Editor's note: This post was written by Vanuza Ramos, a Brazilian journalist and collaborator with Ashoka Changemakers.
In 1991, Dr. Vera Cordeiro realized that the real cause of most pediatric visits to a public hospital in Rio de Janeiro wasn’t illness or accident: it was the children’s living conditions.
“When the patient is discharged, they normally return to their homes, to a social context of vulnerability where they lack conditions to continue treatment,” Cordeiro said. “This makes the condition worsen and the patient must return to the hospital, which is yet another problem for a family already weakened by adverse economic and social realities.”
With other professionals from the Lagoa Hospital technical staff, Dr. Cordeiro set out to break the cycle of hospitalization, discharge, and readmission by transforming the lives of the children and their families. They founded the Saúde Criança Association (ASC) to promote the physical, mental, and social health of children who were patients that were recently released to their families living below the poverty line.
ASC takes a holistic approach to caring for the family of these children, considering not just the health status a single member, but also issues that affect all the family members, including the professional development and income of parents, housing, education, and citizenship. By working in these five areas, the organization aims to provide systematic and integrated services to create an effective economic and social change that benefits the family and the health of the patient.
ASC’s model has been replicated 23 public hospitals in Brazil, aligning health care with combating poverty. The model’s success has been recognized in Brazil and abroad, and now is being more widely promoted by Ashoka Changemakers through the Making More Health: Achieving Individual, Family and Community Well-Being competition.
To join the ASC program, all family members of a recently hospitalized child undergo an evaluation process. The public hospital conducts a screening, and at-risk families are referred to associations that use the Family Action Plan (PAF) methodology.
ASC has developed a database to register families recommended by public hospitals. A team of professionals from a variety of areas—social workers, nutritionists, and psychologists—evaluates the needs of the family group.
After the family is enrolled in the program, this same team monitors them throughout their participation in the project, usually for a period of two years. Upon entering the program, the sick child and their family are followed by a team of health professionals and participate in a series of activities specifically designed for the group.
A Family Action Plan (FAP) is built around the group’s abilities as a way to generate solutions. “The Family Action Plan is the DNA of Saúde Criança,” Cordeiro said. The FAP includes lectures and training courses, consultations with nutritionists, and document registration, as well as other activities that are implemented through partnerships with major organizations and companies.
In addition, more than 700 individuals are ASC volunteers, a testament to the involvement of civil society in the project, and public recognition of their performance.
ASC’s methodology was created and developed collaboratively, with participating families playing a significant role in the process, according to Cordeiro. This may explain the program’s success, which operates a system of “social franchising.”
As ASC grew and its networking became less efficient, it invested in a new management system to guarantee that replication of its methodology would not deteriorate by promoting decentralization and adaptation to local realities of each hospital. The franchise system works through partnerships, all of which meet certain requirements (they must be a nonprofit, involve civil society, and be aligned with the organization’s mission, vision, and values).
ASC conducts training and monitoring of its franchisees. The operating model is not rigid, but the methodology must be followed diligently and carefully so that the program’s ideals are maintained. The main objective of this type of management is “orchestration of knowledge,” Cordeiro said.
An estimated 40,000 people have had their lives transformed by ASC across Brazil. ASC has influenced public policy in the city of Belo Horizonte through the Family Citizen, Belo Horizonte without Poverty program.
Brazil has a very small number of intermediary health care organizations to meet the population’s demands, according to Cordeiro. The absence of this type of intervention aggravates health problems in families, who often have nobody to turn to to help with diseases such as hypertension, diabetes, and other common illnesses.
With rare exceptions, such as Family Clinics in Rio de Janeiro, there is no preventive medicine for low-income populations, especially in the public sphere. ASC’s innovation of the ASC is its management, methodology, and also its sustainability.
ASC has several sources of funding (mainly private dollars), and it intends to expand them further. In addition to partnerships, there is now an ASC Endowment Fund, which receives private donations and aims to ensure long-term sustainability. The ASC is also developing a new source of revenue through economic solidarity, in order to generate income itself and participating families.
ASC is constantly evaluating and evolving its methodology to meet its main objective: to become model that is replicated throughout Brazil and in other countries with similar social conditions. For Cordeiro, “the dream is that every public hospital with pediatric care in Brazil has an ASC nearby, and that other Brazilian municipalities adopt the social methodology as public policy to benefit millions of people.”
ASC has taken steps to improve its governance and sustainability. For the first time, it is negotiating to apply its methodology outside of Brazil, probably in Bogotá, Colombia. The opportunities are endless!
Associação Saúde Criança (Children’s Health Association) was one of three winners of the Ashoka Changemakers Making More Health competition, organized in partnership with Boehringer Ingelheim. It was selected by a panel of expert judges after the Changemakers community voted it a finalist out of more than 470 entries submitted from 82 countries. Read the ASC competition entry to learn more about how it promotes integrated health and social inclusion, transforming the lives of children, families, and communities.