Community health workers perspective on the COVID-19 impact on primary health care in Northeastern Brazil

This article evaluates the COVID-19 pandemic impacts on the Family Health Strategy (FHS) team's work routines across a range of northeast Brazilian cit-ies as perceived by community health workers (CHW). Data on COVID-19, CHW activities, and FHS teams were collected in 2021 by a structured ques-tionnaire. A total of 1,935 CHWs from four state capitals (Fortaleza - Ceara State, Joao Pessoa - Paraiba State, Recife - Pernambuco State, Teresina - Piaui State) and four hinterland cities (Crato, Juazeiro do Norte, Barbalha, Sobral - Ceara State) participated in the study. Most CHWs were women (82.42%), with mean age 46.25 & PLUSMN;8.54 years. Many (39.92%) were infected with COVID-19, of which 70.78% believed they were infected in the workplace. A total of 77.82% defined their role as frontline in the fight against COVID-19, 16.07% reported receiving training for COVID-19, and 13.74% had access to sufficient protective equipment. Most (90.27%) believed their work routines were modified by the pandemic, either strengthening (41.46 %) or weaken-ing (44.41%) the team spirit. Home visits (60.55%), health promotion actions in schools (75.66%) and in specific community groups (93.96%), and other on-site community services (66.01%) showed a reduction in frequency. The sampled cities revealed a significant heterogeneity regarding responses to the COVID-19 pandemic, possibly associated with a lack of coordination by the Federal Government. Regardless of context, the pandemic led to a reconfigu-ration of local health systems, workflows, and primary care protocols for FHS teams. The importance of the Brazilian Unified National Health System (SUS) and its potential for reorganization during crisis should be acknowl-edged while preserving the headway made thus far.