Rb brazil report august 2012 v1

REPORT PREPARED FOR RECKITT
BENCKISER, BRAZIL

SAVING CHILDREN’S LIVES IN NORTHEAST BRAZIL
Reporting period: 1st December 2011 to 30th June 2012 O
prazo estabelecido está correto. O relatório descreve as ações pactuadas entre a fundação Abrinq e a
Save the Children no sub grant.

OUR LIFESAVING PARTNERSHIP
While Brazil has made progress in reducing child mortality in recent years, over 50,000
children under five still die in Brazil each year, and children in the northeast are more than
twice as likely to die before the age of five as children in the southeast. In recent years,
Reckitt Benckiser and Save the Children have been working together to help ensure
Brazilian children survive, thrive and reach their potential. In June 2011 we held the Reckitt
Benckiser Global Challenge in Brazil. Employees from 33 countries joined forces to renovate
two crèches in João de Deus, a community in the northeastern city of Petrolina. Your
support has also been instrumental in delivering our pioneering work with the European
Commission which aims to ensure that children under five in Pernambuco and Bahia get the
care, nutrition and stimulating early education and care that they need to thrive. You have
also helped us to raise awareness of children’s rights across Brazil, through cause related
marketing on packs of Bom Ar, and through a publication of "Fundação Abrinq - Há 20 anos
a voz das crianças no Brasil”, a book celebrating our achievements for Brazilian children
over the last 20 years.
Your support is helping us to reach 18,000 children in Bahia and Pernambuco, ensuring that
they survive and thrive in their first five years. Your support is helping us roll out our
innovative child health and nutrition project to a further 17 municipalities, and to launch a
pioneering maternal and infant health programme across 8 municipalities – tackling the 80%
of under five deaths that happen in a child’s first year of life.
In this report, prepared for Reckitt Benckiser, we share our achievements
together for children over the last seven months.

EXECUTIVE SUMMARY
The purpose of the Saving Children’s Lives in Northeast Brazil project is to
contribute to reducing maternal and infant mortality for children up to five years of age in
the states of Bahia and Pernambuco. The project works in targeted municipalities to provide
technical support to maternal and infant healthcare services, systematise and disseminate
experiences in comprehensive care services for children, work at the municipal level to
encourage exchanges of effective experiences in child and women’s health, as well as
strengthen the participation of civil society in actions addressing child and women’s health
and sexual and reproductive rights.
Together with the Fundação Abrinq-Save the Children Executive Manager for Programmes
and Projects and the Pernambuco State Coordinator for Programmes, we worked to
address the key aspects that needed to be structured and implemented within the Saving
Children’s Lives in Northeast Brazil project. This included establishing the project
baseline, interaction with project partner CNMP (Centro Nordestino de Medicina Popular –
Northeast Centre for Popular Medicine), defining adjustments to the project monitoring

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plan, establishing the timeline for implementation of project activities and planning activities
and coordinating efforts with actors engaged in the project.
After developing the project baseline, we analysed the municipalities with the highest infant
mortality rates and, consequently, those in most urgent need of related interventions. The
project was structured to work in two phases: the first phase was initiated in 2012, targeting
the municipalities of Ipubí, Trindade, Ouricuri and Cabrobó; and the second phase will begin
in 2013, targeting the municipalities of Santa Maria da Boa Vista, Petrolina, Juazeiro, Afrânio,
Santa Filomena and Lagoa Grande. Meetings were held with municipal and regional
authorities/managers and civil society actors to present the project and discuss the
respective strategies and activities to be carried out.
Preparatory meetings were held with the social service trainers who will carry out activities
to build the capacities of professionals and leaders to begin implementation. We are also
working to produce the informative materials that will be distributed, as well as putting the
necessary logistics into place for conducting training activities.
There was however some delay in some activities due to the municipal elections in Brazil
this year, with public health service professionals quite engaged in the election process and
hence unavailable to participate in training activities. The communities have been increasingly
receptive to mobilisation efforts and the election period has helped to increase the level of
importance given to the need for strengthening public policies and services for children and
adolescents, especially in relation to infant mortality.
The strategy for the Stork Network initiative is comprised of a series of measures within
the Single Public Health System (SUS) to ensure that all Brazilians have access to adequate,
safe and humanised services from the moment that pregnancy is confirmed, through pre-
natal care and childbirth, up to the first two years of the baby’s life. The federal
government’s commitment has come in response to an intense mobilisation effort on the
part of civil society to defend early childhood, principally through efforts by the National
Network for Early Childhood, of which Fundação Abrinq-Save the Children and project
partners are members. The goal now is to ensure implementation of the abovementioned
government projects to benefit all children 0-5 years of age in the country and support the
municipalities benefited by the project in order to develop and implement strategies to
address maternal and infant mortality, thereby guaranteeing a healthy, protected and happy
childhood for thousands of children.

