi.nlm.nih.gov/33216679...}	EUA	Educação permanente	Pesquisa Qualitativa
Peretz; Islam; Matiz^{³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641 https://www.nejm.org/doi/10.1056/NEJMp20...}	EUA	Determinantes de saúde	Pesquisa Qualitativa
Kerkhoff et al.^{³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400 https://journals.plos.org/plosone/articl...}	EUA	Modelo de testagem e cuidado na pandemia	Pesquisa Qualitativa
Waters^{⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836 https://www.healthaffairs.org/doi/10.137...}	EUA	Atuação geral das ACS	Artigo de opinião
Rosenthal; Menking; Begay^{⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/ https://pubmed.ncbi.nlm.nih.gov/32858729...}	EUA	Atuação em comunidade indígena	Pesquisa Qualitativa
Nanda et al.^{⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10....}	Índia	Oportunidades a partir da pandemia	Artigo de opinião
Chatterjee et al.^{⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236...}	Índia	Atuação geral das ACS	Pesquisa Qualitativa
Relatos de Experiências com Recomendações
Wiah et al.^{⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/ https://blogs.bmj.com/bmj/2020/03/27/pre...}	Libéria	Propor um programa de ACS	Artigo de opinião
Tran et al.^{⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf https://www.jogh.org/documents/issue2020...}	Vietnã	Atuação geral das ACS	Artigo de opinião
Palafox et al.^{⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/ https://pubmed.ncbi.nlm.nih.gov/32985024...}	Filipinas	Importância das ACS em países de baixa e média renda	Artigo de opinião
Goldfield et al.^{⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/ https://pubmed.ncbi.nlm.nih.gov/32467431...}	EUA	Oportunidades a partir da pandemia	Artigo de opinião

Práticas
Práticas de Cuidado	País/Cenário
1. Restabelecimento de programas de apoio à saúde materno-infantil à saúde sexual e reprodutiva⁹9 World Health Organization. Global influenza strategy 2019-2030. [Local desconhecido]: World Health Organization; 2019.,²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197 https://bmjopen.bmj.com/content/10/12/e0... ,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10.... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236...	Brasil (33), EUA (36), Índia (42, 43), Peru (34)
2. Gestão integrada de doenças transmissíveis e cuidados para condições crônicas²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11. https://link.springer.com/article/10.100... 23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.-²⁴24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189 https://www.tandfonline.com/doi/full/10.... ,²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607 https://phcfm.org/index.php/PHCFM/articl... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/ https://blogs.bmj.com/bmj/2020/03/27/pre...	África do Sul (28), Brasil (23, 33), EUA (24, 36), Índia (43), Libéria (44)
3. Entregar medicamentos em domicílio²⁷27 Brey Z, Mash R, Goliath C, et al. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32501022/ https://pubmed.ncbi.nlm.nih.gov/32501022... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607 https://phcfm.org/index.php/PHCFM/articl... ,³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/ https://pubmed.ncbi.nlm.nih.gov/33110529... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236...	África do Sul (27, 28), Brasil (23), Índia (43), Zâmbia (31)
4. Monitoramento e apoio em Saúde Mental e a membros da comunidade enlutados²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769 https://gh.bmj.com/content/5/6/e002769... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195. 24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189 https://www.tandfonline.com/doi/full/10.... -²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30... ,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836 https://www.healthaffairs.org/doi/10.137... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/ https://pubmed.ncbi.nlm.nih.gov/32858729... ,⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf https://www.jogh.org/documents/issue2020... ,⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/ https://pubmed.ncbi.nlm.nih.gov/32985024...	Brasil (23), EUA (24, 36, 40, 41), Filipinas (46), Inglaterra (25), Vietnã (45)
