Introduction
In April of this year, the CHWW teams based in Westminster welcomed a Brazilian research team including a CHWW counterpart from a CHWW team in Rio de Janeiro as part of a bidirectional learning exchange. The CHWW initiative in the UK was inspired by the Brazilian Family Health Strategy, where the majority of the population are now covered by a CHWW.
The visit was designed to foster mutual learning between our two community outreach models, allowing us to explore how similar approaches are implemented and adapted in different social and healthcare contexts. Over the course of the exchange, we took part in shared workshops, shadowing opportunities, case discussions, and planning sessions with a view to strengthening collaboration and co-producing future work.
The visit of the Brazilian research team to the UK represents the first leg of the bi-directional learning exchange between Fiocruz in Brazil and Imperial College London in the UK to learn from each other and plan future research about resilience in both Health Systems
The project funded by UKRI/ESRC includes two CHWWs in the research team, one Agente Communitarias de Saude or ACS as CHWWs are called in Portuguese from Brazil (Bernardo), and one from UK (Jess). Both tell us about their experience.
Bernardo’s Notes
I’ve been working on the Health Family Strategy in Rio de Janeiro for 4 years, starting on the vaccination campaign for COVID-19. I have a law degree, and originally started on the job to help pay my student debt, because I couldn’t find a job in Law straight away. Turns out the CHWW role was my passion, and I feel like I’m making a difference to people’s lives.
Similarities and Differences Between the Projects
Both procedures regarding the home visit itself are very similar. In both countries, we come to the households, talk to residents, check on their health status, check if they made it to their various appointments and help them arrange a new one if necessary.
There are regular meetings with the GP, the CHWW team, and the manager. The discussions are similar, they talk about cases that are a little difficult to manage, and discuss strategies and solutions. The hiring process is also similar, because the CHWW must be from the community they work in. As in Brazil this is the only requirement, along with a high school degree.
The biggest difference is that the CHWW in the UK doesn’t have an official Basic Health Facility like a GP practice to call their home, work in and help with admin.. The team is not officially employed by the NHS, although they are considered part of the wider medical team, so it depends on the GP they are linked to. Sometimes, the residents try to confirm with the GP if they sent a CHWW to their homes and the GP doesn’t even know about the programme. This may be because it is early days in the programme in the UK.
There is another difference, the CHWW are not only focusing on health, they try to work around any other problem the resident can have, like housing problems, unemployment, and so on.
The number of households covered by the CHWWs are different as well. In Brazil the number is counted by people, around 450 persons for each CHWW, in the UK, there are 120 households allocated to each CHWW.
The UK CHWWs aim to visit all the households at least once a month. For Brazilian CHWWs- at least in my area- there are some rules depending on the condition of the person (age, pregnancy, chronic disease), there is a scheme to guide and clarify:
Daily: People being treated for Tuberculosis and Leprosy.
Weekly: Pregnant women with high risk, and babies from 0-30 days of life.
Monthly: Pregnant women with high-risk pregnancies, and babies from 1 month until 1 year old.
Every 3 months: People with Diabetes, Hypertension and children from 1-2 years old.
Every 6 months: Elderly people (60+ years old), children from 2-6 years old, and population registered on the Bolsa Família (National Income Transfer and Assistance Program).
There is a small difference in the meeting procedure, but it is due to the different structure of Primary Health Care in both countries. While in Brazil, the meetings are done in person, every week, in the UK the team meets online, but they meet in person at least once a month.
Key Learning from the Visit
The most interesting point is that the teams have their own calling cards with a bio, an “ad” about the programme, it has their email address and phone number and the CHWWs use these to help on the approach with the residents. The Coffee Mornings are a great way to help the community to integrate and create bonds with each other.
Overall Impression
The programme is on the right way to winning the attention and the trust of the population. The services offered and done by the CHWWs are essential to keep the community strong, connected and healthy. The most difficult thing is to get resources, political power (it was good to see that during my visit, the Secretary of State for Health talked about his interest in the programme to the Telegraph).
Jess’s Notes
I’ve been working as a CHWW in the Church Street area of north Westminster for nearly a year and a half. My academic background is in Chemistry, and I have a keen interest in research and systems thinking. Although not a traditional route into outreach work, I’ve found that my scientific training and curiosity complement the role well, especially when it comes to observing patterns, understanding complex systems, and identifying small but meaningful points of intervention. I’m particularly drawn to the ways in which reflective practice and evidence-informed methods can support impactful, relationship-centred community work.
