The Programa Saúde da Família (PSF), Family Health Program, in

Portuguese language Portuguese ( or, in full, ) is a western Romance language of the Indo-European language family, originating in the Iberian Peninsula of Europe. It is an official language of Portugal, Brazil, Cape Verde, Angola, Mozambique, Guinea-Bissau and ...

is one of the national

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...

programs in

Brazil Brazil ( pt, Brasil; ), officially the Federative Republic of Brazil (Portuguese: ), is the largest country in both South America and Latin America. At and with over 217 million people, Brazil is the world's fifth-largest country by area ...

, which implements a national

policy Policy is a deliberate system of guidelines to guide decisions and achieve rational outcomes. A policy is a statement of intent and is implemented as a procedure or protocol. Policies are generally adopted by a governance body within an organ ...

for

primary care Primary care is the day-to-day healthcare given by a health care provider. Typically this provider acts as the first contact and principal point of continuing care for patients within a healthcare system, and coordinates other specialist care t ...

settings with the aim of substituting part of the traditional model of primary care based on

medical specialist A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (paediatrics), cancer (oncology), ...

s. As its name says, its main focus is on

families Family (from la, familia) is a group of people related either by consanguinity (by recognized birth) or affinity (by marriage or other relationship). The purpose of the family is to maintain the well-being of its members and of society. Ideall ...

instead of individuals, and it is organized around multidisciplinary Family Health Teams, formed by a core of professionals such as

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

nurse Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health c ...

dentist A dentist, also known as a dental surgeon, is a health care professional who specializes in dentistry (the diagnosis, prevention, management, and treatment of diseases and conditions of the mouth, oral cavity and other aspects of the craniofaci ...

psychologist A psychologist is a professional who practices psychology and studies mental states, perceptual, cognitive, emotional, and social processes and behavior. Their work often involves the experimentation, observation, and interpretation of how indi ...

s and

social work Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social work ...

ers, as well as

community health agent Community health agent (''agente comunitário de saúde'' or ACS, in Portuguese language) is the title of a specific lay health care worker developed in Brazil by way of PACS (Program of Community Health Workers) in 1991 as part of the constructi ...

s, a kind of "

barefoot doctor Barefoot doctors () were healthcare providers who underwent basic medical training and worked in rural villages in China. They included farmers, folk healers, rural healthcare providers, and recent middle or secondary school graduates who receiv ...

". Brazil has currently (August 2009) approximately 30,000 of these teams, deployed in 5,241 of its 5,656 municipalities. The population coverage by PSF is 96.1% (a total of more than 141 million inhabitants). A total of 5,339 municipalities have 230,000 community health agents. PSF is now considered one of the main

strategies Strategy (from Greek στρατηγία ''stratēgia'', "art of troop leader; office of general, command, generalship") is a general plan to achieve one or more long-term or overall goals under conditions of uncertainty. In the sense of the " ar ...

universal health care Universal health care (also called universal health coverage, universal coverage, or universal care) is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized ar ...

, service reorganization and reorientation of professional practice at this level of care, as well as a platform for

health promotion Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, the "process of enabling people to increase control over, and to improve their health." Scope The WHO's 1986 Ottawa Charter for Healt ...

disease prevention Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...

and

rehabilitation Rehabilitation or Rehab may refer to: Health * Rehabilitation (neuropsychology), therapy to regain or improve neurocognitive function that has been lost or diminished * Rehabilitation (wildlife), treatment of injured wildlife so they can be retur ...

. Annual federal investments in the Program amount to ca. 2.5 billion US dollars.

History

PSF as a concept originated in 1991, as a part of the reform of the health care sector demanded by the new

Constitution of Brazil The Constitution of the Federative Republic of Brazil ( pt, Constituição da República Federativa do Brasil) is the supreme law of Brazil. It is the foundation and source of the legal authority underlying the existence of Brazil and the feder ...

, with its intent of increasing the accessibility of health to all, and to enhance the actions of prevention and health promotion. In that year, PACS, a program for training and deploying of

s was started. After many theoretical discussions and preparations, the program was launched by the Ministry of Health in 1994, as part of the so-called

Sistema Único de Saúde The ''Sistema Único de Saúde'' (, ''Unified Health System''), better known by the acronym SUS, is Brazil's publicly funded health care system. Created in 1989, the SUS is the largest government-run public health care system in the world, by nu ...

