Brazil's Family Health Strategy: Using Community Health Care Workers to Provide Primary Care

PROGRAM AT A GLANCEKEY FEATUREBrazil, the world's fifth-largest nation, established a Family Health Strategy in 1994, which uses community health workers (CHWs) to provide basic primary care to families at home, relay information back to health care teams, resolve low-level problems, refer more complex problems to nurses or physicians, and collect data.TARGET POPULATIONMore than 265,000 CHWs serve nearly 67 percent of Brazil's population. Most of the population served are lower-income.WHY IT'S IMPORTANTCountries around the world, including the United States, are looking to reduce costs and provide greater access to care.BENEFITSThe program, which costs $50 per person each year, has lessened the pressure on more-expensive care providers and led to significant improvements in clinical outcomes nationally—reducing hospitalizations and mortality and improving equity and access.LESSONSThe United States has used CHWs on a limited basis, with evidence of cost-effectiveness, but the model could be adopted more broadly. To do so, the U.S. must focus on three core challenges: regulation affecting the training and accreditation of CHWs, ensuring sustainable funding through appropriate payer reimbursement, and integrating CHWs into health care teams