HEALTH-BRAZIL: Church Group Winning War Against Infant Mortality

By Mario Osava Reprint | | Print |

Mario Osava

RIO DE JANEIRO, Aug 24 2000 (IPS) - The infant mortality rate has plunged in thousands of poor communities in Brazil thanks to the non-governmental ‘Pastoral das Criancas’, whose work has made it a sort of parallel ministry of health.

The group, which belongs to the Episcopal Conference of the Catholic Church, trains 145,000 local volunteers to do outreach work benefitting more than 1.5 million children under the age of six and nearly 80,000 pregnant women in 60 percent of the country’s 5,500 municipalities.

The infant mortality rate in the more than 31,000 communities where the Pastoral is active ranged from 12 to 18 per 1,000 in 1999, compared to a national average of 36 per 1,000 live births in the first year of life.

But a strictly quantitative comparison fails to reflect the magnitude of the feat. It must first be understood that the Pastoral is active only in the “pockets of poverty” where many more children usually die of malnutrition and infectious diseases than in other parts of the country.

Furthermore, the cost of the Pastoral’s work is insignificant: less than one real (55 cents of a dollar) a month per child assisted.

That has been made possible by the unpaid work of community leaders, local residents who mobilise and orient their neighbours in basic health-related actions, such as identifying and treating malnutrition, encouraging breastfeeding, and keeping on the lookout for and treating respiratory ailments and diarrhea, which claim many young lives.

The outreach workers make monthly visits to the 10 to 20 families under their care to provide information on health-related topics and nutritional advice.

Each community also holds a monthly weigh-in of babies in a so- called “celebration of life”, in which people sing and say prayers “to strengthen community ties,” said Zilda Arns Neumann, the pediatrician and specialist in preventive care and hygiene who founded the Pastoral in 1983 and continues to coordinate it today.

Among the 1.5 million children benefitted by the programme, malnutrition plunged to eight percent, half of the national average in this country of 167 million.

There are many reasons for the Pastoral’s success, said Arns Neumann, starting with faith and unyielding dedication to the objective of fighting for life “by helping families deal with their problems on their own.”

Other factors are an information system, with indicators to evaluate the health of each child, periodic evaluations by the central coordinating team of the work in each community, training and educational activities in local communities, and easily reproduced technologies and techniques that adapt well to local conditions.

Over 80 percent of the mothers of small babies assisted by the programme’s volunteers now breastfeed, Arns Neumann added.

The dimension of volunteer work is also a decisive factor, said the coordinator of the Pastoral, because it makes possible more direct and frequent contact and assistance, since the community outreach workers have no more than 20 families in their charge, while health ministry workers attend up to 200 families.

Moreover, the Pastoral is ecumenical, which means it pools resources from a range of areas — from those involved in efforts in health and nutrition to people working in education and in providing sewerage services.

The work and methodology of the Pastoral served as the model for a government initiative, the Community Health Programme, in which agents have provided local assistance to families in specific communities since 1991.

In fact, the first 700 agents working with the government programme were trained by the Pastoral, Arns Neumann pointed out with visible pride.

“We are more efficient where the government agents and community outreach workers work together,” because the volunteers tend to forge closer and more affective ties with the families, and are available “on Saturdays and Sundays as well”, thus complementing the technical capacity of the government workers in their areas of specialisation, she said.

The organisation expanded its activities to adult education, game rooms for children and large community gatherings of 200 or 300 people to evaluate and “celebrate” the progress made, exchange information, and discuss approaches to combatting domestic violence and other issues of concern to local residents.

It also promotes a kind of “community mental health therapy,” with massage to reduce the stress of pregnant women or help elderly persons with insomnia, and other kinds of mutual aid.

The Pastoral, which has gained international recognition, winning awards like the one granted by the United Nations Childrens’ Fund (UNICEF), might be nominated by the Brazilian government as a candidate for the Nobel Peace Prize next year.

The campaign to nominate the Pastoral is backed by health minister José Serra, who sees pastoral action as the most effective kind of effort carried out by non-governmental organisations in social areas.

Of the organisation’s annual budget, just over 16 million reals (nine million dollars at the current exchange rate), 82 percent comes from the health ministry, Arns Neumann pointed out.

Besides contributing decisively to reducing the mortality rate among children under six in Brazil, the Pastoral helps track and sound the alert on infant mortality trends in the country, thanks to the agility of its solidarity network.

Early last year, for example, the Pastoral’s volunteers detected a rise in infant mortality in the poorest parts of the state of Sao Paulo, attributed by the programme’s local coordinator Waldemar Caldin to the increase in poverty.

Brazil’s children were hit hardest by the economic stagnation caused by the country’s financial difficulties and the fallout of the international financial crisis that swept through Asia and Russia in 1997 and 1998.