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ARTICLE • Ciênc. saúde coletiva 28 (10) • Oct 2023 • https://doi.org/10.1590/1413-812320232810.10002023EN copy

Working conditions in primary health care in the COVID-19 pandemic: an overview of Brazil and Portugal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The COVID-19 pandemic has put pressure on public health systems worldwide since 2020. This article aims to discuss working conditions in Primary Health Care (PHC) in Brazil, while dialoguing with primary health care (CSP, Cuidados de Saúde Primários) in Portugal in the pandemic scenario. For that purpose, data from the study “Working conditions of health professionals in the context of COVID-19 in Brazil” are presented, for further discussion with the report produced by “Family Health Units - National Association (USF-AN, Unidades de Saúde Familiar - Associação Nacional)” on the CSP in Portugal. In Brazil, regarding the sample of 3,895 PHC health professionals, it was observed: multiple employment relationships, lack of institutional support and specific training, living with fake news and the lack of political cohesion between health authorities, with significant changes in these workers’ mental health. In Portugal, the increase in the workload and the presence of Burnout Syndrome among FHU professionals was emphasized. The pandemic had a significant impact on the health and daily work of health professionals in PHC and CSP. However, the Brazilian context was more adverse due to fake news and divergences regarding conducts related to the fight against the pandemic, due to the actions and denialism by the federal government.

Key words:
COVID-19; Health workers; Primary health care; Work conditions

Type of institution	V.Abs.	%
Public hospital	5,218	34.5
Private hospital	1,701	11.2
Philanthropic hospital	754	5.0
Field hospital	473	3.1
UPA	760	5.0
SAMU	262	1.7
PHC (Centro de Saúde/UBS/USF/UBSF/Mixed Units)	3,895	25.7
Polyclinic/Clinic/Specialized center	850	5.6
Remote care	217	1.4
Long-stay institution	46	0.3
Administration in general	357	2.4
Teaching and research institution	79	0.5
Auditing/medical Expert	1	0.01
Autonomous activity	4	0.03
SADT	89	0.6
Military/Security area	21	0.1
Prison system (socio-educational system)	31	0.2
Commerce/industry	59	0.4
Private practice	145	1.0
Pharmacy/drug store	16	0.1
Petroleum	4	0.03
Others	66	0.4
NR	84	0.6
Total	15,132	100.0

Variables	V. Abs.	%
Professional category
Physician	726	18.6
Nurse	2,285	58.7
Dental surgeon	535	13.7
Other professionals	349	9.0
Sex
Female	3,183	81.7
Male	701	18.0
NR	11	0.3
Age range
Up to 35 years	1,578	40.5
From 36 to 50 years	1,741	44.7
51 years and older	576	14.8
NR	0	0.0
Skin color or ethnicity
White	2,240	57.5
Black/Brown	1,553	39.8
Yellow	84	2.2
Indigenous	11	0.3
NR	7	0.2
Regions
North	382	9.8
Northeast	1,119	28.7
Southeast	1,295	33.2
South	700	18.0
Midwest	398	10.2
NR	1	0.03
Place of professional practice
Capital + Metropolitan Region	1,719	44.2
Interior	2,023	51.9
NR	153	3.9

