Brazil has the largest government-run public healthcare system in the world: Sistema Único de Saúde (SUS). Free for everyone, SUS serves over 150 million people across the country. The real bedrock of SUS is a network of more than 265,000 community health workers (CHWs), the majority of whom are women of color. These individuals provide a vital connection between the communities they serve and the wider health system, offering advice and health support on everything from family planning to stemming the spread of disease.
Unlike many other countries, community healthcare is a verified profession in Brazil, with CHWs employed either by the government or by private organizations. The formal introduction of CHWs into health systems has led to notable improvements in health outcomes, including a reduction of malnutrition, reduction in the infant mortality rate, improvements in women’s health, and HIV, malaria and tuberculosis control. Despite these clear benefits, CHWs in Brazil are still being neglected. For example, data from July 2020 showed that only an estimated 9% received infection control training and personal protective equipment (PPE) to support them in tackling the COVID-19 pandemic.
The Johnson & Johnson Center for Health Worker Innovation (the Center) has been working with partners across Latin America to build resilience, skills and capacity of frontline health workers, especially nurses, midwives and CHWs. As part of this work, the Center came together with cultural producer CEC Brazil to create the book, Caminhos de Saúde (Paths of Health), with funding from Johnson & Johnson through Brazil’s cultural tax benefits.
Caminhos de Saúde shares the stories of 30 CHWs across Brazil, highlighting their daily routines, challenges and successes, and their contributions to the wider health system.
Enlisting CONACS to seek out stories of community health workers
“We knew that we wanted to find and share a wide variety of stories, representing the full spectrum of what it means to be a community health worker within Brazil,” says Ewerton Nunes, Global Community Impact Manager Brazil, Johnson & Johnson. “To find these stories, we needed to work with a partner that had a strong connection to the Brazilian community health worker network. We found it in CONACS.”
CONACS, the professional body representing hundreds of thousands of CHWs across the country, reached out to its network via WhatsApp, sourcing impressive stories of bravery and generosity, of CHWs working in communities stretching from the isolated city of Jordão, to the rural area of Tocantins, to the heavily-populated suburbs of São Paulo.
One of the women featured, 60-year-old Márcia Aparecida de Araújo Castro, has been working as a community health agent for 23 years in the Jardim Florena neighborhood, in the city of Jaraguá, in Goiás. When she started out, there was no electricity in her community, sewage was running in the open and the housing wasn’t fit for purpose. The residents suffered from diseases such as leprosy, leishmaniasis and worms, and were reluctant to trust Márcia and her colleagues at first. “We didn’t have much to offer. How could we talk about disease prevention if people didn’t even have enough to eat?,” she remembers. “Then I realized that in order to be able to help them I would need additional help as well.”
Márcia started bringing information about the neighborhood to the city hall and pushing for masonry houses and improvements. She also pursued partnerships with other bodies and institutions to provide social programs for residents. Today the neighborhood is like another place entirely, with basic sanitation and real houses—a fact which Márcia is rightly proud of. As well as her healthcare work, Marcia has participated in adult literacy programs and has arranged for food and clothing donations to be distributed to underserved areas. “There are those who say: ‘Oh, but that’s not the role of a community health worker!‘ I disagree. Our job is to guide on disease prevention. If you arrive at a home and the person is already sick and does not have the money to buy medicines, I have to find other ways to help,” she argues.
The book is full of similar—and yet clearly individual—stories, from Maria das Dores Martins Silva, who lives and works in the rural village of Sumaúma, 18 kilometers from the municipality of São Domingos do Maranhão, and who worked hard to overcome misinformation about COVID-19 in her community, to Eudes Ferreira de Oliveira, who looks after Amazonic communities in one of the most isolated towns in Brazil, only reachable by boat or small aircrafts. Eudes travels from household to household via a motorized canoe and has helped to eradicate malaria in the area, as well as contributing to lower child mortality levels. “For ten years already, no baby has died here,” he celebrates.
Promoting Caminhos de Saúde
Upon seeing the book, Ilda Angélica, President of CONACS, commented: “We feel invisible. It’s like our history is disappearing. This book will help our sector’s self-esteem. It will certainly make us very proud.”
Most of the print copies of the book will be donated to schools, hospitals and other relevant government organizations, alongside workshops, to spread awareness and recognition of the vital role CHWs play. A limited number of copies will be available for purchase, although the book is available to download in digital form for free, as well as audio versions of the stories for those with accessibility needs. As a companion project to the book, the Center also collaborated with CONACS and CEC Brazil to launch the documentary, ESSENCIAL Equipes de Saúde (Health Teams), which follows Brazilian public health teams as they carry out their daily work routines.
CONACS continues to be a valued Latin American partner for the Center. They were instrumental in the HUB COVID project that was supported by Johnson & Johnson Foundation in 2021 to ensure accurate information around COVID-19 could be found and alleviate the burden on frontline health workers.
Most important, CONACS helps the Center hear directly from community health leaders, to better understand their needs and challenges in the field. These conversations led to the current collaboration with CONACS on the Johnson & Johnson Foundation supported Casa Training Project with the National Council of Municipal Secretariats in Brazil. This initiative seeks to provide healthcare professionals—especially CHWs in the public health system—a national platform for information sharing, quality training materials, and networking.