5. Realizar visitas domiciliares ou peridomiciliares para acompanhamento de doentes²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769 https://gh.bmj.com/content/5/6/e002769... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/ https://pubmed.ncbi.nlm.nih.gov/33110529... ,³²32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext https://www.thelancet.com/journals/lance... ,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197 https://bmjopen.bmj.com/content/10/12/e0... ,³⁵35 Mayfield-Johnson S, Smith DO, Crosby SA, et al. Insights on Covid-19 From Community Health Worker State Leaders. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):268-277. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858726/ https://pubmed.ncbi.nlm.nih.gov/32858726... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836 https://www.healthaffairs.org/doi/10.137...	EUA (40), Zâmbia (31), Peru (34), Brasil (19, 23)
6. Avaliação de temperatura, pressão arterial e oximetria²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30...	Brasil (23), Inglaterra (25)
7. Apoiar introdução de vacinas e tratamentos para Covid-19²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/ https://blogs.bmj.com/bmj/2020/03/27/pre...	Brasil (33), Libéria (44)
Práticas de Vigilância em Saúde	País/Cenário
8. Apoio à realização de testes, condução de rastreamento de contato, isolamento e quarentena²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... 21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769 https://gh.bmj.com/content/5/6/e002769... 22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11. https://link.springer.com/article/10.100... -²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30... ,²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext https://www.thelancet.com/journals/lance... ,²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607 https://phcfm.org/index.php/PHCFM/articl... ,²⁹29 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499 https://phcfm.org/index.php/PHCFM/articl... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/ https://pubmed.ncbi.nlm.nih.gov/32858729... 42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10.... -⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236... ,⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf https://www.jogh.org/documents/issue2020... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/ https://pubmed.ncbi.nlm.nih.gov/32467431...	África do Sul (28, 29), Brasil (23, 33), EUA (36, 41), Índia (42, 43), Inglaterra (25), Vietnã (45)
9. Monitorar pacientes e cuidadores quanto à deterioração clínica da Covid-19 e apoiar encaminhamentos²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11. https://link.springer.com/article/10.100... 23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195. 24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189 https://www.tandfonline.com/doi/full/10.... -²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641 https://www.nejm.org/doi/10.1056/NEJMp20... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836 https://www.healthaffairs.org/doi/10.137... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/ https://blogs.bmj.com/bmj/2020/03/27/pre...	Brasil (23, 33), EUA (24, 38, 40), Inglaterra (25), Libéria (44)
10. Vigilância ambiental com abordagens de saúde única e desinfecção de superfícies²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... 21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769 https://gh.bmj.com/content/5/6/e002769... -²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11. https://link.springer.com/article/10.100... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/ https://blogs.bmj.com/bmj/2020/03/27/pre...	Índia (43), Libéria (44)
11. Atuar em barreiras sanitárias e toques de recolher⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/ https://pubmed.ncbi.nlm.nih.gov/32858729...	EUA (41)
12. Coletar dados para compreender o impacto da pandemia²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769 https://gh.bmj.com/content/5/6/e002769... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236... ,⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/ https://pubmed.ncbi.nlm.nih.gov/32985024... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/ https://pubmed.ncbi.nlm.nih.gov/32467431...	Brasil (23), Filipinas (46), Índia (43), Inglaterra (25)
Práticas de Educação e Comunicação em Saúde	País/Cenário
