Fesma was created by the Decree No. 30.616 / 2015, which defines operational guidelines for action in the 30 municipalities of Minor HDI (Human Development Index) to implement measures to support management in health prevention, care and surveillance, as a (priority) focus on reducing infant mortality and maternal health, reduction of hospitalizations due to complications in diabetes, hypertension, access to health for indigenous populations, African descent and other groups with greater vulnerability of health and social assistance.

Contribute to the health indicators reversals such as, infant and maternal morbimortality, hospitalization rates due to complications of chronic diseases and control of neglected endemics.

Municipal Health Secretariats of the municipalities covered by the Program as co-responsible in the planning and execution of the activities developed by the teams;
Municipal Secretariats of Education: health education actions in schools; Municipal Secretaries of Social Assistance: active search and family support;
Extraordinary State Secretariat for Articulation of Public Policies (SEEPP)
Secretary of State for Education (SEDUC)
State Secretariat of Family Agriculture (SAF): Municipal Committees More HDI: identification and mobilization of Communities in the follow-up of actions;
Federal University of Maranhão - UFMA; State University of Maranhão

The working method consists of:
- Health care actions and health surveillance actions in the perspective of transmission of methodology to strengthen local health management;
- Institutional support through the implementation of the instruments of Primary Health Care Planning, training actions for professionals of the health network of the municipality, with the purpose of strengthening the work process and reorganization of Primary Health Care management.
The professionals have a workload of 40 hours per week, executed by a multidisciplinary team composed of: Physicians, Dentists, Nurses, Nutritionists, Psychologists, Physiotherapists, Pharmacists, Physical Educators, Social Workers, Speech Therapists and Occupational Therapists
The dialogue between the Fesma teams and the state coordination takes place through Tutorials that are in charge of systematizing and mediating the demands of the teams. The Tutors are state technicians from the various departments of the Superintendence of Primary Health Care. The development of the work proposal will have as a guiding methodological axis the strengthening of shared public management, stimulating the participation of local subjects and instances of agreement, deliberation and social control (Municipal Health Councils, Municipal Committees More HDI, Regional Interactive Commissions - CIR), based on the reality of the municipalities.

During these 2 years and 8 months of project execution 820.000 appointments were assisted.
In addition to attendance assistance, management support (training, monitoring) thse were carried out:
- 30 municipalities with adherence to the Program of the State Health Force - Fesma; 30 teams of Fesma professionals deployed;
- Teams of trained health professionals and municipal related policies; Improved health risk indicators;
- Phytotherapy project deployed; Deployment of the “Farmácia Viva” project;
- Management support for improvement of goals and indicators with inter-sectoral actions;
- Joint elaboration of 150 Intervention Proposals available to all municipalities;
- Participation in the 25 caravans carried out by the Government, including other municipalities that were not from the HDI Program.

Difficulties or limitations were: geographical density, difficulty in users access to health services, lack of assistance due to non-compliance with the Basic Attention and other related regulations, reference network of assistance and against weak reference. As a way of overcoming, strategies and methods have been developed to ensure professionals and users the guarantee of greater performance and greater resolve, the execution of integrated actions and through a combination of efforts between state and municipalities with inter-sectoriality, trans-disciplinarily and social participation.

The Fesma program presents as elements for sustainability and replicability actions to more than just the 30 municipalities of Minor HDI, through the intervention plan elaborated jointly with the teams of the municipalities, expansion of actions for urban areas of large cities in municipalities with vulnerability pockets for priority focus, mainly pregnant women and children under 1 year old, to reduce maternal and infant mortality, together with support to municipal management in the qualification of the work process in primary care and to improve coverage in Primary Care as recommended by the Ministry of Health.

- Acting in remote and areas of difficult access, in the care of patients with risks, especially children, pregnant women and the elderly.

- Active search of patients of greater social vulnerability and in conditions of precarious clinics.

Social network such as Facebook, Instagram, magazines, books with reports and experiences from municipalities users.