(SUS), or ''Unified Health Care System'', the most ambitious initiative of the Brazilian federal government to establish a hierarchically-organized and rationally funded program of public health, which is responsible for providing care to 75% of Brazil's current population of approximately 190 million inhabitants. The Program expanded rapidly and, in 2006. recognizing its importance, the federal government issued the Decree No. 648 of March 28, 2006, where it was established that PSF was going to be a strategic priority of the Ministry of Health to organize primary care in the country, and the main tool to enable universal and continuing access to health services under the basic principles of SUS: universality, equity,

decentralization Decentralization or decentralisation is the process by which the activities of an organization, particularly those regarding planning and decision making, are distributed or delegated away from a central, authoritative location or group. Conce ...

, comprehensiveness, and

community A community is a social unit (a group of living things) with commonality such as place, norms, religion, values, customs, or identity. Communities may share a sense of place situated in a given geographical area (e.g. a country, village, tow ...

participation. The unique identification and central registry of all citizens of the country, using a so-called

SUS Card Sus or SUS may refer to: Places *Sus, Lachin, a village *Sus, Pune, India, a neighborhood *Sus, Pyrénées-Atlantiques, France, a commune * Susch, Graubünden, Switzerland, a municipality formerly called Süs People * Martin Sus (footballer ...

, was to be one of its main organization supports. In its most recent development, a program for establishing in each region a Family Health Support Nucleus (NASF: Núcleo de Apoio à Saúde da Família) was started by the federal government in cooperation with state and municipal governments, In addition, a system of

SUS School Sus or SUS may refer to: Places *Sus, Lachin, a village *Sus, Pune, India, a neighborhood *Sus, Pyrénées-Atlantiques, France, a commune * Susch, Graubünden, Switzerland, a municipality formerly called Süs People * Martin Sus (footballer ...

s (training schools in several cities and states) was established, in order to provide the buildup and training of the huge specialized workforce required by SUS and PSF. The initial training of community health agents is part of its mission. PSF has, so far, produced a positive impact on the direction of this new model of health care and prevention, but it still has not been able to completely substitute the former model, based in an overvaluation of the practices of

curative care Curative care or curative medicine is the health care given for medical conditions where a cure is considered achievable, or even possibly so, and directed to this end. Curative care differs from preventive care, which aims at preventing the appear ...

, medical specialists and

hospital A hospital is a health care institution providing patient treatment with specialized health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically has an emerge ...

s, with its emphasis on an excess of technological procedures and

drug A drug is any chemical substance that causes a change in an organism's physiology or psychology when consumed. Drugs are typically distinguished from food and substances that provide nutritional support. Consumption of drugs can be via insuffla ...

s, leading to high costs. This traditional model has resulted in an undesired fragmentation of care. PSF strives to offer integrated health care focused on the family, instead of individuals, but the penetration of the model is still incomplete in most of the cities.

Characteristics

According to this decree the following characteristics were defined for the Family Health Program:Basic Health Care Dept Ministry of Health: Family Health Program
# Maintain a central

registry Registry may refer to: Computing * Container registry, an operating-system-level virtualization registry * Domain name registry, a database of top-level internet domain names * Local Internet registry * Metadata registry, information system for re ...

of families and individuals and use consistently its data to analyze the health situation of the community, taking into account the social,

economic An economy is an area of the Production (economics), production, Distribution (economics), distribution and trade, as well as Consumption (economics), consumption of Goods (economics), goods and Service (economics), services. In general, it is ...

cultural Culture () is an umbrella term which encompasses the social behavior, institutions, and Social norm, norms found in human Society, societies, as well as the knowledge, beliefs, arts, laws, Social norm, customs, capabilities, and habits of the ...

demographic Demography () is the statistical study of populations, especially human beings. Demographic analysis examines and measures the dimensions and dynamics of populations; it can cover whole societies or groups defined by criteria such as edu ...

