Around the world, people are living longer as disease patterns have shifted away from infectious killers and maternal health risks toward chronic health ailments. This transition poses daunting new challenges to governments with weak health systems and limited healthcare coverage. Brazil, an emerging global economic leader, has made progress in this area with its Programa Saúde da Família (PSF) (“Family Health Program”). The PSF is the largest comprehensive, community-based, primary healthcare program in the world. And it has made remarkable strides in reducing deaths and illness from cardiovascular disease, while also contributing to major improvements in infant survival.source

The PSF began in 1994 as a relatively small pilot program in the northeastern state of Ceara that provided a decentralized free healthcare system. The program quickly became the main strategy for Brazil’s entire national health system and it expanded rapidly across de country.source By mid-2014, the PSF was providing comprehensive primary-care services in 95 percent of Brazil’s municipalities. More than 37,300 healthcare teams and 261,600 community health workers covered around 60 percent of the entire national population.source

One estimate suggests that the PSF saved almost 450,000 lives between 1996 and 2012.source The PSF has contributed to the decreases in the number of heart disease and stroke deaths, as well as a plunge in hospitalizations for these conditions. The program has also improved immunization and prenatal-care coverage.source In municipalities with the PSF services, infant mortality rates dropped by around 25 percent more than in municipalities that had not participated in the program.source

"Brazil's Family Health Programme is probably the most impressive example worldwide of a rapidly scaled up, cost effective, comprehensive primary care system." —Matthew Harris & Andy Haines, British Medical Journal, 2010

In 2008, the Brazilian government allocated about 8 percent of its health budget of BRL2.4 billion (US$30 billion) to the PSF. Researchers found that the PSF is highly cost-effective in the Brazilian context. A municipality of 100,000 inhabitants with program coverage of 40 percent would be expected to spend between US$1.3 million and US$2 million on the PSF annually to save an estimated 57 lives after five years and 150 lives after eight years of PSF operation.source

The Brazilian experience shows that scaled-up community-level primary healthcare can improve the early detection and management of cardiovascular disease and other pressing health challenges. Decentralization of decision-making authority to lower levels and community engagement were also central to the success of the program.