The parts of the visit I was involved with included a workshop on the Functional Resonance Analysis Method (FRAM), which offered a systems-based lens for understanding complex interactions within our outreach work. I also took part in a session workshopping ideas for upcoming grant applications, where we explored how our shared experiences and perspectives could feed into research and service development. A highlight of the visit was hosting the research team for a day in Church Street, during which they shadowed me through three meetings: a case discussion with the care navigator at one of the local GP surgeries we work closely with, our weekly internal team meeting for updates and peer support, and a joint teaching and case discussion session with our clinical lead and the CHWW team working in the south of Westminster. The visit concluded with a reflective session in which we discussed our fieldwork experiences, exchanged feedback, and began planning future academic outputs and collaborative initiatives.
Similarities and Differences Between the Projects
One of the most striking similarities between our project in Church Street and the initiative in Rio de Janeiro is the central role that relationship-building plays in both models. In each setting, forming strong, trust-based connections with residents is considered fundamental to the work. These relationships are not only the foundation for effective support and advocacy, but also a way of understanding the broader needs and lived realities of the communities we serve. Whether in the densely populated, diverse neighbourhoods of north Westminster or in the dynamic urban environment of Rio de Janeiro, taking the time to listen, build rapport, and develop mutual trust is seen as essential to achieving sustainable and meaningful outcomes.
A key difference has emerged, however, in the way each project currently structures its outreach work. In Rio, the model has evolved to take a more targeted, provider-led approach. Outreach workers there prioritise visits based on specific health conditions such as diabetes, hypertension, or pregnancy, focusing their time and resources on those with particular clinical or social vulnerabilities. In contrast, the Church Street project remains more closely aligned with the original Brazilian model in its earlier form, where the emphasis is on reaching every household in the catchment area on a monthly basis, regardless of condition. Our approach follows the principle of proportional universality. We aim for monthly visits to all households, with the frequency and intensity of engagement adjusted according to the scale and nature of each household’s needs.
Despite these operational differences, the foundational CHUI principles continue to underpin both models. The work remains comprehensive, in that outreach is oriented toward addressing all of the resident’s needs, whether clinical, social, or practical, while building a team of support around them where needed. It is hyperlocal, with outreach workers recruited from the communities they serve, trained and employed to deliver regular, meaningful contact. It is universal, in that every resident in the household is seen regularly, although in Rio this is now more selectively applied based on health conditions. And it is integrated, meaning the outreach teams work closely with local primary care services to ensure joined-up support and continuity of care.
Key Learning from the Visit
One of the most valuable aspects of this visit was the opportunity to reflect on how similar outreach models can evolve differently in response to their specific health system and social context. Seeing how the Brazilian project in Rio de Janeiro has shifted toward a more targeted, condition-based approach offered insight into how services may adapt over time to manage demand or meet particular population health priorities. At the same time, it affirmed the importance of staying anchored in the core principles of outreach, relationship-building, local knowledge, and integration with primary care, regardless of the structural setting.
Participating in the Functional Resonance Analysis Method (FRAM) workshop was another key learning moment. It helped me to take a step back and consider the invisible complexity within our everyday work: the interactions between people, systems, values, and constraints that shape outcomes in ways we don’t always see. This systems-thinking lens was especially useful when considering how small decisions, like the timing of a visit or how we introduce ourselves to a new household, can influence much larger patterns of engagement and trust.
Hosting my counterpart in Church Street was both affirming and thought-provoking. His thoughtful questions and observations helped me see our work from a new angle, things I might usually take for granted stood out as interesting or innovative when viewed through his eyes, such as our use of calling cards and leaflets that we leave for residents. This highlighted the true value of bidirectional exchanges: not only learning from others, but also gaining a deeper understanding of our own practices in the process.
The visit reminded me of the power of global solidarity in public health approaches. While there are real differences in infrastructure and resources, the foundational commitment to community-led, preventive, and relationship-based models is something we share. It was energising to see that, even across continents, we are working toward the same goals.
Overall Impression
Overall, the visit was a rich and rewarding experience, both professionally and personally. It created space for genuine exchange, critical reflection, and shared curiosity. Having the chance to spend time with the research team, including my counterpart from Rio de Janeiro who is working within a model that originally inspired our own, brought a sense of continuity and connection that was both grounding and motivating. It reminded me that this work doesn’t exist in isolation; it’s part of a broader, global effort to centre care around people and communities.
The visit also reinforced the value of pausing to reflect on our own practices, and to see familiar routines through fresh eyes. It sparked ideas for future research and collaboration, and re-energised my commitment to both the outreach model and the values it represents. I left the experience with a deeper appreciation for the adaptability of our work, the strength of its core principles, and the possibilities that emerge when we make time to learn from each other.
