"O ACS é o para-raios": a saúde mental dos agentes comunitários no contexto de reorganização da Atenção Primária à Saúde no Rio de Janeiro

Abstract

The city of Rio de Janeiro underwent a process of reorganization of Primary Health Care (PHC) between 2018 and 2020, where Family Health teams and Oral Health teams were suppressed. The changes disfigure the model of the Family Health Strategy (ESF) and remove from this care model its role as a privileged strategy to strengthen PHC. Community Health Agents (CHA) are one of the categories most affected by the reorganization, since there was a large reduction in the number of professionals and, with the flexibility of population coverage parameters, their work process was extremely affected and precarious. The literature points out that there is an important component of emotional distress in these subjects, who also require care in this area. Structural violence and the social suffering to which they are subjected make these professionals a more vulnerable group to emotional suffering. Due to the scenario of uncertainties they faced, it is believed that the PHC reorganization process had an impact on the mental health of Community Agents. Thus, the aim of the present study is to investigate how the context of PHC reorganization in the city of Rio de Janeiro affected the mental health of these professionals. Therefore, individual interviews were carried out with 9 ACS working in a family clinic located in the north of Rio de Janeiro. In general, the professionals interviewed showed suffering with the uncertainties experienced in the period in question and with the precarious working conditions that followed it. The precarious situation that the PHC had been facing was aggravated by the COVID-19 pandemic, with an increase in the overload of professionals. The way these professionals expressed suffering in the interviews can be related to the concept of suffering idioms. It is possible to establish relationships between the suffering experienced by community agents and the PHC reorganization process, since this process left them in a situation of greater vulnerability. However, it is not possible to place this phenomenon in a diagnostic category, as the suffering of these professionals points to social and economic issues. To do so would pathologize their lived experience and disregard the social suffering and structural violence to which they are subjected.