Marcus McAlister
NAPC CHWW Programme Manager
A model brought to life
In April, I travelled to Brazil to visit the Community Health Worker model that inspired our Community Health and Wellbeing Worker Programme (CHWW) in the UK. The experience felt powerful and humbling. I spent time with Brazilian Community Health Workers, known locally as CHWs or ACS, and with the communities they serve. That experience brought the model to life. No report or policy paper could have done the same.
The CHWW Programme in the UK uses a neighbourhood based, asset led approach to help people improve their health and wellbeing. It focuses on the wider social determinants of health. Our workers build trusted relationships. They connect people to local support. They prioritise prevention. In Brazil, I saw these same principles in action at scale, shaped by more than 35 years of experience.
400,000 workers and counting
Brazil has grown its CHW workforce from just a handful of workers to more than 400,000. They are embedded as a central part of primary care, working in the most deprived areas and focusing on prevention, population health, and increasingly planetary health. Walking through communities with Brazilian CHWs, joining home visits, and seeing their day to day work made clear just how deeply rooted they are in the lives of the people they serve.
Across the week, we saw how much each system had to learn from the other. Brazilian CHWs demonstrated the strength of territorial mapping, vector surveillance, and community mobilisation at scale. UK CHWWs shared insights into challenges we are grappling with, such as housing conditions, warmth, fuel poverty, and social isolation. Despite the differences in context, the underlying principle was the same. A salaried, skilled, supported, and supervised worker who is embedded in community life can make a profound difference.
On the front line of climate change
One of the most striking aspects of the visit was how clearly CHWs are already responding to the health impacts of climate change, even if this is not always formally recognised. Whether supporting families during extreme weather, identifying environmental health risks, or preventing avoidable hospital admissions, much of what CHWs do every day contributes to both adaptation and mitigation.
At the same time, everyone recognised the challenges. Less than one percent of global climate finance goes to health, yet CHWs stand on the front line of the climate crisis. In the Amazon, in coastal regions, and in areas of urban deprivation, they support communities that have contributed least to climate change but feel its impacts most. We need to better resource and recognise this workforce. They play an essential role in both health and climate resilience.
Learning in the field: Duque de Caxias
A highlight of the visit was taking part in field activities in Duque de Caxias, alongside colleagues from Fiocruz, Imperial College London, and partners from across Brazil and the UK. At the UBS Enir Angela Biciati Moreira health unit, we joined Brazilian CHWs in small groups, walking the territory and learning directly from their work. It was inspiring to see international cooperation in practice, grounded in real communities rather than theory.
We were also joined by UK colleagues, including MP Simon Opher, who described seeing the “incredible power” of this approach for the NHS. Moments like this reinforced the importance of continued collaboration and exchange between countries. As Matthew Harris and others have emphasised, this is very much a two way process of learning. Language and culture are not barriers when the focus is shared purpose.
A shared movement
What stayed with me most was the sense of mutuality, respect, and joy. CHWs from both Brazil and the UK spoke about their work with pride and compassion. They recognised that, despite different systems and contexts, they are part of a shared effort to improve lives and strengthen communities.
There is also hope. The ingenuity of solutions already being developed within communities, and the passion of the workforce delivering them, is genuinely uplifting. This visit was not only about learning from the past, but also about building for the future.
As we continue to embed and grow the CHWW Programme in the UK, these insights will be invaluable. We are developing a curriculum that reflects what we have learned, helping to validate, equip, and connect a workforce that is already doing vital work. This experience reaffirmed for me that community health work is not just a model. It is a movement. And it is one we are building together.
If you have any questions about Community Health and Wellbeing Workers, please contact us at napc@napc.co.uk