OUR ACHIEVEMENTS

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OBJECTIVES & ACTIVITIES
PROJECT GOAL: By 2016 to contribute to reductions in under five and
maternal mortality in Pernambuco and Bahia states, Brazil.
OBJECTIVE 1: To improve the quality of community health services and
uptake of maternal health services in 10 municipalities of Pernambuco and
Bahia, Brazil
1.1 Develop an accurate situation analysis of maternal and infant mortality in
ten municipalities.
The situation analysis of maternal and infant mortality in ten municipalities was carried out in
collaboration with research centres located in the region, represented by the Federal
University of the San Francisco Valley (UNIVASF – Universidade Federal do Vale do São
Francisco).
Save the Children, Fundação Abrinq and representatives from the University met in July to
jointly develop the assessment and establish the institutional terms and commitments. Four
professors from the institution participated in the meeting, representing two research
laboratories (LETRANS – Trans-disciplinary Health and Education Laboratory – and the
Education Observatory), as well as three members of Fundação Abrinq-Save the Children.
The meeting led to an agreement to work in collaboration with the research groups
coordinated by the respective professors, involving university students in carrying out the
activities. It was also decided that primary sources would be used for data collection,
thereby enabling a deeper understanding of the data available in each municipality, providing
on-site observation in regards to situations of vulnerability for expecting mothers and
children. Also in regards to data, the group determined that indicators for project results
would be part of the analysis, such as:
• number of high-risk pregnancies monitored by healthcare centres

• number of avoidable deaths

• number of births by natural methods and caesareans

• infant mortality rates

• causes of death

• number of pre-natal consultations

• initiatives carried out by infant mortality committees

• number of low-weight newborns

• number of children up to six months old who are exclusively breastfed

• number of pregnant adolescents

• expecting mothers having access and intake at healthcare centres

• reproductive health planning in municipalities

• social participation of women in negotiation mechanisms for healthcare

• socio-economic conditions of expecting mothers

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• degree of vulnerability among women that undergo abortion and/or lose a child during the
first year of life.

It was also proposed that the research be divided into two phases:
The first phase, denominated as a pilot process, will be carried out in two municipalities
during the second semester of 2012, entailing the collection and analysis of data. Data
collection instruments will be evaluated and adjusted as needed in regards to data collection
in the remaining municipalities.
The second phase will be carried out in the first semester of 2013 and will cover all ten
municipalities targeted in the assessment, utilising collection instruments that have been
adjusted as needed. It was proposed that the main objective of the assessment would be to
deepen the analysis of public policies at the municipal level in regards to expecting women
and care for newborn children, thereby providing recommendations to municipal
authorities/managers. Finally, it was determined that an agreement would be developed for
collaboration with UNIVASF in order to establish all operational aspects pertaining to the
research initiative.
1.2 Train 250 existing community health professionals in antenatal care,
family planning and gender, birth preparation and newborn care.
In June, we met with the Project Coordinator from the Northeast Centre for Popular
Medicine (CNMP) in Recife to develop the first proposal for the training of health
professionals from the Municipal Health Secretariats. We also discussed the Saving
Children’s Lives in Northeast Brazil project, specifically including:
• The municipalities that will participate in activities during the first year (Ipubi, Trindade,
Cabrobó and Ouricuri).
• Priority themes to address, specific to each site.
• How the Fundação Abrinq-Save the Children Project Leader will head the process for
establishing linkages with the municipalities.
• Developing a work plan, an operational agreement and an action plan for CNMP, as well
as delineating its responsibilities and activities within the project.
CNMP’s staff has extensive experience in working directly with communities in the semi-
arid Sertão region of Pernambuco, and collaborating in the implementation of research and
mobilisation efforts with civil society to empower the most vulnerable groups. CNMP has a
track record of implementing actions in partnership with Fundação Abrinq-Save the Children
through the ‘Children with All Their Rights’ programme, working in the consolidation of
networks involving civil society actors towards developing public policies for children, as
well as in carrying out health-related actions in areas such as food and nutrition, medicinal
plants and holistic health practices, among others.
As part of the efforts planned for implementation in conjunction with the municipalities,
CNMP will carry out activities with healthcare professionals that will address pre-natal care,
family planning, preparation for childbirth and caring for newborns. CNMP will address
problems related to infant and maternal health, ensuring that women receive support during
pregnancy and are oriented to complete the six pre-natal exams.
In June, CNMP provided all of the information required for formalisation of the agreement,
although there is still a need to organise the work plan and adjust the action plan.
Negotiations dealt largely with the issues of equipment maintenance and the CNMP facilities.

