» Health Professionals
Luciana L.A. Ribeiro Garzoni
Patricia Canto Ribeiro
Marco Antonio Menezes
Environment, Health Care and Promotion Vice-Presidency – Fiocruz
In Brazil, the first initiatives involving community health agents were developed and validated in the 1970s in Planaltina, a rural municipality close to Brasília, with the so-called health assistants. The experience was expanded to the state of Ceará in the 1980s, resulting in a significant reduction in the infant mortality rate based on improved access for pregnant women and children to hospital care, as well as monitoring of child development. From a strategy of municipalization of health teams involving health agents, nurses and later doctors, the Family Health Program was originated, which in the 90’s was expanded by the Ministry of Health to the whole country. Currently, however, there is a need to update the teams with professionals specialized in family health, being essential to approach universities and continuing education actions for existing teams.
With the change in the epidemiological profile, it is understood that the updating of professionals in the Family Health Strategy should be focused mainly on diseases of the modern world, such as chronic non-infectious diseases, including, for example, cardiovascular diseases, diabetes, cancer and other problems such as alcohol , drugs and violence. However, neglected diseases, including Chagas disease and other infectious and parasitic diseases that mainly affect the most vulnerable populations, continue to be a serious problem, and their eradication is one of the goals of the sustainable development goals of the UN 2030 agenda, of which Brazil is a signatory. The recent return of Brazil to the hunger map points to the need for increased attention to the problems associated with neglected populations.
Brazil, which in 2006 received the certificate of control of the main vector of Chagas disease, Triatoma infestans, from the Pan American Health Organization, has approximately 3 million people infected with Trypanosoma cruzi. Cases of chronic infection are not compulsory notification in the country and because it is a silent disease, many patients are diagnosed only when cardiac and/or digestive alterations are already quite advanced, and even then, only when the health professional suspects Chagas disease. In addition to chronic cases that are invisible in the country, we also have cases of oral vector infection in the Legal Amazon region and also through classic vector infection due to the high rates of domiciliation of other vector species such as Triatoma brasiliensis in states of the Northeast region such as Piauí. As a result, specific and widespread actions have been carried out for the continued training of professionals in the Family Health Strategy of the Unified Health System, including physicians, nurses, community health agents and endemic agents, as well as, with the population, aiming at improving the access of people infected with T. cruzi to diagnosis, treatment and vector control. In this context, the Family Health Strategy plays a fundamental role in the prevention and control of Chagas disease, since the teams are present in the most remote regions of the country and in urban areas, where most of the infected people from endemic areas in the decades past, currently reside. However, integrated, intersectoral and large-scale actions need to be induced to ensure that health professionals, including endemic agents, community health agents, nurses and doctors, can act, thus guaranteeing vector control and access of infected people to diagnosis. and the treatment of Chagas disease.