Breaking the link between Poverty and Poor Health: A Program and Evaluation Plan of Associação Saúde Criança (Brazil Child Health) based in Rio de Janeiro, Brazil
Creators: name: Doshi, Neeti
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2012

description: Introduction Globally, health outcomes and poverty continue to exist in an inverse relationship. As part of a comprehensive effort to promote social justice, the World Health Organization convened a Commission on Social Determinants of Health (CSDH) in 2008 to provide guidance on how to reduce avoidable, unfair and remediable disparities in health outcomes between population groups, both within and among countries. One group that has carried out this approach for over twenty years is Associacao Saúde Criança, a non-governmental organization which has reduced pediatric hospitalization rates for thousands of low-income families in Brazil. Systematic Review As part of an effort to study Saúde Criança, I completed a literature review to identify, describe, and compare existing programs that aim to improve health outcomes among poor and socioeconomically disadvantaged populations in the developing world. MEDLINE and the WHO Global Health Library were searched for original research articles about such programs. The review identified shared accountability between program participants and stakeholders as a key element of program success, and found that evaluations of these programs tend to be difficult and resource-intensive. The review also illuminated the limited evidence base available to programs seeking to address inequities through a holistic approach. Program Plan To provide a detailed description of the activities and elements that comprise Saúde Criança, as well as a contextual and theoretical background to the program, I spent four-weeks on site, observing program activities, reading program materials, and interviewing leaders, workers, and participants. The crux of the program was found to lie in a Family Action Plan that defines five equally important domains of well-being: health, housing, education, citizenship, and income generation. Evaluation Plan In order to contribute to future implementation and expansion of the Saúde Criança model, I developed a process evaluation plan. This plan proposes employing an external evaluator and a multi-dimensional qualitative research strategy including interviews, focus groups, document review, and direct observation. Potential avenues for the dissemination of these results include conference presentations and publication in relevant journals. Discussion After twenty years in practice, Saúde Criança serves as a bridge at many different levels: between public health and medicine; between marginalized communities and their rights as civil members of society; and between the private and public sectors. Their public health impact is evident, and dissemination of their methodology holds great potential to reduce the worldwide burden of disease due to poverty. I am hopeful that the literature reviewed here, as well as the program and evaluation plans provided will help inform future implementation and evaluation of the Saúde Criança model beyond Brazil’s borders.