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Once discussions were finalised, the final version of the abovementioned documents were
submitted in July to the Fundação Abrinq-Save the Children Legal Department for analysis.
We continued discussions with CNMP in July, particularly with the nurse-obstetrician who
will carry out the training of municipal managers in August, and training workshops for
healthcare professionals in September and October. A total of 100 healthcare professionals
working in maternity hospitals, Basic Health Centres and the Mother Owl Programme1 will
be trained in quarters three and four of 2012.
This activity was initially planned for implementation in August, however due to the
upcoming Brazilian elections the relevant professionals are heavily engaged in the political
campaigns for mayor and legislative councils, making it difficult to establish a feasible
schedule. On several occasions we had to reschedule meetings with municipal managers, in
addition to the training meetings, in order to reach a consensus on the timeframe.
1.3 Support ten municipal health departments to improve their maternal and
infant health services.
We are working with CNMP to carry out a training activity in August for 60 healthcare
services managers, including coordinators of services in Sexually Transmitted Diseases/AIDS,
epidemiology, maternity wards, basic care, hospitals, nurses and health secretaries, among
others. The nurse-obstetrician will conduct workshops to provide municipal health
secretariats with needed support to develop strategic planning initiatives in healthcare,
aiming at increasing targeted services for expecting mothers, mothers in postpartum and
their children in the municipalities targeted by the project.
Training will take place in the municipalities of Ouricuri, Trindade and Ipubi in August.
1.4 Produce maternal and infant health awareness materials
Informative materials, such as banners, information material in folders, and posters are being
produced and will be ready in September. Information highlighted in the folders will address
health-related issues to orient expecting mothers on pre-natal, childbirth, postpartum and
caring for newborns.

OBJECTIVE 2: To mobilise and raise awareness of maternal and infant
mortality and sexual and reproductive rights in ten municipalities of
Pernambuco and Bahia, Brazil.
2.1 Train 150 Reproductive and Maternal Health Promoters
In June, we began mapping leaders in the targeted municipalities, through the work of a
Social Educator working in collaboration with the CNMP, with a goal to train 60
reproductive and maternal health promoters in 2012. We are working to design the training
in coordination with the Rural Workers Union, women’s movement, church-based child
services and community health agents.
The course consists of two modules: the first eight-hour module addresses sexual and
reproductive rights, while the second eight-hour module addresses themes related to
family planning. The first module began in the first week of August in Ouricuri. The
workshop was held at the Community Health Agents Association over a 16-hour period,
with the participation of 15 women. Discussions focussed on the sexual and reproductive
rights of women in Brazil and ensuring these rights in the region. The facilitator raised the
1
MÃE CORUJA (Mother Owl) is an initiative of the Pernambuco state government which works with pregnant women
through SUS (the state health system). In this project, Mäe Coruja will support us to identify pregnant women in the
community, support us in delivering maternal and child health awareness, and in our work to
improve municipal health services.

