Picture yourself in Rio de Janeiro -- not on Ipanema's gorgeous sandy beach as most of us would -- but in one of the hundreds of favelas or shantytowns that are spread throughout the city. Substandard housing, overcrowding and limited basic services such as poor sanitation systems are the norm. In this context, favela dwellers are overexposed to adverse and unexpected health events, which constitute a major channel for the intergenerational transmission of poverty.
Most poor families must cope with a vicious cycle in which misery and illness lead to hospital admission and subsequent readmission and/or death as a result of poverty and the lack of adequate coping mechanisms. Even more vulnerable to the negative consequences of severe health conditions are single mothers and their children, which represent approximately 25 percent of poor urban households in Brazil.
When severe health problems occur in these circumstances, it is not enough to be able to have access to public hospitals. In addition to the psychological toll of dealing with chronic diseases, there are more bills to pay and a loss of income since someone has to take care of the family member who is hospitalized. It is not enough for these poor families to receive medical treatment since they will go back to living in terrible conditions, with less income, more debt and few opportunities for improving their wellbeing.
The picture is indeed dire, but an innovative Brazilian NGO developed an approach to healthcare that is proven to be effective and which helps families during health shocks to prevent relapse, and generate the conditions for a much brighter future. For over 20 years Saúde Criança -- "Child Health," in English -- has helped thousands of poor families, mostly female-headed households, cope with chronic health problems that affect their children. It does so through fostering partnerships with public hospitals and implementing a co-responsibility scheme with families whose children suffer major health issues such as cancer, brain tumors, or chronic respiratory problems.
Together with the beneficiary family, Saúde Criança's volunteers design a Family Action Plan through which the organization provides direct support in five key areas that create a solid foundation for a better future: health, education, housing, income generation and citizenship. In return, and in order to continue receiving the benefits of the program, family members commit to achieve specific monthly goals such as enrolling in a professionalization course, attending doctor's appointments, sending their children to school, receiving nutritional counsel and participating in workshops on specific topics such as drug abuse, self-esteem and domestic violence, among others.
The innovative work of Saúde Criança relies on successfully bridging the gap between ideas and implementation. The organization developed a comprehensive concept of health that takes into account the biological, socioeconomic and psychological conditions of beneficiaries and implements a multidimensional program that complements medical treatment. Their pioneering work has been recognized across the world, as in The Global Journal and IADB and has expanded across six states in Brazil. Further, its positive effects have been confirmed by a rigorous program evaluation carried out by Georgetown University researchers, who found that there are long-term and sustainable gains across the five key themes, particularly in children's health, housing and employment.
Far too often NGO programs are seen as handouts for the poor, and sometimes it is not enough just to try to do good. Saúde Criança's model shows that a holistic approach to healthcare is an investment that provides positive returns to society by improving the wellbeing of vulnerable and socially excluded families.
Daniel Ortega Nieto -- Georgetown University, PhD candidate.
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