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Brazil’s Family Health Strategy—Delivering Community-Based Primary Care in a Universal Health System

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Brazil’s health system relies heavily on community health care workers to expand residents’ access to primary care services. At least once a month, these lay workers visit each household in their assigned area to ensure residents are keeping up with medical appointments and treatment recommendations and to watch for risk factors for common chronic diseases as well as signs of violence, drug use, and truancy. These workers are integral members of local primary care teams that are each responsible for up to 1,000 households. Commonwealth Fund–supported researchers described the features and benefits of the program, known as the Family Health Strategy, in a New England Journal of Medicine “Perspective.”

Improving Primary Care One Household at a Time

  • Thanks to the program, nearly two-thirds of Brazilians currently receive care from primary care teams, which include physicians, nurses, nurse assistants, and community health workers. The health workers play a vital role in promoting healthy behaviors and instituting public health campaigns.
  • Studies of the Family Health Strategy program have found it has improved health care access and quality and increased patient satisfaction compared with traditional health care centers and private facilities. It has also reduced infant mortality and otherwise improved children’s health. Among adults, the program has lowered mortality from cardiovascular and cerebrovascular causes and substantially reduced hospitalization rates for ambulatory care–sensitive conditions. In addition, complication rates for certain chronic conditions, such as diabetes, have fallen.
  • Despite its accomplishments, the program faces serious financial and organizational challenges. Its rapid expansion has led to a physician shortage.


Brazil’s community-based approach to primary care has yielded improvements in quality, access, and health outcomes, but the program faces capacity and financial constraints.

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Publication Details



J. Macinko and M. J. Harris, “Brazil’s Family Health Strategy—Delivering Community-Based Primary Care in a Universal Health System,” New England Journal of Medicine Perspective, June 2015 372(23):2177–81.