In Brazil, the CHW system was introduced in the early 1990s and was eventually scaled nationwide as part of the unified health system in 1997. CHWs in Brazil visit families in their homes once a month where they deliver a range of services including, but not limited to: identification of risk factors; referrals; monitoring growth of children; maintaining registers of pregnant women; ensuring vaccination compliance; guidance on HIV/AIDS prevention; provision of preventive care to the elderly; accompaniment to antenatal care visits; and education related to food and nutrition.1 Outside of the home, CHWs also organize community meetings for educational activities. Much of the success of CHWs can be attributed to the support systems that are present within the health system. CHWs are connected to a team of providers, called Family Health Teams (FHTs). FHTs comprise a physician, nurse, and four to six CHWs, and each team is responsible for a catchment of approximately 1000 families. Additional specialists including nutritionists, social workers, psychologists, obstetricians and gynecologists, and public health workers also serve each empanelled population.2
CHWs are a valuable important tool for proactive population outreach but must be supported by adequate referral structures, infrastructure (including drugs and supplies and transportation), and transportation. CHW Impact has developed a report on CHW programs and levers for success. Additional information on CHWs and suggestions for building a strong and sustainable CHW program can be found at www.chwimpact.org.
Learn even more about CHWs in Brazil on the Exemplars in Global Health webpage.