o the Editor: The Perspective article by Macinko and Harris (June 4 issue)1 encourages us to contribute to the debate over health care in Brazil in order to clarify several key points. First, Brazil's community health agents have no specialized technical training, which prevents them from fully exercising the functions intended for them. Second, both physical facilities and human resources are inadequate, and examination quotas are insufficient to meet the demand. Health care coverage is often inefficient and provides low-quality services.2 Third, poor integration between primary care and secondary and tertiary care overloads emergency departments. Fourth, underfunding by the federal . . .