The Brazilian Community Health Worker model
Brazil’s Family Health Strategy (Estratégia Saúde da Família) is widely regarded as one of the most successful large-scale community health programmes globally. Central to this model are Community Health Workers (Agentes Comunitários de Saúde), who are embedded within the communities they serve.
The programme is widely described as having started with a small number of community health workers over 30 years ago, growing to a workforce of over 400,000 CHWs, operating in 95% of the countries municipalities and covering 70% of the population.
Key features of the Brazilian model include:
Proactive outreach
CHWs visit every household in their designated area on a regular basis.
Defined populations
Each worker is responsible for a specific number of households, allowing them to build strong, trusting relationships.
Prevention-focused care
Emphasis is placed on preventing illness, promoting wellbeing, and addressing social determinants of health.
Integration with primary care teams
CHWs are part of multidisciplinary teams, ensuring continuity of care and effective referral pathways.
Community trust and cultural competence
Workers are from the communities they serve, enabling culturally appropriate support.
Outcomes
Over the last 30 years, areas with high coverage of Community Health Workers have seen the following results;
- 34% reduction of cardiovascular mortality
- 31% stroke mortality
- Improved horizontal equity
- increased breastfeeding, vaccination and cancer screening rates, nationally.
From Brazil to the UK: Dr Matthew Harris’ experience
A key influence in bringing this model to the UK was the firsthand experience of Dr Matthew Harris, who worked as a GP in Brazil over 20 years ago.
Dr Harris was the GP serving a population of around 5,000 people in a favela (urban slum). The community faced significant deprivation and a high burden of disease, including conditions rarely encountered in the UK such as leprosy, dengue haemorrhagic fever, schistosomiasis and leptospirosis, alongside the wider impacts of poverty, poor housing and limited access to services.
Despite these challenges and the scale of need, Dr Harris observed something remarkable: there was rarely a queue for appointments, and he seldom saw patients who did not require medical advice, diagnosis or treatment.
He attributed this to the work of the Community Health Workers he worked alongside.
These workers carried out regular, proactive visits to households, identifying issues early, supporting people to manage their health, and building trusted relationships within the community. They provided practical support, health education and signposting, helping people access the right help before problems escalated.
This photo shows a delegation from the UK meeting Brazilian colleagues. It includes Prof Matthew Harris and two of his CHWs from his time working as a GP in Brazil 20 years ago. They are stood outside the building that was their clinic
As a result, people with medical needs were more likely to reach clinical services at the right time, while many non-clinical issues were addressed through community-based support.
This experience challenged conventional assumptions about demand in primary care. Rather than simply reducing pressure on clinical services, it demonstrated how strong community-based support can help ensure that the right professionals are seeing the right people for the right reasons.
When Dr Harris returned to the UK, he recognised that many of the underlying challenges, particularly health inequalities and the impact of deprivation, were also present, albeit in different forms. He saw clear potential for adapting the Brazilian model to the NHS context.
His experience has since helped shape the development of the CHWW programme, supporting the translation of key principles from the Brazilian approach into a model designed for communities across the UK. Matthew Harris is a co-lead on the national CHWW programme and NAPC.
Key adaptations for the UK context
While inspired by Brazil, the CHWW programme has been adapted to align with the UK’s health and care system. These adaptations include:
- Alignment with NHS structures: Integration within PCNs and collaboration with local authorities and voluntary organisations.
- Flexible delivery models: Tailoring the approach to different community contexts across England.
- Workforce development: Structured training, supervision, and career pathways for CHWWs.
- Data and evaluation: Use of evidence and evaluation to measure impact and inform ongoing development.
The CHWW programme builds on proven international best practice, with Brazil’s Family Health Strategy providing a powerful foundation. By adapting these principles to the UK context, NAPC is supporting a shift towards a more proactive, equitable, and community-driven model of care.
As the programme continues to grow, the lessons from Brazil remain central. They demonstrate the value of investing in relationships, prevention, and community-based support as key drivers of better health and wellbeing.
