Second Family Health Extension Adaptable Lending

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The Second Family Health Extension Project for Brazil objectives are as follows: (i) increase access to Family Health-based primary care in large, urban municipalities; (ii) raise the technical quality of and patient satisfaction with primary care; and (iii) improve the efficiency and effectiveness of Family Health service providers as well as the broader delivery system. The project components are the following: (i) expansion and consolidation of family health care in municipalities. This component aims at scaling up and strengthening Family Health Program (PSF) capacity at municipal level. The strategic aim is to raise PSF population coverage from 34 to 37 percent in participating municipalities. Coverage extension activities will continue to focus on large urban areas, which are characterized by poorly integrated, traditional service delivery systems and large numbers of families living in poverty and confronting severe social risk; (ii) strengthening state capacity for supervision, monitoring and technical support of Family Health services. This component aims at strengthening state capacity to support municipalities extend coverage, improve technical quality, and manage service delivery; improve the supply, quality and stability of family health teams; and conduct supervision and monitoring as key functions of state health secretariats; and (iii) strengthening federal oversight of the Family Health Program. This component aims at strengthening PSF policy and technical support, and oversight capacity at federal level. This component will strengthen the capacity of the Ministry of Health to provide support to states and municipalities regarding the implementation of the Program. The project lessons learned at inception were: (i) PSF has great potential to improve the coverage and quality of basic care, as well as health outcomes; (ii) successful implementation of new primary care models depends on changes in underlying incentives; and (iii) given the dynamic nature of the Brazilian health system, it is important to allow for flexibility, but within an agreed framework that emphasizes results