13. Educar as comunidades e populações em risco sobre sinais, sintomas e rotas de transmissão²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11. https://link.springer.com/article/10.100... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607 https://phcfm.org/index.php/PHCFM/articl... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197 https://bmjopen.bmj.com/content/10/12/e0... ,³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400 https://journals.plos.org/plosone/articl... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10.... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236... ,⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/ https://pubmed.ncbi.nlm.nih.gov/32985024... ⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/ https://pubmed.ncbi.nlm.nih.gov/32467431...	África do Sul (28), Brasil (23, 33), EUA (39), Filipinas (46), Índia (42, 43), Peru (34)
14. Agir como ponte para acesso ao sistema formal de saúde e à telemedicina²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11. https://link.springer.com/article/10.100... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641 https://www.nejm.org/doi/10.1056/NEJMp20... ,⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/ https://pubmed.ncbi.nlm.nih.gov/32985024... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/ https://pubmed.ncbi.nlm.nih.gov/32467431...	Brasil (23, 33), EUA (36, 38, 47), Filipinas (46)
15. Organizar postos de higiene das mãos²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/ https://blogs.bmj.com/bmj/2020/03/27/pre...	Libéria (44)
16. Combater a desinformação, o medo e a desconfiança²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10.... 43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236... -⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/ https://blogs.bmj.com/bmj/2020/03/27/pre... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/ https://pubmed.ncbi.nlm.nih.gov/32467431...	Brasil (23, 33), EUA (36, 47), Índia (42, 43), Libéria (44)
17. Desenvolver estratégias de comunicação diversas²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236...	Brasil (23), EUA (36), Índia (43)
18. Atuar como tradutor linguístico e cultural³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/ https://pubmed.ncbi.nlm.nih.gov/33110529... ,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641 https://www.nejm.org/doi/10.1056/NEJMp20... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/ https://pubmed.ncbi.nlm.nih.gov/32858729... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/ https://pubmed.ncbi.nlm.nih.gov/32467431...	EUA (36, 38, 41, 47), Zâmbia (31)
Práticas Administrativas	País/Cenário
19. Organização do fluxo de atendimento nos serviços de APS²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.	Brasil (23)
Articulação Intersetorial e Mobilização Social	País/Cenário
20. Entrega de alimentos, material de limpeza e apoio social a pacientes que testaram positivo e suas famílias²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11. https://link.springer.com/article/10.100... 23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195. 24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189 https://www.tandfonline.com/doi/full/10.... -²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641 https://www.nejm.org/doi/10.1056/NEJMp20... ,³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400 https://journals.plos.org/plosone/articl... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/ https://pubmed.ncbi.nlm.nih.gov/32858729... 42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10.... 43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236... 44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/ https://blogs.bmj.com/bmj/2020/03/27/pre... -⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf https://www.jogh.org/documents/issue2020...	Brasil (23, 33), EUA (24, 36, 38, 39, 41), Índia (42, 43), Inglaterra (25), Libéria (44), Vietnã (45)
21.Identificar e articular apoio em situações de violência doméstica³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836 https://www.healthaffairs.org/doi/10.137... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236...	EUA (36, 40), Índia (43)
22. Facilitar acesso a assistência jurídica³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641 https://www.nejm.org/doi/10.1056/NEJMp20... ,⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf https://www.jogh.org/documents/issue2020...	EUA (36, 38), Vietnã (45)

Formação
Responsáveis pela Formação	País/Cenário
Profissionais dos serviços de Atenção Primária à Saúde, com treinadores locais e nacionais^{³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197 https://bmjopen.bmj.com/content/10/12/e0... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236... ,⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf https://www.jogh.org/documents/issue2020...}	Índia (43), Brasil (33), Peru (34), Vietnã (45)
