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

Portuguese language Portuguese ( or ) is a Western Romance language of the Indo-European language family originating from the Iberian Peninsula of Europe. It is the official language of Angola, Brazil, Cape Verde, Guinea-Bissau, Mozambique, Portugal and São Tom� ...

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 de ...

programs in

Brazil Brazil, officially the Federative Republic of Brazil, is the largest country in South America. It is the world's List of countries and dependencies by area, fifth-largest country by area and the List of countries and dependencies by population ...

, 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 or ...

for

primary care Primary care is a model of health care that supports first-contact, accessible, continuous, comprehensive, and coordinated person-focused care. It aims to optimise population health and reduce disparities across the groups by ensuring equitable ...

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 (pediatrics), cancer ( oncology), ...

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

families Family (from ) is a group of people related either by consanguinity (by recognized birth) or affinity (by marriage or other relationship). It forms the basis for social order. Ideally, families offer predictability, structure, and safety as ...

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

physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...

nurse Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alle ...

dentist A dentist, also known as a dental doctor, dental physician, dental surgeon, is a health care professional who specializes in dentistry, the branch of medicine focused on the teeth, gums, and mouth. The dentist's supporting team aids in provi ...

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 explanation, interpretatio ...

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 wo ...

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 constructio ...

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'', "troop leadership; 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 "art o ...

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 a ...

, 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 ...

disease prevention Preventive healthcare, or prophylaxis, is the application of healthcare measures to prevent diseases.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental health a ...

and rehabilitation. 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 () is the Constitution, supreme law of Brazil. It is the foundation and source of the legal authority underlying the existence of Brazil and the federal government of Brazil. It replaced the ...

, 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 1990, 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 related to planning and decision-making, are distributed or delegated away from a central, authoritative location or group and gi ...

, comprehensiveness, and

community A community is a social unit (a group of people) with a shared socially-significant characteristic, such as place, set of norms, culture, religion, values, customs, or identity. Communities may share a sense of place situated in a given g ...

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 Communes of France, commune *Susch, Graubünden, Switzerland, a municipality formerly called Süs People * Fran ...

, 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 * Frank Süs, German f ...

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 appea ...

, medical specialists and

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

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

drug A drug is any chemical substance other than a nutrient or an essential dietary ingredient, which, when administered to a living organism, produces a biological effect. Consumption of drugs can be via insufflation (medicine), inhalation, drug i ...

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 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 a concept that encompasses the social behavior, institutions, and Social norm, norms found in human societies, as well as the knowledge, beliefs, arts, laws, Social norm, customs, capabilities, Attitude (psychology), attitudes ...

demographic Demography () is the statistics, statistical study of human populations: their size, composition (e.g., ethnic group, age), and how they change through the interplay of fertility (births), mortality (deaths), and migration. Demographic analy ...

and

epidemiological Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and Risk factor (epidemiology), determinants of health and disease conditions in a defined population, and application of this knowledge to prevent dise ...

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

map A map is a symbolic depiction of interrelationships, commonly spatial, between things within a space. A map may be annotated with text and graphics. Like any graphic, a map may be fixed to paper or other durable media, or may be displayed on ...

ping and

reconnoitering In military operations, military reconnaissance () or scouting is the exploration of an area by military forces to obtain information about enemy forces, the terrain, and civil activities in the area of operations. In military jargon, reconnai ...

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. Some researchers regard the evolution of forethought - the cap ...

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 ...

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 has a variety of definitions, which have been used for different purposes over time. In general, it refers to physical and emotional well-being, especially that associated with normal functioning of the human body, absent of disease, p ...

and

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

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 fields such as sociology, anthropology, psychology, economi ...

teamwork Teamwork is the collaborative effort of a group to achieve a common goal or to complete a task in an effective and efficient way. Teamwork is seen within the framework of a team, which is a group of interdependent individuals who work toge ...

, 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 interdisciplinary idea that systems possess properties as wholes apart from the properties of their component parts. Julian Tudor Hart (2010''The Political Economy of Health Care''pp.106, 258 The aphorism "The whole is greater than t ...

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 is the philosophy, philosophical study of Morality, moral phenomena. Also called moral philosophy, it investigates Normativity, normative questions about what people ought to do or which behavior is morally right. Its main branches inclu ...

, commitment and respect; # Promote and encourage community participation in the

social control Social control is the regulations, sanctions, mechanisms, and systems that restrict the behaviour of individuals in accordance with social norms and orders. Through both informal and formal means, individuals and groups exercise social con ...

, 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 in English in the Commonwealth of Nations, Commonwealth English, is a healthcare professional who is knowledgeable about preparation, mechanism of action, clinical usage and legislation of medications in ...

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

s, physical educators,

physiotherapist Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...

speech therapist Speech is the use of the human voice as a medium for language. Spoken language combines vowel and consonant sounds to form units of meaning like words, which belong to a language's lexicon. There are many different intentional speech acts, suc ...

occupational therapist Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use evidence-based practice, scientific bases and a Holism, holistic perspec ...

s, etc.

References

External links

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

(In Portuguese)

History

Characteristics

References

External links

See also