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The family health system: analysis of a health survey in São Paulo, Brazil
  1. José Ricardo Mello Brandão,
  2. Reinaldo José Gianini,
  3. Hilegonda Maria Dutilh Novaes,
  4. Moisés Goldbaum
  1. Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
  1. Correspondence to José Ricardo de Mello Brandão, FMUSP CSE Butantã, Av. Vital Brasil, 1490-05503-000, São Paulo, Brazil; ricardo.brandao{at}


Background The Family Health Strategy (FHS) has been implemented as a strategy for primary care improvement in Brazil. Working with teams that include one doctor, one nurse, auxiliary nurses and community health workers in predefined areas, the FHS began in 1994 (known then as the Family Health Program) and has since grown considerably. The programme has only recently undergone assessment of outcomes, in contrast to more routine evaluations of infrastructure and process.

Methods In 2001, a health survey was carried out in two administrative districts (with 190 000 inhabitants) on the outskirts of the city of São Paulo, both partially served by the FHS. Chronic morbidity (hypertension, diabetes and ischaemic heart disease) of individuals aged 15 or older was studied in areas covered and not covered by the programme. Stratified univariate analysis was applied for sex, age, education, income, working status and social insurance of these populations. Multivariate analysis was applied where applicable.

Results There was a distinct pattern in the morbidity profile of these populations, suggesting differentiated self-knowledge on chronic disease status in the areas served by the FHS.

Conclusion The FHS can increase population awareness of chronic diseases, possibly through increasing access to primary care.

  • Access to health service
  • health services
  • outcome assessment
  • primary health care
  • public health policy
  • chronic diseases
  • community workers
  • health services evaluation
  • health surveys
  • national health program

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  • Funding FAPESP, Pio XI, 150005468-901, São Paulo, Brazil. FAPESP had no participation in any decision regarding the research.

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the Ethics Research Committee of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (CAPPesq).

  • Provenance and peer review Not commissioned; externally peer reviewed.