Violence and vulnerability of the Community Health Worker in the territory: implications for tackling COVID-19

The scope of the study was to investigate the relationship between COVID-19 and social vulnerability variables in Fortaleza, as well as to verify the influence of violence on the work of the Community Health Worker (ACS) and the implications for tackling COVID-19. Primary quantitative data (e.g., questionnaires with the ACS) and secondary data (e.g., HDI, homicide, illiteracy, Bolsa Família [PBF] coverage and Family Health Strategy [ESF] coverage) were used. There was a relationship between COVID-19 and indicators of social vulnerability, where cases had a negative relationship with HDI and illiteracy; and deaths had a positive relationship with the homicide rate and PBF coverage. Regions with high death rates due to COVID-19 and social vulnerability have greater FHS coverage and less home visits by the CHA. The latter's role in tackling COVID-19 is limited by the violence in the territory. The thorough performance of the ACS in confronting this pandemic is dependent on intersectoral policies. Thus, the creation of a policy to tackle COVID-19 with the participation of the ACS needs to consider intersectoral actions for curtailing and preventing violence in the territory, in addition to adequate training in the prevention and detection of COVID-19.