Dr. Fábio Luiz Vieira — professional portrait

Territorialisation in Primary Care: Research, Practice and Academic Dissemination

Territorialisation is a core methodology in Brazil’s Unified Health System (SUS), supporting the organisation of primary care around defined populations and socially meaningful geographic areas. More than a mapping exercise, it represents a structured approach to understanding social determinants, health needs, and the dynamics of communities as a basis for planning care.

This page presents a practical and academic experience integrating research, service management, and postgraduate teaching.

Territorialisation as a Health System Methodology

Territorialisation involves the systematic analysis of a defined geographic area — including its population, social context, health needs, and available resources — to guide the organisation of primary care services.

It connects epidemiological reasoning with real-world service delivery, enabling a proactive and population-based approach to healthcare. Rather than a purely administrative process, it requires engagement with communities and adaptation to complex and often fragmented urban environments.

A Research-Action Experience in Urban Primary Care

The current work with territorialisation originated during my Specialisation in Family Medicine at UNIFESP (Universidade Federal de São Paulo), where it was developed as the central theme of my monograph, under the academic supervision of Prof. Dra. Eleonora Menicucci.

This was not a purely academic exercise. The project was conducted as a research-action experience, directly linked to real-world implementation.

At the time, I was acting as:

Manager of the Vila Aparecida Family Health Unit, São Paulo

This dual role allowed the integration of academic reflection with frontline decision-making in a socially complex urban setting.

The territorialisation process involved:

  • Defining catchment areas in a highly vulnerable and fragmented urban environment

  • Addressing informal settlements and physical barriers

  • Balancing equity, accessibility, and service capacity

  • Incorporating community perspectives into planning decisions

This experience demonstrated that territorialisation is not a fixed technical model, but a negotiated and context-dependent process, shaped by real-life constraints and social dynamics.

Postgraduate Teaching and Knowledge Dissemination

Following this experience, territorialisation became a central theme in my academic and teaching activities.

I was invited to teach this methodology in postgraduate programmes, focusing on its practical application in primary care settings. These activities included:

  • Translating theoretical frameworks into real-world implementation

  • Sharing field-based insights from service organisation

  • Discussing the limitations of purely top-down planning models

  • Exploring how territorial thinking supports continuity of care

This teaching experience was developed in collaboration with institutions such as UNESP, contributing to the training of healthcare professionals in primary care.

Territory as a Dynamic Process

A key insight from this work is that territorialisation is not a one-time activity.

Territories evolve continuously due to:

  • Population changes

  • Urban development

  • Shifts in health needs

  • Expansion or reorganisation of health services

Effective territorialisation therefore requires continuous reassessment and flexibility. It should be understood as an ongoing organisational process, rather than a fixed geographic definition.

Relevance for Contemporary Health Systems

Although developed within the Brazilian health system, territorialisation has increasing relevance in international contexts.

Health systems in different countries are exploring:

  • Population-based care models

  • Community-oriented primary care

  • Integration of social determinants into service planning

The Brazilian experience highlights the importance of aligning healthcare delivery with socially meaningful territories in order to improve access, equity, and continuity of care.

Integration of Research, Practice and Education

This work represents an integrated professional trajectory connecting:

  • Postgraduate academic research

  • Leadership in primary care service organisation

  • Teaching and professional training

  • Knowledge dissemination in different contexts

It reflects an approach to medicine in which clinical practice, public health, and education are closely interconnected.

Workshops and International Training

Workshop on territorial approaches to health system organisation — Luanda, Angola, 2012

Academic and Professional Background in Territorialisation

References – Wikimedia Commons