Childhood illnesses among the poor occur within a larger socioeconomic context in which the conditions of poverty serve to instigate and perpetuate the symptoms of disease. Saúde Criança aims to break this persistent cycle of poverty and suffering by providing holistic support to families to address their total well-being, not merely their disease. This is achieved through a multidimensional action plan that addresses all the components necessary to achieve sustainable good health for the entire family, including support in health, housing, income generation, education, and citizenship. By lifting families out of poverty, Saúde Criança’s method represents true recovery for those who suffer.

Problem

Saúde Criança works with families from some of the most disadvantaged neighborhoods in Rio de Janeiro and all over Brazil. The typical family assisted by the program comes from the favelas (slums) and is comprised of a single, African-Brazilian mother with about 3-4 children. Here, they live in abject poverty with little access to government resources and often they have grown accustomed to being marginalized and forgotten by those in power. As a result, they consider themselves to be hopeless and unable to escape from their surroundings. Their dreams of success become forgotten when it becomes a daily struggle just to survive. In this context, acute and chronic medical conditions have severe and long-lasting consequences on not only the family´s health but its overall welfare as well. Frequently, the decision to buy medicine or continue treatment for a sick child means relinquishing dinner for the day or being unable to provide for other members of the family. Even if the expensive treatments are purchased, they are rendered ineffective when the child returns back to the dirty alleyways and cramped housing characteristic of most houses in a favela. Thus, families become poorer, both financially and in spirit, while their health conditions stagnate or even worsen.

Solution

The traditional perspective of medicine focuses largely on the biology and regards good health as simply the absence of disease. This approach ameliorates the immediate health problem but does not represent a long-term solution because it ignores the wider context in which the illness occurs. Poor children may be given medicine at the hospital to treat their diseases but if they return to an impoverished home in the favelas without the means to take care of themselves, they will frequently become sick yet again. This quickly devolves into a vicious cycle of poverty and suffering as the parents must then spend more money and time to tend to their child, further stretching their already meager resources and digging themselves deeper into a rut. In contrast, Saúde Criança espouses a model of healthcare that transcends the typical approach and addresses all aspects that contribute to total well-being, including biological, social, and psychological factors. With tailor-made family plans that address several different dimensions of health at once, Saúde Criança´s methodology treats the root of the problem by bringing the family out of poverty. More than a mere donation, the assistance that Saúde Criança provides supports the family for the long-term by empowering them to become economically and socially self-sufficient. To our knowledge, this is the only systematic anti-poverty program developed and fully-run by members of civil society.

Example

The key to Saúde Criança´s methodology is the Family Action Plan, a 2-year blueprint made in conjunction with the family that outlines all of the major goals the family should aim to achieve in all five pillars of health. Fulfillment of the minimum standards of the plan enables families to become self-sufficient and is necessary for graduation from the program. The goals and strategies differ according to the areas they address: - Health: Saúde Criança provides specialized food, medicine, and technical support to ensure that the child’s chronic or acute illness is well-managed. By the end, every member of the family should be in at least satisfactory condition, as defined by the hospital. - Housing: Homes in poor condition are repaired and refurbished using materials and labor provided by Saúde Criança to have access to basic amenities, such as water, sewage, painted walls, and a roof without leakages. - Income Generation: Family members (particularly mothers) are enrolled in professional training courses where they learn marketable skills that help ensure stable and higher incomes upon graduation. - Citizenship: Saúde Criança provides guidance and legal advice in obtaining official registration documentation, which permits access to government social service programs. - Education: Parents and teenagers attend educational lectures on issues such as nutrition, hygiene, violence and domestic abuse, infant development, family planning, STDs, AIDS, and basic care. In addition, Saúde Criança acts as an intermediary between children and their school counselors.

Marketplace

Saúde Criança is proud to have an official partnership with the municipality of Belo Horizonte in Minas Gerais, which has adopted Saúde Criança’s methodology (Family Action Plan) into its new health policy, “Família Cidadã: Cidade Solidaria.” Saúde Criança is currently working with the municipalities of Rio de Janeiro, R.J. and Florianopolis, S.C., on similar pilot programs. Because the Family Action Plan model is easily adaptable to poor communities all over, working at the federal level will allow Saúde Criança to impact the entire country of Brazil. Besides Saúde Criança’s official partnership with the municipality of Belo Horizonte and with pilot programs in Rio de Janeiro and Florianópolis, it also supports and advises 23 other NGOs that have replicated its methodology. Both of these activities help spread and attest to the strength of its work. Moreover, Saúde Criança collaborates closely with the businesses with which it is partnered. For instance, it worked intimately with McKinsey to develop its data management system and with DM9 to organize its advertising campaign. These efforts have significantly strengthened the organization. Finally, Saúde Criança and Georgetown University have begun to work together to explore the long-term impact of the methodology on families.