Ratio of CHWs to 10,000 population
19851990199520002005201020150510
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Events
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1985199019952000200520102015
1985
End of military rule
1987
First Community Health Program (PACS) in Ceara, after Jucas pilot, due to a drought emergency (6K CHW)
1988
Brazilian Federal Constitution establishes right to health and Unified Health System (SUS)
1990
Organic Health Law recognizes importance of quality of life, not just "absence of illness"
1991
PACS expands from Ceara state to the full North East Region
1994
Introduction of the national Family Health Strategy (ESF), expands and replaces PACS
1998
ESF is recognized as an integral part of SUS; a vigorous ESP national scale-up begins
Introduction of the Piso de Atenção Básica (Basic Care Grant; PAB), main financing mechanism of the FHS
2004
Oral Health teams included into ESF
2005
Introduction of "Evaluation to improve quality" system
2008
Introduction of Primary Care Support Units (NASF) to expand services and Primary Care Access and Quality (PMAQ) to improve quality
2010
Expansion reaches about 50% of Brazil population (120-130M people), growth rate declines
2017
230,000 CHWs reach 58% of Brazilian families (120M people) in 2017, mostly in the lower income quintiles of the population
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