Brazil’s Family Health Program (PSF) is promoting a proactive model of health care delivery in which family health care providers deliver quality basic care to households and communities. The program, initiated in 1994, has successfully and rapidly expanded coverage of primary health care in rural and peri-urban areas, reaching about one-fifth of the Brazilian population (38 million) by 2000.

The Family Health Extension Program ($136 million) is the first of three World Bank loans designed to support the expansion of the PSF to urban areas. The project aims to:

• increase access to and utilization of basic health care services among low-income populations in about 100 of the largest urban municipalities;
   
• improve the quality of family health service provision by developing and strengthening training in the PSF model for health care personnel;
   
• improve the performance and effectiveness of basic health care services through strengthening monitoring and evaluation, management and accreditation systems.

The project is designed to have the following social and economic impacts:

• Regular family coverage by primary care provider located in neighborhood.
   
• Increase in vaccination coverage and reduction of infant mortality.
   
• Reduction of spending for inappropriate but costly hospital admission for low complexity illnesses such as respiratory infections and child diarrhea.
   
• Cost containment through early detection and prevention of illnesses (diabetes, hypertension, cervical cancer) to avoid expensive treatment.
   
• Reduction of out-of-pocket spending by the poor on costs related to transport (to access providers) and drug purchases.