Brazil: Organisation of Services

The Brazilian Family Health Strategy (FHS) was established in 1994, and a primary component of the strategy was the creation of Family Health Team (FHTs). Each FHT includes a general practitioner, nurse, auxiliary nurse, and multiple community health workers (CHWs), and together they are assigned a geographic panel of approximately 600-1000 families. CHWs are particularly valued for their ability to liaise with communities and tailor care to specific population needs.1 Each CHW is assigned a portion of the team’s empaneled population – typically 150 families – where they provide preventive care in communities and homes, perform disease surveillance, and collect vital data.2 CHWs or similar cadres of providers are commonly included in care teams in LMIC. Particularly in rural areas, CHWs commonly engage in proactive population outreach, data collection, and/or health education activities.

Also within the FHS team structure, nurses have both clinical and organizational responsibilities. In addition to patient care, nurses are team leaders and coordinate CHWs. However, one study found that many nurses reported little autonomy, support, and control over their environment in this role.3 This finding underscores the value of incorporating leadership support, training, and frequent monitoring when implementing care teams. Despite some of these challenges, the FHS has contributed to improvements in health outcomes and coverage, including a decrease in hospital admissions due to diabetes, a decrease in child and infant mortality, and an increase completion of antenatal care.2

Learn even more about embedding CHWs in FHTs in Brazil on the Exemplars in Global Health webpage


  1. Fausto MCR, Giovanella L, de Mendonca MHM, de Almeida PF, Escorel S, de Andrade CLT, et al. The work of community health workers in major cities in Brazil: mediation, community action, and health care. J Ambul Care Manage. 2011;34(4):339–53.
  2. Brazil: A community-based approach to comprehensive primary care [Internet]. [cited 2017 Sep 26]. Available from:
  3. Lorenz VR, Guirardello E de B. The environment of professional practice and Burnout in nurses in primary healthcare. Rev Lat Am Enfermagem. 2014;22(6):926–33.