Brazil, Costa Rica, & Ghana: Organisation of Services

Empanelment was a central component of health care reforms introduced in the early 1990s in Costa Rica, Brazil, and Ghana. The Equipo Basico de Atencion Integral de Salud (EBAIS) model in Costa Rica and the Family Health Strategy (FHS) in Brazil established multidisciplinary care teams to provide comprehensive care to a geographically empaneled population of approximately 3500 and 4500 individuals, respectively. 1 2 A similar reform took place in Ghana where trained nurses called Community Health Officers (CHOs) provided health services to an empaneled population both by way of door-to-door services and at Community-based Health Planning and Services (CHPS) compounds. All three countries demonstrated significant gains in access to PHC: during the first decade of implementation, access to PHC services in Costa Rica increased from 25% to 93% 1, coverage in Brazil increased from 4% in 1998 to 62% in 2014 (14), and the pilot experiment for strengthening CHPS implementation in a Northern region of Ghana demonstrated an eight-fold increase in encounters with health services. 3

As demonstrated by these countries, the most immediate result of geographic empanelment was the establishment of a geographically accessible first point of contact in the health system. Additionally, Costa Rica, Brazil, and Ghana all coupled empanelment with the deployment of CHWs to communities. After establishing panels, CHWs were able to provide integrated, person-centered care and form continuous relationships through regular home visits and community-based care. More information on community-based care can be found in proactive population outreach and provider availability.

Learn more about Costa RicaGhana, and Brazil.


  1. Pesec M, Ratcliffe HL, Karlage A, Hirschhorn LR, Gawande A, Bitton A. Primary health care that works: the costa rican experience. Health Aff (Millwood). 2017 Mar 1;36(3):531–8. 
  2. Macinko J, Lima Costa MF. Access to, use of and satisfaction with health services among adults enrolled in Brazil’s Family Health Strategy: evidence from the 2008 National Household Survey. Trop Med Int Health. 2012 Jan;17(1):36–42. 
  3. Nyonator FK, Awoonor-Williams JK, Phillips JF, Jones TC, Miller RA. The Ghana community-based health planning and services initiative for scaling up service delivery innovation. Health Policy Plan. 2005 Jan;20(1):25–34.