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serious dilemmas related to infant and maternal health in the municipality and in the state of
Pernambuco, helping these women to better understand their rights and in turn make better
decisions in relation to their bodies, accessing pre-natal care and preparing for childbirth.
Each one of the promoters will train an additional 20 persons, who will work in their
respective communities to raise people’s awareness on the serious problems related to
infant and maternal health.
2.2 Carry out 40 community drama events (four per municipality)
In June, we began to identify entities in the region that carry out educational activities in
communities through street theatre methodologies, and met with two representatives in
July from theatre groups working in the region in order to begin negotiations for the
development of interventions with populations targeted by the project. Presentations were
made on the themes (sexual and reproductive health, the importance of pre-natal care,
childbirth, postpartum, risks during pregnancy, caring for newborns and exclusive
breastfeeding), that should be addressed with the population, locations where these
activities can be carried out and definition of municipalities. We then requested the theatre
company to provide information on all related aspects pertaining to logistics, administration
and finances in order to implement these activities.
To finalise the development of the theatre proposal, we will analyse the content of the
theatrical presentation once it is ready and adapt the language in order facilitate
understanding by the general public, as well as identify the areas that tend to attract a large
concentration of people in the municipalities and plan the logistics for conducting the
activity. We intend to initiate activities in the second half of August in the four municipalities
targeted for the first year of project implementation. Three presentations will be made in
each location through to November 2012.
2.3 Deliver 20 radio programmes on issues related to maternal and child
health
Following are the themes to be addressed in radio presentations which are being developed
in August, and will be aired on local radios starting September:
Programme 1 Health for expecting mothers: Healthy posture and the right to quality pre-natal
care
Programme 2 The right to humanised childbirth and quality care
Programme 3 Care during the baby’s first days of life and the importance of exclusive
breastfeeding through the first six months
Programme 4 Avoidable early childhood diseases and the importance of childhood vaccinations
Programme 5 The importance of nutrition in the development of children during early
childhood
Programme 6 Potable water and basic sanitation contributing to the health of expecting
mothers and children

OBJECTIVE 3: To improve the capacity of civil society groups on a municipal,
state and federal level to advocate for improved and better funded reproductive,
maternal and child health services
3.1 Develop state-level maternal and infant mortality reporting systems in
Pernambuco.

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This activity is planned for Year two of the project, building on a set of experiences that
have proved successful and been developed in the municipalities as a result of training for
committees, technical work groups and healthcare services teams. As in the case of
developing new expertise in the municipalities, we will organise workshops that are capable
of meeting the new demands that arise for improving notification of cases of infant mortality,
thereby improving the quality of related information.
3.2 Train 200 Community Maternal and Infant Health Advocates to represent
women in their communities
In conjunction with Activity 2.1, we will initiate a phase to collect information on the
institutions and leaders in the municipalities targeted by the project, through the work of
the Social Educator, working with CNMP in the training of 60 health defenders in 2012. We
are working to provide training through the Rural Workers Union, women’s movement,
church-based child services (pastoral) and community health agents. Training meetings will
be held in communities, union facilities and community residents’ associations, addressing
issues related to women’s rights, healthcare policies, public protection services, community-
driven oversight, conflict mediation and development of the social protection networks. This
will enable women to understand their rights and make better decisions in relation to
preparing for childbirth and in regards to family planning.
Activities for this action are planned to take place in August in Ouricuri and Ipubi
municipalities, led by the Social Educator. 15 women representing their communities will
participate in the training, which will strengthen civil society oversight efforts by Community
Health Committees towards defending the sexual and reproductive rights of women. These
committees will work as focal points for identifying and bringing to light problems existing in
the public healthcare system, including the Municipal Maternal and Infant Mortality
Committees (see section 3.3).
3.3 Set up or improve ten Municipal Infant and Maternal Mortality
Committees
The Infant Mortality Committees are inter-institutional entities of a predominantly
educational nature, comprised of governmental institutions and civil society organisations
and with multiple professions represented. Their function is to identify stillbirths and infant
deaths and provide visibility and oversight, as well as monitor cases. They constitute an
important instrument for evaluating healthcare services, as well as providing guidance and
input on public policies and service interventions, contributing to improved knowledge
regarding deaths and reducing mortality.
In July, we participated in a meeting of the IX Regional Health Administration (IX GERES) in
the city of Ouricuri, together with 11 Municipal Health Secretaries, the Regional Health
Director, the Regional Coordinator for the Mother Owl Programme and ten technical staff
members working on child health in these municipalities. Along with our presentation of the
Saving Children’s Lives in Northeast Brazil project, the meeting agenda focussed on
analysing data on infant mortality in this region and the project’s investment in developing
the Municipal Infant Mortality Committees.
We were informed at the beginning of the meeting that these municipalities do not have
their own committees due to the lack of paediatric physicians in the respective areas (this is
a standard requirement that must be met to officially institute the Municipal Committee).
Each municipality has alternatively established a Technical Work Group, which analyses
reported deaths, though not in an in-depth manner, and follows up by submitting
observations to the Regional Infant Mortality Committee, whose role is to bring the cases to
closure and report the causes of death.