Instituições de ensino especializadas na área^{²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30... ,³⁷37 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/ https://pubmed.ncbi.nlm.nih.gov/33216679...}	Inglaterra (25), EUA (37)
Modalidade de Ensino	País/Cenário
Modalidade de Ensino On-line^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30... ,³⁷37 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/ https://pubmed.ncbi.nlm.nih.gov/33216679... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10....}	Inglaterra (25), EUA (37), Índia (42)
Objetivos e Conteúdos	País/Cenário
Conhecimentos e habilidades para prevenir, detectar e controlar a infecção por coronavírus^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,²²22 Corburn J, Vlahov D, Mberu B, et al. Slum Health: Arresting Covid-19 and Improving Well-Being in Urban Informal Settlements. J Urban Health. 2020 [acesso em 2021 fev 2]; 97(3):348-357. Disponível em: https://link.springer.com/article/10.1007/s11524-020-00438-6 Erratum in: J Urban Health. 2021 Feb 11. https://link.springer.com/article/10.100... ,³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/ https://pubmed.ncbi.nlm.nih.gov/33110529... ,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197 https://bmjopen.bmj.com/content/10/12/e0... ,⁴⁶46 Palafox B, Renedo A, Lasco G, et al. Maintaining population health in low- and middle-income countries during the Covid-19 pandemic: Why we should be investing in Community Health Workers. Trop Med Int Health. 2021 [acesso em 2021 fev 2]; 26(1):20-22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32985024/ https://pubmed.ncbi.nlm.nih.gov/32985024...}	Peru (34), Zâmbia (31)
Uso de internet e aplicativos^{²³23 Maciel FBM, Santos HLPCD, Carneiro RADS, et al. Community health workers: reflections on the health work process in Covid-19 pandemic times. Ciênc. Saúde Colet. 2020 [acesso em 2021 fev 2]; 25(supl2):4185-4195.}	Brasil (23)
Avaliações e intervenções em déficits cognitivos, físicos e emocionais de idosos pós-hospitalização^{²⁴24 Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with Covid-19. J Aging Soc Policy. 2020 [acesso em 2021 fev 2]; 32(4-5):387-395. Disponível em: https://www.tandfonline.com/doi/full/10.1080/08959420.2020.1773189 https://www.tandfonline.com/doi/full/10....}	EUA (24)
Primeiros socorros ou avaliação de emergências médicas^{²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30...}	Inglaterra (25)
Mitos e verdades sobre testes e tratamento para Covid-19^{³⁷37 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/ https://pubmed.ncbi.nlm.nih.gov/33216679...}	EUA (37)
Uso adequado de EPIs^{³⁷37 Katzman JG, Tomedi LE, Thornton K, et al. Innovative Covid-19 Programs to Rapidly Serve New Mexico: Project ECHO. Public Health Rep. 2021 [acesso em 2021 fev 2]; 136(1):39-46. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33216679/ https://pubmed.ncbi.nlm.nih.gov/33216679...}	EUA (37)
Condições de Trabalho
Insuficiência de EPIs^{²⁰20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... ,²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext https://www.thelancet.com/journals/lance... ,³²32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext https://www.thelancet.com/journals/lance... ,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197 https://bmjopen.bmj.com/content/10/12/e0... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10....}	Brasil (32), Índia (42), África (26) e Peru (34)
Baixos salários, atrasos no pagamento, alta carga de trabalho e falta de atenção psicossocial^{³²32 Lotta G, Wenham C, Nunes J, Pimenta DN. Community health workers reveal COVID-19 disaster in Brazil. Lancet. 2020 [acesso em 2021 fev 2]; 396(10248):365-366. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31521-X/fulltext https://www.thelancet.com/journals/lance... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10....}	Brasil (32) e Índia (42)
Pagamento por meio de bolsas, salário, por desempenho ou voluntariado^{¹⁹19 Akseer N, Kandru G, Keats EC, et al. Covid-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 [acesso em 2021 fev 2]; 12(2):251-256. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32559276/ https://pubmed.ncbi.nlm.nih.gov/32559276... 20 Ballard M, Bancroft E, Nesbit J, et al. Prioritising the role of community health workers in the COVID-19 response. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002550. Disponível em: https://gh.bmj.com/content/5/6/e002550 https://gh.bmj.com/content/5/6/e002550... -²¹21 Bhaumik S, Moola S, Tyagi J, et al. Community health workers for pandemic response: a rapid evidence synthesis. BMJ Glob Health. 2020 [acesso em 2021 fev 2]; 5(6):e002769. Disponível em: https://gh.bmj.com/content/5/6/e002769 https://gh.bmj.com/content/5/6/e002769... ,³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400 https://journals.plos.org/plosone/articl... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10....}	EUA (39) e Índia (42)
