Journal of Community Health

, Volume 42, Issue 6, pp 1187–1196 | Cite as

Delivery of Community-Based Care Through Inter-professional Teams in Brazil’s Unified Health System (UHS): Comparing Perceptions Across Community Health Agents (CHAs), Nurses and Physicians

  • Rahbel Rahman
  • Rogério Meireles Pinto
  • Margareth Santos Zanchetta
  • Melanie M. Wall
Original Paper


Given the shortage of medical providers and the need for medical decisions to be responsive to community needs, including lay health providers in health teams has been recommended as essential for the successful management of global health care systems. Brazil’s Unified Health System (UHS) is a model for delivering community-based care through Family Health Strategy (FHS) interdisciplinary teams comprised of medical and lay health providers—Community Health Agents (CHAs), nurses, and physicians. This study aims to understand how medical and lay health providers’ perceptions and attitudes could impact the delivery of community-based care. The study compares perceptions and attitudes of 168 CHAs, 62 nurses, and 32 physicians across their job context, professional capacities, professional skills, and work environment. Descriptive and bivariate analysis were performed. CHAs reported being the most efficacious amongst the providers. Physicians reported incorporating consumer-input to a lesser degree than nurses and CHAs. CHAs reported using a lesser variety of skills than physicians. A significant proportion of physicians compared to CHAs and nurses reported that they had decision-making autonomy. Providers did not report differences that lack of resources and poor work conditions interfered with their ability to meet consumer needs. This study offers technocratic perspectives of medical and lay health providers who as an inter-professional team provide community-based primary health care. Implications of the study include proposing training priorities and identifying strategies to integrate lay health providers into medical teams for Brazil’s Unified Health System and other health systems that aim to deliver community-based care through inter-professional health teams.


Community-based primary care Inter-professional health teams Lay health providers Community health workers Global health systems 



The authors thank the Columbia University School of Social Work and the Institute for Latin American Studies at Columbia University for supporting this research with pilot and dissemination funding, respectively. We thank research participants who provided the data for this research. We also thank the following: Estratégia Saúde da Família providers and administrators critical to the execution of this research Ivanete Hindriches da S. Torres, Roselí Monteiro Silva, Gilberto da Silva Dorneles, Paulo de Tarso Machado Assis, Maria do Carmo de Castro Tófani, and Nádia Cristina Dias Duarte; our partners at Universidade Católica Rio de Janeiro Sueli Bulhões da Silva, and Luíza Helena Nunes Ermel; and individuals who provided overall support—Susan Witte, Barbara L. Simon, Myra Sabir, and Anya Y. Spector.


This study was funded by Columbia University School of Social Work and the Institute for Latin American Studies at Columbia University.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Department of Social WorkBinghamton UniversityBinghamtonUSA
  2. 2.School of Social WorkUniversity of MichiganAnn ArborUSA
  3. 3.Daphne Cockwell School of NursingRyerson UniversityTorontoCanada
  4. 4.Department of BiostatisticsColumbia UniversityNew YorkUSA

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