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As a result, it will not be possible to meet the goal of creating ten Mortality Committees in
municipalities targeted by the project. Instead, we will work to strengthen the Technical
Work Groups and strengthen/enhance the effectiveness of the Regional Committee.
Several actions and planned activities within the scope of the Regional Committee were
presented at this meeting, such as training of Technical Work Groups in each municipality
and workshops with healthcare professionals regarding the death notification process. In
order to avoid duplication of activities planned by the government, we reached an
agreement with meeting participants that the Saving Children’s Lives in Northeast
Brazil project would strengthen activities already planned, including, encourage and
stimulate improvements to the quality of information on mortality, with increased coverage
for information systems, improved records on death reports and birth records and
developing proposals to create public policies aimed at reducing infant and peri-natal
mortality at the municipal level.
We will participate in the next Regional Committee meeting in August to organise a
schedule of activities.
3.4 Share learning and best practice developed in the project
This activity is planned for November 2012, with the objective of broadening the debate on
infant mortality, its causes and possible intervention strategies. We will carry out a seminar
in collaboration with civil society and government in order to present and discuss diverse
practices related to the theme, as well as present proposals for Year two of project
implementation.

OBJECTIVE 4: To improve the quality of early childhood health, nutrition and
education services for 13,000 children under five in 17 municipalities of
Pernambuco and Bahia. Leveraging funds from the European Commission, this
objective will be fulfilled in phase one of the project. We will then deliver our maternal
and infant health programme in six of these municipalities in phase two.
This section needs to summarise the activities and achievements of the whole EC
programme, not just the budget lines funded by RB
4.1 Train community health professionals
We began training for municipal technical teams in the Mother Owl Programme on
providing maternal and infant healthcare, as part of the ‘Children with All Their Rights’
programme. Two classes were structured; one in the town of Salgueiro and another in Serra
Talhada, each comprised of 32 professionals – including two technical staff from the Mother
Owl Programme and one teacher from the Education and Culture Circles in the cases of
municipalities where there was no Mother Owl Programme in place. Two professionals
from the Basic Healthcare System were invited to participate from sites where there was no
such programme. Local Coordinators also participated in both classes. In addition to
representatives from the 16 new municipalities, these classes are also comprised of new
technical staff that was hired in municipalities from the first phase of the programme (as a
result of the public employee hiring process for staffing the Mother Owl Programme, which
led to several substitutions).
These professionals will receive training from January to October (ten months) and will take
on the commitment to work during this period as multipliers, training an additional 20 basic
healthcare professionals in their municipalities. These professionals will thus be able to
improve the quality of services to children up to five years of age and incorporate

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methodologies such as the International Child Development Programme (ICDP) and
Nutritional Education for families receiving services.
The positive results from the training of professionals in municipalities from the first phase
of the ‘Children with All Their Rights’ programme has led the General Coordinator of the
Mother Owl Programme to invite the ‘Children with All Their Rights’ programme to train all
of the professionals and incorporating the ICDP and Nutrition Education methodologies in
the 105 municipalities in Pernambuco where the Mother Owl Programme is operating.
4.2 Train teachers and carers
An evaluation of the ICDP was carried out in November 2011 and identified several
challenges for providing continuity in disseminating the methodology to professionals and
families engaged in the Mother Owl Programme. The ICDP methodology seeks to
strengthen relations within families and interactions between adults and children,
encouraging a family environment that ensures a greater level of protection, safety and
affection.
Despite the positive results achieved in 2011, the evaluation brought out the need to
intensify training for healthcare professionals, including nurses, professionals from the Family
Health Support Centres and community health agents, as well as teachers from the
Education and Culture Circles who provide literacy training to mothers reached by the
Mother Owl Programme. The purpose of the abovementioned training is to ensure that the
utilisation of the ICDP methodology with families is incorporated into the routines of these
professionals, as opposed to being limited to periodic interventions.
A planning meeting took place in April with technical teams from the Mother Owl
Programme in each municipality to organise a complementary training session with new
healthcare professionals and staff from the Education and Culture Circles. The training
focusses on the ICDP and nutrition education methodologies, seeking to increase the
number of professionals from these areas with the capacity to utilise these methodologies
with the families to whom they provide services. Based on the previous experience working
with families, there was a need to adapt the ICDP and Nutrition Education methodologies
for services that are provided in homes, given that these methodologies were originally
designed for direct application with mothers groups to foment the exchange of experiences
and peer education.
However, we have found that for families living in rural areas or in communities located in
remote areas, it is very difficult for them to get to the town centres, thus making it
impossible for them to participate in meetings with healthcare professionals and other
families. Based on this finding, the technical teams from ICDP and CNMP that are
responsible for the entire Nutrition Education action are adapting their methodologies to
home-based services, such that community health agents can work with families on an
individual basis during their monthly visits to each residence. This has also provided an
opportunity to intensify these professionals’ commitment to applying the methodology,
giving them the understanding that it is not just another task, but rather a tool that can
facilitate the activities that already comprise their daily routines.
The ICDP and CNMP teams worked extensively from January to April 2012 to revise the
methodology and produce didactic materials to support the work of targeted professionals,
with special emphasis on producing the ICDP nutrition education poster, album and video.
The work with new professionals began in June and will take place in 13 municipalities. The
ICDP team conducted visits to nine different municipalities (Petrolina, Santa Maria da Boa
Vista, Santa Filomena, Exu, Cabrobó, Orocó, Parnamirim, Araripina, Ouricuri) during the
months of April and May in order to carry out planning for these activities. Meetings were

