| Salvador |
Integration of PHC and surveillance |
“The moment was not just the integration of surveillance and PHC actions, I think we were able to coordinate with other sectors such as the department's staff training office; and it was a moment where we had all this cooperation and communication. But in terms of the issue of PHC and surveillance as a whole, a project was written that was developed that actually started to happen and was carried out, which was the integration of surveillance and PHC.” (EGSSA8) |
| New roles and responsibilities for CHWs |
“…it’s something that comes more naturally to family and primary health professionals, realizing how important the relationship between surveillance and care is.” (EGSSA6) |
| Difficulties in ensuring social distancing and physical separation of suspected cases from other patients in FCCs/PPCs |
"Initially, one of the difficulties in our FHC was that the entrance and exit are the same door. So it was really difficult to organize patient entry. There was very little room for the number of patients to keep a safe distance, so we tried our best to limit the number of appointments.” (EPSSA22) |
| Online clinical monitoring of mild cases of COVID-19 in home isolation |
“We receive symptomatic patients here. The city council sent a protocol saying that patients who arrived with suspected SarsCov2 infection should be received and monitored every 24 or 48 hours. We would telephone to find out how the patient was progressing.” (EPSSA6)
“There is a remote modality, but it’s very difficult to put it into practice because the quality of the tablet is poor, the quality of the sound and internet connection are poor. The patients’ internet connection is bad and the place where they are can often be noisy. Yet we tried to put it into practice with some very selective cases. But it’s really hard.” (EPSSA18) |
| Effective communication with patients |
“Create strategies together with the CHWs to establish a flow of information. And with the municipal health department to prioritize groups of actions that can produce positive results in the catchment area, and support from the health department. We spend a lot of time inside the health center and have wound down community visits during the pandemic” (EPSSA13). |
| Feira de Santana |
Integration of PHC and surveillance |
“We managed to integrate PHC and health surveillance to a certain extent, but it started to diminish because if you don’t have managers with integrated planning across all sectors it diminishes over time.” (EGFSA4). |
| Reorganization of PHC team work processes |
“A technical note arrived and we received over a thousand messages in the groups. And when we asked why we didn’t know about the patient flows, they said. “Ah, but it was in the technical note sent to the WhatsApp group. Patient flowcharts should be formally issued when updated.” (EPFSA7). |
| Difficulties in ensuring social distancing and physical separation of suspected cases from other patients in FCCs/PPCs |
“The room that was created already existed. It was a room where we held meetings, and we turned into an isolation room. We put some chairs in and a tape like that for people to keep their distance from the attendant so that patients wouldn’t get close, but it was us who did it”. (EPFSA7) |
| Hiring of CHWs |
“As there are no CHWs, they should hire a community health agent to identify people with symptoms in the catchment area and draw up a strategy.” (EPFSA8). |
| Online clinical monitoring of mild cases of COVID-19 in home isolation |
“We carry out remote monitoring of cases…. There’s a spreadsheet that we fill in for ten days, recording the patient’s symptoms”. (EPFSA4)
“This was another major problem in some places that needed to install internet or telephone lines and didn’t have [internet] because there was no coverage; and this really needs to improve”. (EGFSA5). |
| Effective communication with patients |
“The FCC doesn’t carry out educational activities to tackle COVID-19 in the catchment area. It doesn’t disseminate information or do leafleting, because the center doesn’t have a CHW”. (EPFSA8) |
| Vitória da Conquista |
Integration of surveillance teams into FCCs/PPCs |
“… surveillance ended up taking the lead, in the sense of taking on the organization, to pass things on later to our colleagues, especially those in other sectors.” (EGVDC4)
“The response demanded a lot from PHC and managers were not always able to understand exactly what needed to be done.” (EGVDC3 ) |
| Reorganization of PHC team work processes |
“One team attended non-symptomatic patients in the morning and another symptomatic patients in the afternoon.” (EPVDC4) |
| Difficulties in ensuring social distancing and physical separation of suspected cases from other patients in FCCs/PPCs |
“The PCC handles suspected cases and confirmed cases, so we closed the reception room and used it temporarily for asymptomatic patients. And we had to put up this makeshift partition to isolate consultations from reception because patients were coming in and out a lot and crowding the corridor.” (EPVDC9) |
| Relocation/changes to the roles and responsibilities of CHWs |
“Before, we didn’t have a receptionist and we got a rural CHW to help out in reception to control screening, reception, and symptomatic patient flows” (EPVDC9) |
| Online clinical monitoring of mild cases of COVID-19 in home isolation |
“We telemonitored the cases using the telemedicine service. The only thing we did in-person was notification.” (EPVDC4) |
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FCC - Family Care Center; PCC - Primary Care Center; UCC - Urgent Care Center; SAMU - Mobile Emergency Care Service; ADE - reception and unscheduled care; MID - home isolation remote monitoring; ACOM - risk communication and community engagement; VGEP - surveillance, management and permanent education.Source: Authors.