Summary
Brazil — which has the world's fifth-largest population and seventh-largest economy — has a decentralized health system, where municipalities are responsible for most primary care services as well as some hospitals and other facilities. All publicly financed health services and most common medications are universally accessible and free of charge at the point of service for all citizens, even the 26 percent of the population enrolled in private health plans.
An important innovation in the country's health care system has been the development, adaptation, and rapid expansion of a community-based approach to providing primary health care, the Family Health Strategy (FHS). Originally created in the 1990s as a maternal and child health program relying on community health agents (lay members of the community who are paid members of the health care team), FHS now provides primary care for defined populations by deploying interdisciplinary health care teams. The core of each FHS team includes a physician, a nurse, a nurse assistant, and four to six full-time community health agents. In 2014, 39,000 teams with more than 265,000 community health agents, and 30,000 oral health teams, served 120 million people (62 percent of the population). Perhaps the most important FHS component is the use of community health agents. Each agent is assigned to approximately 150 households, usually the same area where the agent lives. Agents visit each household within their area at least once per month and collect individual- and household-level data. During each visit, they promote health-promotion activities and basic clinical care. They may ask household members why they missed an appointment (and help schedule a new one), check whether prescriptions have been filled and whether patients have been taking their medications regularly, ask about changes to household composition, and identify potential warning signs of violence, neglect, truancy, or drug use, among other problems. They also actively look for risk factors such as smoking and symptoms of common chronic disease such as hypertension and diabetes. Community health agents thus help bridge the divide between primary care and public health efforts.