Credit, Disclosure/Department of Health
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According to the Ministry of Health, the primary care program in Brazil now includes more than 49,000 teams
Item Information
- Author, André Biernath
- Rolle, from BBC News Brazil in London
- Twitter, @andre_biernath
- Jun 8, 2023 5:11 03
Updated 3 hours ago
English doctor Matthew Harris is currently working in London on a project inspired by what he learned from Brazil’s Unified Health System (SUS) more than 20 years ago.
A year after studying medicine in the UK, he moved to Pernambuco in 1999 and after passing the exams to renew his diploma in the country, he began working as a general practitioner in a health post in the municipality of Camaragibe, in the Recife metropolitan area.
Harris stayed at the clinic for four years. Little did he know at the time that the experience would transform his career and even spark changes in Britain’s National Health Service (NHS) two decades later.
He is currently a researcher at Imperial College London’s School of Public Health, leading a project aiming to implement community health agents, which have existed in the SUS for decades, on British territory.
The doctor does not hesitate to say that this initiative is 100% inspired by the Family Health Strategy (ESF), a program created by the Brazilian Ministry of Health in the 1990s and still active today and bringing results recognized by professionals be highly praised on the field. .
Harris received the BBC News Brasil team in a room in the Department of Primary Care and Public Health at the University West of the English capital to share a little insight into his professional career and the UK initiative inspired by SUS.
Credit: Giovanni Bello/BBC News Brazil
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Doctor Matthew Harris worked in Camaragibe (PE) for four years
the first steps
The GP says conditions in Camaragibe in 1999 were not the best. “I worked in a rural area with around 5,000 inhabitants,” he contextualizes.
Harris describes his first practical experience in medicine as “challenging”.
“I had just graduated from university, didn’t have the confidence to speak Portuguese and had to do my job in a very poor community in northeastern Brazil,” he recalls.
“The clinic had few medicines sent by the council. It was a very different situation from what I was used to in the UK.”
Despite all the difficulties, Harris quickly realized something important. “Despite all the challenges and a lack of resources, we can still achieve extraordinary things in primary medical care,” he says.
And in his view, the link in this Brazilian public health chain is a professional called a Community Agent.
These individuals are the cornerstone of the Family Health Strategy (ESF). Launched in the 1990s, the program is based on the premise that such agents visit people’s homes in a specific region, neighborhood or city.
The aim is to understand and monitor the key health issues affecting these individuals and of course to relay this information to the nurses, nursing assistants, GPs and GPs who work in the primary health unit responsible for that location.
The Health Ministry contacted by the report said the country currently has 49,172 family health teams responsible for caring for 167 million registered citizens (or 79% of the total population) in primary health services, which the government sees as “the gateway.” to the SUS”.
“When I arrived, I had no idea how the public health system in Brazil was based on these community agents,” Harris admits.
The English doctor gradually realized how useful the information received from these professionals was in everyday life. “They know and understand the place where they work down to the last detail,” he emphasizes.
“The community agents are the first to know about changes. And that information is used intelligently before the problems become too big,” he adds.
Community officials attend technical training courses organized by municipalities and other organizations to learn about health promotion and disease prevention.
You will use this information in interviews and home visit conversations. When trained and supervised by a nurse or doctor, they can also perform simple tests, such as taking body temperature, blood sugar and blood pressure, or finding out whether drug treatments for chronic diseases such as high blood pressure and diabetes are available. will be taken over.
Credit, Disclosure/Department of Health
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ESF experts monitor the population of a given location and try to understand the main health problems of these people
Lives saved by information
Asked by BBC News Brasil about specific episodes that shaped his career, Harris recalled the story of an 11yearold boy who ended up in the emergency room.
“He has been complaining of a headache for several days. Unfortunately, the emergency services could only offer paracetamol and hope for an improvement,” he reports.
But the work of a community agent changed that story. “During a routine visit, the doctor noticed that the boy was still not well and warned us. His eyes started to swell up and it just kept getting worse,” he says.
When Harris took the boy to an appointment, he noticed two things: the blood pressure was abnormal and the child had a wound on his foot.
“By putting all of these pieces together, I was able to diagnose poststreptococcal glomerulonephritis,” Harris adds.
This oddly named disease is a complication that affects the kidneys of patients who have had an infection with the Streptococcus bacterium.
In the case of this incident in Pernambuco, the doctor suspected the disease when he added the evidence of the cut on the foot (an indication of a bacterial infection) with low blood pressure and a headache (indicating kidney disease).
“If he wasn’t diagnosed early enough, he would likely have kidney failure and eventually die,” says Harris. “But the quick discovery through the work of the community worker literally saved this boy’s life.”