Variables	V.Abs.	%
Type of Employment Relationship in PHC
Statutory (effective position employee)	1,921	49.3
Employee (CLT of company/public foundation)	413	10.6
Employee (CLT of a company/private entity or philanthropic institution)	275	7.1
Temporary public administration contract	768	19.7
Temporary contract in a company/private entity	51	1.3
Self-employed (individual, legal entity, cooperative member, owner/partner)	105	2.7
Commissioned position in public administration, without effective bond	120	3.1
Resident/Specialization student/Intern/Scholarship fellow	225	5.8
Other types	11	0.3
NR	6	0.2
Anther work activity besides PHC
Yes	1,233	31.7
No	2,654	68.1
NR	8	0.2
Weekly workload
Up to 20 hours	94	2.4
21 - 40 hours	2,541	65.2
41 - 60 hours	1,000	25.7
61 - 80 hours	215	5.5
81 hours and longer	37	0.9
NR	8	0.2
Reason for rorking in the fight against COVID-19
I already worked in the specific sector	2,771	71.1
I already worked in the sector and I looked for another job	97	2.5
Before, I worked in another sector and I was displaced by Covid-19	523	13.4
I had never worked in this sector and the job opportunity arose	153	3.9
It is my first job	243	6.2
NR	108	2.8
Reference unit for COVID-19 assistance
Yes	2,146	55.1
No	1,729	44.4
NR	20	0.5
Availability of personal protective equipment (PPE) (YES)
(more than one answer is allowed)	3.326	85,4
Surgical mask	3,326	85.4
N95/PFF2 mask	2,610	67.0
Gown/overcoat	3,001	77.0
Procedure gloves	3,674	94.3
Ocular protection/googles	3,164	81.2
Disposable cap or shoe covers	3,269	83.9
We had to improvise
Course/training for adequate use of PPE	1.296	33,3
Yes	1,296	33.3
No	1,706	43.8
I learned from the colleague	200	5.1
Video I looked up on the internet	682	17.5
NR
Feeling of protection against COVID-19	1.968	50,5
Yes	1,968	50.5
No	1,909	49.0
NR
Institutional support	1.474	37,8
Yes	1,474	37.8
No	2,361	60.6
NR
Situations that interfered with the work to fight the pandemic (I AGREE)	3.598	92,4
(more than one answer allowed)	3.196	82,1
Fake news in health is an obstacle in the fight against the new coronavirus	3,598	92.4
I assisted a patient who expressed belief in fake news about COVID-19	3,196	82.1
The positions of the health authorities on COVID-19 have been consistent and enlightening	1,174	30.1

Variables	V.Abs.	%
Changes in the professional routine (more than one answer allowed)
Lack of knowledge and uncertainties related to the disease, scenarios of new work practices and knowledge	269	3.1
Strenuous work (long, uninterrupted working hours, multiple shifts, poor working conditions, temporary confiscation of vacation rights, no rest, compulsory isolation in Covid-19 sectors)	2,033	23.7
On the verge of exhaustion (work overload, multiple functions and responsibilities, stress, conflicts of interest, exhaustion, anxiety, devaluation of what you do, regret about choosing a profession, Burnout Syndrome)	1,121	13.1
Complexity and rigidity of the work process in the fight against Covid-19	759	8.8
Fear of Death and imminent contamination	746	8.7
Ritualistic process of garmenting and ungarmenting PPE	226	2.6
Biosafety and contradictions (ongoing demands to follow safety and security measures while working and shortages of PPE)	1,413	16.5
Sad and tense hospital environment during Covid-19 care	404	4.7
Deprivation of social life among co-workers	153	1.8
Deprivation of freedom to come and go and socializing with friends	315	3.7
Deprivation of family life	351	4.1
Tension on the way home and vice versa	49	0.6
Risk group professionals	19	0.2
Sleep, mood, appetite, weight disorders, changes in habits (sedentary lifestyle, illness in general, absences due to COVID-19, absenteeism)	236	2.7
Feeling grateful for saving Lives	77	0.9
Uncommitted and insensitive management related to the worker	100	1.2
Worker citizenship at risk (job losses, unemployment, loss of income, low and late wages, expenses with equipment purchases, alternative transport and food)	315	3.7
Feelings about professional life (more than one answer allowed)
More appreciated and recognized by the user population	897	19.6
More respected by colleagues	397	8.7
Best team relationship	719	15.7
More embraced by the leadership/management of the services	459	10.0
Less appreciated and recognized by the user population	945	20.7
Less respected and appreciated by the leadership/management	1,155	25.3
Significant alteration (more than one answer allowed)
Sleep disturbance, such as insomnia or hypersomnia	2,136	15.5
Change in appetite/weight	1,139	8.3
Loss of confidence in oneself, the team or the work done	891	6.5
Difficulty experiencing happiness	760	5.5
Negative feeling of the future/negative, suicidal thoughts	1,163	8.4
Irritability/frequent crying/general disturbances	1,918	13.9
Loss of career or life satisfaction/sadness/apathy	1,260	9.1
Difficulty concentrating or slow thinking	1,347	9.8
Increased consumption of medications, alcohol or energy drinks, cigarettes	823	6.0
Inability to relax/stress	1,565	11.3
Other alterations	150	1.1
Did not experience any significant alterations	649	4.7
Duration of alterations
Last week	76	2.4
Last 15 days	137	4.3
Last month	959	30.0
Since the start of the pandemic	1,679	52.4
Since before the pandemic	351	11.0

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