The Community Health Agent Program of Brazil

Brazil’s Family Health Strategy Program organizes Family Health Teams composed of a physician, nurse, nurse assistant, and several Community Health Agents (CHAs). The number of CHAs and the Family Health Teams’ breadth of work varies depending on the area, but most of the teams administer promotive, preventive, curative, and rehabilitative care. Brazil’s progress toward achievement of national health indicators is widely ascribed to its primary health care program and CHAs engaging local communities in the health system.

Background
The Brazil Programa Saúde da Família (Family Health Program, now called the Family Health Strategy and abbreviated PSF) was launched in 1994. It builds upon several decades of experience in rural underserved areas with Community Health Agents (CHAs). CHAs were legally recognized as professionals in 2002.

Implementation
Each CHA is a member of a Family Health Team and is responsible for providing services for up to 750 individuals living in a geographically defined area. Currently, Brazil has 265,000 CHAs working as part of 43,000 Family Health Teams. Each team includes a physician, a nurse, a nurse assistant and a variable number of CHAs depending on the size and vulnerability of the population served.

Roles/responsibilities
The scope of work for the Family Health Teams varies with location, but most teams provide a comprehensive array of promotive, preventive, curative, and rehabilitative services. CHAs register and follow up the households in the areas where they work and engage their communities in the health care process, strengthening their link to the formal health system.

Training
CHAs are usually selected by the health department in each municipality. They must be literate and live in the community where they will be working. The curriculum comprises 1,200 hours of training divided into formal didactic learning and field training activities.

Supervision
CHAs are supervised by nurses and physicians from the Family Health Teams based at the local clinics with which they are attached. The supervision process varies among Family Health Teams depending on capabilities and needs.

Incentives and remuneration
CHAs are full-time (eight hours per day, five days per week) salaried workers earning in the range of US$ 281-472 per month.

Impact
Brazil has experienced marked improvements in a wide range of national health indicators over the past three decades, and much of this progress has been attributed to the strength of its primary health care program and the critical role played by CHAs.