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