and

epidemiological Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population. It is a cornerstone of public health, and shapes policy decisions and evidenc ...

characteristics of the territory; # Define the territory of operation, and carry out

map A map is a symbolic depiction emphasizing relationships between elements of some space, such as objects, regions, or themes. Many maps are static, fixed to paper or some other durable medium, while others are dynamic or interactive. Although ...

ping and

reconnoitering In military operations, reconnaissance or scouting is the exploration of an area by military forces to obtain information about enemy forces, terrain, and other activities. Examples of reconnaissance include patrolling by troops (skirmishers, ...

the delimited area, in order to understand that particular segment of the population, with continuous updating; # Perform the assessment,

planning Planning is the process of thinking regarding the activities required to achieve a desired goal. Planning is based on foresight, the fundamental capacity for mental time travel. The evolution of forethought, the capacity to think ahead, is consi ...

and implementation of health care activities based on the knowledge about

health risk A health risk assessment (also referred to as a health risk appraisal and health & well-being assessment) is a questionnaire about a person's medical history, demographic characteristics and lifestyle. It is one of the most widely used screening t ...

s, thus being able to prioritize solutions to the more prevalent health problems of families; # Practice extended family care, effected through the knowledge of the structure and function of families, proposing interventions that will influence effectively the processes of

health Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiza ...

and

illness A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that ar ...

of individuals, families and the community; # Promote

interdisciplinary Interdisciplinarity or interdisciplinary studies involves the combination of multiple academic disciplines into one activity (e.g., a research project). It draws knowledge from several other fields like sociology, anthropology, psychology, ec ...

teamwork Teamwork is the collaborative effort of a group to achieve a common goal or to complete a task in the most effective and efficient way. This concept is seen within the greater framework of a team, which is a group of interdependent individual ...

, integrating technical and professional areas of different backgrounds; # Promote and develop partnerships with community agents and integrate with social projects, with the aim of promoting health in accordance with priorities and under the coordination of municipal management; # Assess different knowledge and practices from the perspective of a

holistic Holism () is the idea that various systems (e.g. physical, biological, social) should be viewed as wholes, not merely as a collection of parts. The term "holism" was coined by Jan Smuts in his 1926 book ''Holism and Evolution''."holism, n." OED Onl ...

and

problem solving Problem solving is the process of achieving a goal by overcoming obstacles, a frequent part of most activities. Problems in need of solutions range from simple personal tasks (e.g. how to turn on an appliance) to complex issues in business an ...

approach, enabling the creation of bonds of trust with

ethics Ethics or moral philosophy is a branch of philosophy that "involves systematizing, defending, and recommending concepts of right and wrong behavior".''Internet Encyclopedia of Philosophy'' The field of ethics, along with aesthetics, concerns m ...

, commitment and respect; # Promote and encourage community participation in the social control, planning, implementation and evaluation of actions, and # Perform systematic monitoring and evaluation of actions implemented, in order to readjust and improve the whole process. Based on this same ordinance, the composition of family health teams was established, and its scope of action was defined as restricted to a maximum of 4,000 inhabitants (approximately 1,000 families). The core team consisted minimally of a physician, a nurse, several nursing assistants (or practical nurses) and several community health agents. The team has 30 working hours per week for all members. Several Brazilian cities hire other professionals such as

pharmacist A pharmacist, also known as a chemist (Commonwealth English) or a druggist (North American and, archaically, Commonwealth English), is a healthcare professional who prepares, controls and distributes medicines and provides advice and instructi ...

nutritionist A nutritionist is a person who advises others on matters of food and nutrition and their impacts on health. Some people specialize in particular areas, such as sports nutrition, public health, or animal nutrition, among other disciplines. In many c ...

s, physical educators,

physiotherapist Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient ...

speech therapist Speech is a human vocal communication using language. Each language uses phonetic combinations of vowel and consonant sounds that form the sound of its words (that is, all English words sound different from all French words, even if they are th ...

occupational therapist Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use scientific bases and a holistic perspective to promote a person's abilit ...

s, etc.

References

External links

Official website of the Brazilian Ministry of Health
(In Portuguese)

(In Portuguese)

History

Characteristics

References

External links

See also