The international impact of the Brazilian Family Health Strategy in Angola, Belgium, South Africa, and the United Kingdom.

The objective of this study was to assess the international impact of Brazil's Family Health Strategy (FHS) through case studies focusing on four countries that adopted elements of the FHS to improve aspects of their own health systems. Cases were solicited from Angola, Belgium, South Africa and the UK and analyzed through a comparative case study methodology. Results show that each country adopted slightly different aspects of the FHS, with a common element being the role of community health workers (CHW) as a means to extend care to the community and, in the case of Angola and South Africa, to supplement the short supply of health workers. Each country team had familiarity with the FHS through literature, personal contacts, direct experience or observation, and partnerships. While each case is at a different level of maturity, with the Angolan and South African teams at a more advanced stage, all faced a set of common challenges in adapting and implementing elements of the FHS, including the lack of formal job categories for CHWs, a tension between more restricted and more comprehensive roles of the CHW, challenges recruiting and integrating CHWs into healthcare teams, and barriers to scaling initiatives up to achieve results at scale.