What is the background? Describe what happened in the project
Since 1994, Brazil has developed an army of lay CHWs that are recruited from their own communities, trained in a range of basic health promotion areas that span the lifecourse, and are deployed to cover geographically defined micro-areas of up to 150 households. Each household receives a visit by their CHW every month, irrespective of need, and because they are integrated members of the local primary health care team, any and all health and social care problems arising at each visit can be quickly and effectively referred. Each CHW provides household-based support for breastfeeding, immunization and screening uptake, chronic disease management, sexual health, lifestyle, and nutritional advice. Each CHW manages community based health education groups for hypertension and diabetes but also runs groups for the elderly, for women, and for community therapy, for no other reason than to provide social support for those at times isolated from local networks. Each CHW delivers health protection and environmental health advice before, during and after epidemic or pandemic situations.
Each CHW collects census-quality socio-demographic characteristics of household occupancy that is updated at each monthly visit. Scaled to over 50% of the population this is a remarkably powerful tool to improve individual and population health outcomes. Several studies have now shown the Family Health Strategy to be responsible for significant reductions in infant mortality, hospitalizations for chronic disease and other primary care sensitive conditions, improvements in breast-feeding, immunization and screening uptake and even for increasing the availability of workforce supply.
What was the impact and what can be learned?
The CHW role is beginning to be recognized as a health and social care innovation of benefit to industrialized economies – an exciting opportunity for reverse innovation. It is a brilliantly elegant solution to the complexity and inefficiencies that arise from multiple roles, multiple layers and multiple systems common in older primary care systems. In particular, the CHW develops the ‘vinculo’ – a bond and sense of responsibility for their own micro-area that leads to trust and acceptance to act as community change agents. This element is notably absent from UK healthcare that has become increasingly depersonalized. Researchers from Imperial College and Bangor University have been collaborating with the Betsi Cadwaladr University Health Board to bring the lessons from the Brazilian CHW model to North Wales. In March 2013, a senior delegation visited Pernambuco State for a detailed immersion into the primary care system. Working closely with the Brazilian Ministry of Health, the Federal University of Pernambuco, and the Municipal Health Secretariat of Recife, plans are being elaborated to translate this role into pilot sites in North Wales. Medical student and GP exchanges are proposed to embed the learning at a service level. This evolving and emerging health link is an important part of the UK Department of Health-Brazilian Ministry of Health Memorandum of Understanding for bilateral collaboration in health care signed in October 2011.