Credit, Disclosure/Department of Health
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Primary care teams serve almost 80% of the Brazilian population
Back at home
After four years in Pernambuco, Harris returned to the UK in 2003 with at least one certainty: there was a need to replicate the ESF in UK public health.
And a task of this magnitude carries with it a range of symbols and meanings.
One of the main reasons is the fact that the creation of SUS in Brazil in the late 1980s was inspired by the UK’s NHS and now those roles have been reversed.
“Even before my return, I knew immediately that I had learned something from the Brazilians and that I had to pass it on. I had to pass it on and open the eyes of professionals to community agents,” he points out.
“Everyone needs to know about Brazil’s success model,” recommends the researcher.
But the mission turned out to be more difficult than he had thought.
“Unfortunately, it took me between 10 and 15 years to explain the importance of a system like the ESF, because people here are not used to Brazilian reality and have misconceptions about the country,” he laments.
“But the truth is that the realities of Brazil and the UK are closer than meets the eye. There are more things that unite us than elements that divide us,” believes the doctor.
“Of course we don’t have diseases like leptospirosis, schistosomiasis and dengue fever here. But we also suffer from diabetes, tuberculosis, high blood pressure, depression, asthma, diarrhea…” he compares.
Harris believes the Covid19 pandemic was one of the factors that helped speed up the processes and allowed the establishment of an interim UK ESF.
“We argued that we needed a system of community health officers, like in Brazil, to monitor people closely,” he points out.
And this is how the initiative came to life: The pilot project started at the Churchill Gardens Estate, a housing development in Westminster, central London.
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Community agents go through neighborhoods and make home visits to identify residents’ top health concerns
the first results
According to Harris, the original idea was to see if people would be willing to open the doors of their homes to speak to health officials.
“And we noticed in the first six months that this is not only possible, but also that the residents have accepted the approach very well,” he reports.
The doctor estimates that in the first year and a half of the project, around 70% of the houses in the neighborhood were visited at least once by healthcare professionals.
“The agents are able to relate to people and really understand their needs. It is important that they live there themselves and see themselves as part of this community,” he emphasizes.
Harris says the team conducted some studies to measure the practical results of the experiment.
“When we compared the homes that received the visits with those that weren’t part of the pilot, we found that the first group participated more in vaccination campaigns and underwent more routine testing,” he says.
“Of course, we cannot prove that this change is entirely related to health compounds. But it is at least an indication that this has been happening since these professionals began their work,” he adds.
According to the expert, the staff of the program are trained to identify and even solve the main health problems that affect every family.
This makes individuals feel freer and more empowered to take care of other important aspects that have been neglected, such as: B. Updating the vaccination certificate or carrying out tests for the early detection of cancer.
Otherwise, the training of the British Community Agents was essentially the same as that of the Brazilian professionals.
But Harris believes the practical implications of a project like the ESF go beyond increasing vaccination or control rates.
“At the Churchill Gardens Estate, for example, we observed that people had lived in the same houses for many years but did not know their neighbors or speak to each other. Residents started talking more and planning programs together, like having coffee,” he adds.
The doctor understands that the strategy has created a kind of ‘social cohesion’ something very similar to what happened in Brazil even in the regions served for decades by the ESF.
The pilot scheme has already been expanded to other areas of London and is set to be rolled out in areas such as Yorkshire and Liverpool.
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Nahima is one of the community health workers based in London
Low cost, high value
Harris points out that more developed countries, like the UK itself, don’t pay much attention to what is being done in developing countries.
“Our tendency is to follow closely what is happening in countries like the United States, Germany, Australia or New Zealand and practically ignore the politics of countries in Latin America, Africa and Southeast Asia. But there’s no good reason for that.” .. like that,” he protests.
For him, the work of municipal health officials is an example of this scenario.
“A highly costeffective program, Brazil’s ESF helps solve the most common problems by providing holistic support to families in the most important place of all: their home,” says Harris.
The expert estimates that around 40% of people’s health needs can be met through community representatives through interviews and home visits.
“You can talk about vaccines and be aware of the symptoms of chronic diseases [como hipertensão e diabetes]Treating wounds, suggesting routine checkups, or simply checking that the person is taking the medication correctly,” he explains as an example.
Finally, the Imperial College researcher highlights how simple and inexpensive healthcare solutions can bring extraordinary results in certain situations.
“It is clear that we have room for sophisticated technologies that push the frontiers of medicine,” he says.
“But sometimes I feel like we go beyond what is necessary and forget that the most basic interventions can make all the difference,” he concludes.