Vínculos com ONGs, organizações comunitárias, hospitais, clínicas, sistemas locais e nacionais de saúde^{²⁸28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607 https://phcfm.org/index.php/PHCFM/articl... ,²⁹29 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499 https://phcfm.org/index.php/PHCFM/articl... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641 https://www.nejm.org/doi/10.1056/NEJMp20... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836 https://www.healthaffairs.org/doi/10.137... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/ https://pubmed.ncbi.nlm.nih.gov/32858729... ,⁴³43 Chatterjee PK. Community preparedness for Covid-19 and frontline health workers in Chhattisgarh. Indian J Public Health. 2020 [acesso em 2021 fev 2]; 64:S102-S104. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32496236/ https://pubmed.ncbi.nlm.nih.gov/32496236... ,⁴⁵45 Tran BX, Phan HT, Nguyen TPT, et al. Reaching further by Village Health Collaborators: The informal health taskforce of Vietnam for Covid-19 responses. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(1):010354. Disponível em: https://www.jogh.org/documents/issue202001/jogh-10-010354.pdf https://www.jogh.org/documents/issue2020...}	África do Sul (29, 28), Brasil (33), EUA (36, 38, 40, 41), Índia (43) e Vietnã (45)
Processo de trabalho multiprofissional em hospital ou na Atenção Primária à Saúde^{³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁸38 Peretz PJ, Islam N, Matiz LA. Community Health Workers and Covid-19 - Addressing Social Determinants of Health in Times of Crisis and Beyond. N Engl J Med. 2020 [acesso em 2021 fev 2]; 383(19):e108. Disponível em: https://www.nejm.org/doi/10.1056/NEJMp2022641 https://www.nejm.org/doi/10.1056/NEJMp20... ,⁴⁷47 Goldfield NI, Crittenden R, Fox D, et al. Covid-19 Crisis Creates Opportunities for Community-Centered Population Health: Community Health Workers at the Center. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(3):184-190. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32467431/ https://pubmed.ncbi.nlm.nih.gov/32467431...}	Brasil (33), EUA (38, 47)
Coordenação e/ou supervisão por enfermeiros, médicos, assistentes sociais, farmacêutico ou lideranças tribais^{²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30... ,²⁷27 Brey Z, Mash R, Goliath C, et al. Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32501022/ https://pubmed.ncbi.nlm.nih.gov/32501022... 28 Mash R, Goliath C, Perez G. Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e4. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2607 https://phcfm.org/index.php/PHCFM/articl... -²⁹29 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499 https://phcfm.org/index.php/PHCFM/articl... ,³³33 Duarte RB, Medeiros LMF, Araújo MJADM, et al. Agentes Comunitários de Saúde frente à Covid-19: Vivências junto aos profissionais de enfermagem. Enferm. foco. 2020 [acesso em 2021 fev 2]; 11(1): 252-256.,³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400 https://journals.plos.org/plosone/articl... 40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836 https://www.healthaffairs.org/doi/10.137... -⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/ https://pubmed.ncbi.nlm.nih.gov/32858729... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/ https://blogs.bmj.com/bmj/2020/03/27/pre...}	África do Sul (27, 28, 29), Brasil (33), EUA (39, 40, 41), Inglaterra (25), Libéria (44)
Legitimidade
Indicador de Baixa Legitimidade	País/Cenário
Assaltos, sequestros, estupros, preconceitos de gênero e da baixa formação profissional^{²⁹29 David N, Mash R. Community-based screening and testing for Coronavirus in Cape Town, South Africa: Short report. Afr J Prim Health Care Fam Med. 2020 [acesso em 2021 fev 2]; 12(1):e1-e3. Disponível em: https://phcfm.org/index.php/PHCFM/article/view/2499 https://phcfm.org/index.php/PHCFM/articl... 30 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/ https://pubmed.ncbi.nlm.nih.gov/33209177... -³¹31 Sham L, Ciccone O, Patel AA. The Covid-19 pandemic and Community Health Workers: An opportunity to maintain delivery of care and education for families of children with epilepsy in Zambia. J Glob Health. 2020 [acesso em 2021 fev 2]; 10(2):020329. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33110529/ https://pubmed.ncbi.nlm.nih.gov/33110529... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10....}	África do Sul (29), Índia (42), Nigéria (30), Zâmbia (31)
