Effects of Urban Violence on Primary Healthcare: The Challenges of Community Health Workers in Performing House Calls in Dangerous Areas

  • Hugo Cesar Bellas
  • Alessandro JatobáEmail author
  • Bárbara Bulhões
  • Isabella Koster
  • Rodrigo Arcuri
  • Catherine Burns
  • Kelly Grindrod
  • Paulo Victor R. de Carvalho
Original Paper


Community health workers in developing countries usually perform house calls in degraded and violent territories. Thus, in this paper we study the effects of urban violence in the performance of CHWs in poorly developed territories, in order to understand the challenges of delivering care to dangerous communities in developing countries. We conducted telephone surveys for 5 months in 2017, within a systematic sample of 2.000 CHWs based on clinics distributed along the health regions of the city of Rio de Janeiro, Brazil. We completed 766 interviews, approximately 40% of the sample, 86% man and 14% women. Most participants are 30 to 39 years old (35%), followed by 27% of 40 to 49 years old participants. As CHWs work on the sharp end of the healthcare system, responsible for outreaching, community education, counseling, and social support, our study presents contributions to government and management levels on working conditions inside communities, constraints in assistance, and difficulties in implementing primary care policies.


Community health workers Primary health care House calls Exposure to violence 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Research Involving Human Participants/Informed Consent

Regarding scientific research involving human beings, this study was conducted in accordance with the ethical principles of the Resolution No. 466/2012 of the Brazilian National Council of Health Care/Brazilian Ministry of Health and approved by ethics committees. Therefore, all participants had to express their agreement with to informed consent terms read by the telephone interviewer. In addition, participants had the option of receiving a copy of the informed consent terms by email. Moreover, participants’ confidentiality was ensured as their responses were not identified.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Hugo Cesar Bellas
    • 1
  • Alessandro Jatobá
    • 1
    Email author
  • Bárbara Bulhões
    • 2
  • Isabella Koster
    • 3
  • Rodrigo Arcuri
    • 4
  • Catherine Burns
    • 5
  • Kelly Grindrod
    • 5
  • Paulo Victor R. de Carvalho
    • 6
  1. 1.Centro de Estudos Estratégicos, Fundação Oswaldo Cruz – FIOCRUZRio de JaneiroBrazil
  2. 2.Instituto de Medicina SocialUniversidade do Estado do Rio de Janeiro - UERJRio de JaneiroBrazil
  3. 3.Escola Nacional de Saúde Pública Sergio Arouca - ENSP, Fundação Oswaldo Cruz - FIOCRUZRio de JaneiroBrazil
  4. 4.Universidade Federal do Rio de JaneiroRio de JaneiroBrazil
  5. 5.University of WaterlooWaterlooCanada
  6. 6.Instituto de Engenharia Nuclear - IEN, Comissão Nacional de Energia Nuclear, CNENRio de JaneiroBrazil

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