The Brazilian Community Health Agent Programme (O Programa dos Agentes Comunitários de Saúde) forms part of the Brazilian Family Health Strategy (FHS), a national primary healthcare strategy which has led to substantial improvements in population health.

The FHS model involves interdisciplinary healthcare teams including a doctor, a nurse, a nurse assistant and four to six community health agents (CHAs).

CHAs are full-time paid employees. Usually they have had no previous health training, and are only required to have completed secondary education. The crucial recruitment criterion is being an established resident of a given neighbourhood, with the ability to communicate well with local residents.

CHAs are assigned approximately 150 households, each of which they must visit at least once a month. During these visits, the CHAs carry out a range of tasks, such as helping with prescriptions or making appointments. They also gather data, and identify health issues and risk factors affecting members of the household.

CHAs liaise closely with the clinicians on their team and feed back their findings at regular meetings, providing a strong insight into the problems experienced by the community. These insights are used to inform the wider public health activities of the Family Health Teams. For example, Family Health Teams operating in the São Paulo periphery have used intelligence gathered by CHAs to inform workshops on different health topics, targeted at particular groups who have been identified as at particular risk.

Evaluations of the FHS model have shown that it not only leads to greater satisfaction among users, but also leads to better health outcomes. For example, it has led to large reductions in infant mortality. In adults, benefits have included reduced mortality from cardiovascular diseases.

There is also evidence that FHS has improved detection of cases of neglected tropical diseases. The model has been used only to inform local service provision, however it has the potential to feed into wider-scale research and innovation.

Image credit: Prefeitura de Olinda

Community health agents