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held with local technical professionals from the Mother Owl Programme, seeking to
establish strategies for ensuring multiplication among new professionals and families, taking
into consideration the peculiarities of each municipality. A consensus was built among all the
municipalities around three issues that represent challenges for this activity in the coming
period:
1. Overcoming logistical difficulties in the municipality
2. Containment of costs incurred by the municipality in light of the election period
3. The current drought; and the multiple demands placed on the Mother Owl
Programme technical staff, limiting their time and availability.
In order to meet these challenges, the Fundação Abrinq-Save the Children team and the
Mother Owl Programme management team are working together to seek strategies that can
minimise these risks and increase this action’s potential for professionals working with
families, so as to guarantee that a maximum number of families can be benefited by the
activities that are underway.
Plans for the coming semester are to train an additional 260 professionals (13 municipalities
x 20 professionals), thereby disseminating the methodologies to 6,500 individuals (260
professionals x 25 families) and achieving the target established for the project.
It is important to emphasise that the professionals who have already been trained through
the programme during 2010 and 2011 have been undergoing a monitoring process. When
asked about the principal changes that have occurred as a result of the training, 59% of the
professionals interviewed expressed that the most significant changes are related to
improvements in their own individual professional methods. At the same time, 18% indicated
that the most positive results are related to families that benefit from a greater amount of
information, contributing to positive changes in family relations, which is reflected in greater
care and attention to the health and well-being of their small children. Further, 9% of the
professionals reported that the training led to changes in their own family relations.
Based on the theoretical and practical knowledge obtained through this training,
professionals were asked about the manner in which early childhood care is occurring within
their own professional activities. 43% affirmed that their on-going care services to children
have intensified, thereby guaranteeing basic rights, whereas 18% broadened their activities in
the promotion of the health and well-being of children, such as vaccinations and nutritional
monitoring. In addition, 14% of the professionals affirmed that they are seeking to provide
early childhood care services through the use of activities based on play and entertainment.
This data reinforces the importance and effectiveness of the work carried out, pointing to
the achievement of one of the programme goals to be reached through training
interventions – specifically, the expansion of the capacities of professionals in providing care
services to children up to five years of age and thereby improving the quality of care services
towards providing comprehensive care. In other words, guaranteeing integrated actions in
health, education, nutrition and protection.
4.3 Carry out health, hygiene and well-being education programmes for
mothers, families and community leaders
This activity was planned for the month of July, however, it has been delayed as the
materials to be provided by the Reckitt Benckser group have not yet been provided. This
activity will be undertaken as soon as these materials are made available.
4.4 Facilitate the establishment of community groups

