Back in 2011, I was telling a senior consultant in Public Health about Brazil’s extraordinary primary care system which is based on an army of over 250k community health workers (CHW). It had been established in the northeast of the country in the mid-1990s, in response to a cholera epidemic, and since had scaled nationally, now serving over 70% of the population. The principles seemed simple enough. Individuals from a neighbourhood are recruited and trained on a wide array of health and social care issues for a few weeks and then spend their working days visiting all the households that they are responsible for. Not many households, just around 200 each, but each CHW makes sure that the households get at least one visit per month. (more…)