Family rehab in Brazil: A holistic approach to fighting health spending-induced poverty

Operating out of an abandoned horse stable in Rio de Janeiro’s Parque Lage, a brave, forward-thinking program is working to <strong>alleviate poverty in families seeking care for their children—and preventing re-admission when there is no money for medicine</strong>.

Now operating across 28 hospitals, [Saúde Criança]( (Child Health) has grown to inspiring heights since its founding in 1992.

In this interview, ACCESS Health International’s <strong>Virginia Resende asks the program’s founder, Dr. Vera Cordeiro, about her program’s structure including their sustainability model, and vision for future expansion</strong>.

*Virginia: What drove you to start this initiative?*

*Dr. Cordeiro*: Brazil is home to some of the world’s worst social and economical inequalities. In Rio de Janeiro we have around 10 million people, one third of the population, living in a miserable condition. These people live with a terrible choice when one of their children gets sick: feed the children or buy medicine?

I’m a physician and I used to work at Hospital da Lagoa (a public hospital) at the pediatric department. I founded Saúde Criança, to break the poverty-illness- hospitalization- discharge- re-hospitalization- death cycle and to assist not only the children but to restructure their entire families.

*How do you break this cycle?*

We started the Family Action Plan or PAF (Plano de Ação Familiar) to get to the root cause of the problem which is the circumstances of extreme poverty in which many families live. In many cases, mothers give up paid work to take care of their sick child, and the father is normally absent. The family members lack basic information about issues like disease, nutrition, rights and official documents. Through PAF, which we developed with pro-bono assistance from McKinsey & Company, families are provided with free medicine, money to renovate their houses, professional training, and legal support.

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The family attends Saúde Criança’s project for about two years and only graduate from the project after meeting goals. After two years, mothers have completed professional courses and start working. Their income is higher than at the beginning of the program, the children are healthy, living conditions improved, and the family can sustain itself.
Each month 1,000 families are assisted through your centers. The average cost of the program for each family is R$615 (US$362).

*How do you sustain this project?*

We are planning the long-term sustainability through various ways:

* A trust fund with monthly interest currently covers about 25% of our budget; we are expanding the fund so the interest covers 50% of our budget.
* Selling Saúde Criança Products at mall kiosks and online raises financial revenue to promote partial sustainability . This diminshes our dependence on donations.
* Donors can become a godparent and sponsor a child’s PAF

*How did you go about expanding your model?*

We have the ambitious goal of bringing Saúde Criança to every public hospital in Brazil—and abroad, since the same issues affect poor families everywhere. Saúde Criança Lagoa—the first location—will function as the Replication Center in the Southeast.

We have identified potential replication centers in the South, Northeast, and Center West, which will, like Lagoa, train program administrators and organize the project’s activities in the region’s institutions. A pilot project will identify best practices for Replication Centers.

After we received the Skoll [Global Development] Award in 2003, the Avina Foundation sponsored a working group with public and private representation to try to implement the FAP in one of the poorest areas of Belo Horizonte. This was a success and was scaled up to the 26 Centers of Reference in Social Assistance (CRAS) to cover the whole city. Whereas in São Paulo the conditions were more complex and the project didn’t work well.

Another way we want to expand is by influencing public policy in municipalities all over Brazil. We want local governments to use FAP to integrate the different programs and reach more beneficiaries. Compared to state governments, municipalities have a lighter structure. We will approach municipalities with the success case of Belo Horizonte and proposing a pilot project based on our methodology.

*How do you choose organizations to partner with and replicate your model?*

Many come through networks that I am a part of like Ashoka, Skoll, Avina, and the Schwab Foundation. We look for partners that understand our mission and think similarly.

*What are your long term goals?*

McKinsey helped us develop a strategic plan for Saúde Criança and its offspring to develop the governance and replication methodology. The key milestones are the strengthening of the main office at Lagoa to better serve the beneficiaries, function as an innovation lab, and oversee replication. Other goals include improving the management skills of the team, developing a financial plan, improving internal communication, marketing the network, improving Human Resources management, developing a fundraising area and setting up an IT area for the network.

*How can Brazil’s government help support the organization?*

Lending space for us to function in would be a big help. When we got kicked out of Lagoa hospital due to controversy about our project, we had to set up space in a public park, in abandoned horse stables with crumbling walls. Then we faced resistance from the neighbors because this park is located in one of the richest areas of the city. But when our work became recognized, Brazil’s former president formally lent us this space for ten years. This lease will end in 2012. We hope it will be renewed.

*Why was the project controversial?*

Each time we started in an institution the directors, social workers and medical team were suspicious about our intentions. They thought we were linked to politicians who could use the work in future campaigns. We overcame this barrier by presenting on the results of our work and giving the testimony of Dr. Odilon Arantes, the head of Lagoa hospital’s pediatric department at the time. He said we were solving the problem of children being re-admitted to the hospital.

*How has the private sector supported your initiative?*

We have private partners that give support to specific area.

* L’Oreal donates the products used in our beauty classes, such as hair dye and shampoo.
* Senac gave us the methodology that we use in the Income Generation Project.
* The Instituto Lojas Renner sponsors the cooking classes
* Unimed donates dietary supplements and pays a nutritionist’s wages
* Johnson & Johnson sponsors the Aconchego Project and pays a social worker’s salary
* Queiroz Galvão, a construction company, sponsors the Housing Project.
* White Martins-Praxair Foundation sponsors the Income Generation Project, in the Beauty area; they also helped us use their methodology and pay part of our communications budget.
* Ursula Zindel Hilti Foundation sponsors training and pay wages for 10 of our employees
* Skoll Foundation that sponsors the replication of our methodology.

*Do you see many changes in the healthcare sector in Brazil from when you started your career?*

What changed for the better was the decentralization especially at the municipal level, with for instance, the family clinics in Rio de Janeiro. However the inefficient administration, lack of medication and specific exams and analysis is the same.