Temores que os profissionais estejam espalhando a Covid-19^{²⁶26 Nepomnyashchiy L, Dahn B, Saykpah R, et al. Covid-19: Africa needs unprecedented attention to strengthen community health systems. Lancet. 2020 [acesso em 2021 fev 2]; 396(10245):150-152. Disponível em: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31532-4/fulltext https://www.thelancet.com/journals/lance... ,⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10....}	Índia (42), África (26)
Indicador de Ganho de Legitimidade	País/Cenário
Recomendações de fortalecimento ou implantação de programas nacionais de ACS^{¹⁹19 Akseer N, Kandru G, Keats EC, et al. Covid-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 [acesso em 2021 fev 2]; 12(2):251-256. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32559276/ https://pubmed.ncbi.nlm.nih.gov/32559276... ,²⁵25 Haines A, Barros EF, Berlin A, et al. National UK programme of community health workers for Covid-19 response. Lancet. 2020 [acesso em 2021 fev 2]; 395(10231):1173-1175. Disponível em: 10.1016/S0140-6736(20)30735-2. https://doi.org/10.1016/S0140-6736(20)30... ,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,⁴⁰40 Waters R. Community Workers Lend Human Connection to Covid-19 Response. Health Aff (Millwood). 2020 [acesso em 2021 fev 2]; 39(7):1112-1117. Disponível em: https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00836 https://www.healthaffairs.org/doi/10.137... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/ https://blogs.bmj.com/bmj/2020/03/27/pre...}	EUA (36, 40), Inglaterra (25)
Felicitações públicas, legislação contra violência aos profissionais de saúde e campanhas antiestigma por autoridades^{⁴²42 Nanda P, Lewis TN, Das P, et al. From the frontlines to centre stage: resilience of frontline health workers in the context of Covid-19. Sex Reprod Health Matters. 2020 [acesso em 2021 fev 2]; 28(1):1837413. Disponível em: https://www.tandfonline.com/doi/full/10.1080/26410397.2020.1837413 https://www.tandfonline.com/doi/full/10....}	Índia (42)
Reconhecimento dos diferentes sistemas de crenças das populações atendidas pelas ACS^{³⁰30 Omoronyia O, Ekpenyong N, Ukweh I, et al. Knowledge and practice of Covid-19 prevention among community health workers in rural Cross River State, Nigeria: implications for disease control in Africa. Pan Afr Med J. 2020 [acesso em 2021 fev 2]; 37:50. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33209177/ https://pubmed.ncbi.nlm.nih.gov/33209177... ,³⁴34 Reinders S, Alva A, Huicho L, et al. Indigenous communities’ responses to the COVID-19 pandemic and consequences for maternal and neonatal health in remote Peruvian Amazon: a qualitative study based on routine programme supervision. BMJ Open. 2020 [acesso em 2021 fev 2]; 10(12):e044197. Disponível em: https://bmjopen.bmj.com/content/10/12/e044197 https://bmjopen.bmj.com/content/10/12/e0... ,³⁶36 Logan RI, Castañeda H. Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud. Int J Environ Res Public Health. 2020 [acesso em 2021 fev 2]; 17(24):9223. Disponível em: https://www.mdpi.com/1660-4601/17/24/9223 https://www.mdpi.com/1660-4601/17/24/922... ,³⁹39 Kerkhoff AD, Sachdev D, Mizany S, et al. Evaluation of a novel community-based Covid-19 ‘Test-to-Care’ model for low-income populations. PLoS One. 2020 [acesso em 2021 fev 2]; 15(10):e0239400. Disponível em: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239400 https://journals.plos.org/plosone/articl... ,⁴¹41 Rosenthal EL, Menking P, Begay MG. Fighting the Covid-19 Merciless Monster: Lives on the Line-Community Health Representatives’ Roles in the Pandemic Battle on the Navajo Nation. J Ambul Care Manage. 2020 [acesso em 2021 fev 2]; 43(4):301-305. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32858729/ https://pubmed.ncbi.nlm.nih.gov/32858729... ,⁴⁴44 Wiah SO, Subah M, Varpilah B, et al. Prevent, detect, respond: how community health workers can help in the fight against covid-19. BMJ. 2020. [acesso em 2021 fev 2]. Disponível em: https://blogs.bmj.com/bmj/2020/03/27/prevent-detect-respond-how-community-health-workers-can-help-fight-covid-19/ https://blogs.bmj.com/bmj/2020/03/27/pre...}	EUA (36, 39, 41), Nigéria (30), Peru (34), Libéria (44)

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