Decentralization in Brazil's Unified National Health System is challenging the management capability at the local level. Municipalities are required to operate health teams, provide infrastructure, technology, and supplies for the health services, and organize the work process. An epidemiological survey assessed the management of work, education, information, and communication in primary care services in 41 municipalities with more than 100,000 inhabitants each in the Northeast and South of the country. Health professionals and administrators were insufficiently trained for their daily responsibilities, and the infrastructure and management tools were deficient. Precarious work contracts (lack of formal job stability) for health workers is a serious problem in Brazil's primary care system. The work supervision was weakly linked to health care and planning. Continuing education for the health team was limited, and health information focused only on collection of data to send to the State and Federal management levels. Thus far health communication has been ineffective as a tool to connect primary care managers and professionals to the population and society.