Digital Health coordinated by an enhanced Primary Health Care (PHC) SystemThe late Professor Barbara Starfield was already emphasizing that primary care should serve as the coordinator of care in universal health coverage systems. Primary Health Care (PHC) teams generate demand for other levels of care and provide the foundational clinical and epidemiological records. Therefore, there is a significant risk of creating parallel waiting lines if Digital Health initiatives establish new care pathways that allow patients to access specialty care directly within Brazil’s Unified Health System (SUS), bypassing PHC coordination.
Instead, strengthening Family Health teams (eSF) toward a “version 2.0,” along with targeted funding for uni- and multi-professional residency programs in PHC, could help reduce the unnecessary referrals that are routinely generated within the SUS by team physicians.
Another strategy to bolster eSF teams would be to expand the minimum team composition by adding a new professional role: a “digital assistant,” who could function as a “clinical secretary 2.0” in primary care. This professional would be trained in digital health management and possess strong competencies in informatics. Additionally, it is essential to reestablish the role of Community Health Workers (ACS - Agentes Comunitários de Saúde) in home visits, particularly in the context of an increasingly aging population and the growing reliance on digital communication tools such as WhatsApp. According to the 2022 Brazilian Institute of Geography and Statistics (IBGE) Census, 15.6% of Brazil’s resident population is aged 60 years or older, representing a 56% increase compared to the 2010 Census. In cities such as Rio de Janeiro (21.4%), São Paulo (20.3%), Porto Alegre (19.8%), Curitiba (19.5%), and Belo Horizonte (18.9%), the proportion of older adults has already surpassed or is approaching 20%1.
Once again, Portugal-whose contributions to PHC have long informed Brazilian health policy2-offers a relevant model for adaptation. In Portugal, clinical secretaries are recruited amongst individuals who have completed the 12th grade (equivalent to a high school diploma in Brazil). These individuals may complete an intensive 12-month training program, administered by the Portuguese National Health Service, totaling between 1,200 and 1,400 hours. Upon completion, they receive certification as technical assistants. In Brazil, the Open University of the Unified Health System (UNA-SUS) could play a similar role in delivering this type of Digital Health training.
In the closing years of the 20th century, Brazil innovated by creating the Community Health Worker (ACS) category in the mid-1990s, later formally recognized as a profession under federal law. More than 30 years later, the time has come for another innovation within the SUS, integrated into Family Health teams: the “digital assistant,” with specialized training in health management within the SUS and competencies in information technology. This initiative would provide young individuals graduating from high school with the opportunity to enter the SUS workforce, gain professional qualifications, and contribute to the 21st century digital health ecosystem, with State Health Secretariats and the Ministry of Health playing a central role in financing this proposal.
References
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1 Instituto Brasileiro de Geografia e Estatística (IBGE). Cidades e Estados do Brasil [Internet]. [acessado 2025 ago 25]. Disponível em: https://cidades.ibge.gov.br/brasil/panorama
» https://cidades.ibge.gov.br/brasil/panorama - 2 Soranz D, Pisco L. Reforma dos Cuidados Primários em Saúde na cidade de Lisboa e Rio de Janeiro: contexto, estratégias, resultados, aprendizagem, desafios. Cien Saude Colet 2017; 22(3):679-686.
