Abstract:
Community health workers (CHWs) are framed as the link betwee
communities and the formal health system. CHWs must establish
trusting relationships with the community and with the broader health
service. How to find the optimal balance between the various strands of
work for CHWs, and how to formalise this, has been the focus of
different studies. We performed an extensive documentary analysis of
federal legislation in Brazil to understand the institutionalisation of the
CHW workforce in Brazil over the last 3 decades. The paper offers three
contributions to the literature: the development and application of an
analytical framework to consider the institutionalisation process of
CHWs; a historical analysis of the professional institutionalisation of
CHW in Brazil; and the identification of the paradoxes that such
institutionalisation faces: firstly, institutionalisation focused on
improving CHW remuneration created difficulties in hiring and paying
these professionals; when CHW are incorporated within state
bureaucracy they start to lose their autonomy as community agents;
and that the effectiveness of CHW programmes depend
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