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This activity is underway for mapping the potential for mobilising civil society. A document
was produced based on the data collected in the 16 new municipalities. This data was
tabulated and analysed and will be presented in the next TAG meeting. Results from the
mapping exercise will be utilised to orient the mobilisation strategy and networking of civil
society for fomenting a municipal early childhood network.
4.5 Build government capacity
The Saving Children’s Lives in Northeast Brazil project is incorporating mapping
activities on the potential of civil society mobilisation that is underway through the Children
with All Their Rights Programme, in conjunction with the NGO, Acari. Through a pre-
designed questionnaire, the mapping exercise was directed at institutions that make up the
child rights system, such as: Guardianship Councils, Child and Adolescent Rights Councils,
Church-based Child Services, Day Care Centres, Unions (Rural Workers Union - STR – and
the Family Agriculture Workers Union – SINTRAFE) and NGOs.
An instrument is being produced for data collection in 16 municipalities, where data will
tabulated and analysed for presentation during the next TAG meeting. Results from the
mapping exercise will be utilised to orient the mobilisation strategy and networking of civil
society for fomenting a municipal early childhood network.
The ‘Children with All Their Rights’ programme has been supporting and advocating for
governments, society, care providers, mothers and fathers take on and fulfil their
commitments pertaining to early childhood, contributing to the improvement of conditions
for the development and survival of children up to five years of age from excluded
populations in the semi-arid region of Northeast Brazil. The mapping exercise has provided
an instrument for facilitating actions carried out by partners in the municipalities – towards
building a fundamental understanding of the reality faced by institutions responsible for
guaranteeing the rights of children during early childhood.

CHALLENGES AND LESSONS LEARNED
We have faced some challenges in our mobilisation efforts with public healthcare services,
due to an election year in Brazil, and the limited schedule available by the Municipal Health
Secretariats to participate in project activities. We are working with managers in order to
arrange these meetings, wherever possible. The strategic approach adopted has been to
focus mobilisations at the community level, as the election period has heightened the
importance given to ensuring public policies and services for children and adolescents,
principally in addressing aspects related to infant mortality.

By October, we will have carried out mobilisation efforts with public service actors and
activities targeting the population at large. Priority will be given to the training of health
promoters and community leaders, along with health-related social marketing. Once newly
elected administrations are in place in Year two of project implementation, training
interventions targeting the government will be intensified.
THE DIFFERENCE WE ARE MAKING
Beneficiary Target To date
Children under five with improved access to 13,000
essential health, nutrition and early education
services.

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Infants with better chances of survival thanks to a 5,000
safer birth and being better cared for by their
mothers and health professionals in their first days
and years of life.
Pregnant women supported by trained health 5,000
staff who are able to support pregnant women to
plan for their pregnancy, get their six antenatal
checks, detect danger signs during pregnancy and
support mothers and their babies’ first days of life.
Women of childbearing age will have improved 3,000
knowledge of their sexual and reproductive rights,
family planning and the need to access antenatal
care and will be trained to share this knowledge
with others in their community.
Community members – both men and women 5,000
- will have been reached through community
drama events and be aware of issues of maternal
and child health, sexual and reproductive rights and
gender.
Health professionals with improved knowledge 250
of lifesaving antenatal care, birth preparation and
newborn care skills
Health promoters trained and active in their 150
communities, spreading the word about
women’s and children’s right to health, the need to
use health facilities and healthy practices.
Women trained in legal issues related to 200
gender, reproductive rights and maternal
and infant health and are participating in
community committees.
Of these defending these rights on municipal 50
government forums.
Municipal and two state governments are 10
better informed on issues surrounding maternal
and child health in their community and have a
proven model to address this.

VITAL GIFTS IN KIND
Gifts in Kind which have been received
Gifts in kind distributed
Photo of distribution

UPDATE ON CRECHES
P12

CASE STUDY
JOANA’S STORY, CABROBÓ, PERNAMBUCO STATE
Joana was born on March 15, 2012 in the city of
Cabrobó, located in the interior region of Pernambuco
State, in the semi-arid Sertão region of Northeast Brazil.
Joana came into the world by caesarean childbirth, born
prematurely and with a low birth weight (1,315 grams).
She remained hospitalised for 30 days and upon being
discharged from the hospital her weight was 1,580
grams.
During pregnancy, her mother – Simone – only went to
three pre-natal medical consultations, since her
menstruation cycle was usually irregular and she thus
only discovered she was pregnant after three months. In
the fifth month of her pregnancy, she developed swelling
in almost her entire body and it was only at this point
that she pursued medical assistance. She also suffered
from pre-eclampsia and the risk of aborting during pregnancy, and was hospitalised for three
days in the ICU prior to going into labour at the HDM/IMIP Hospital in the town of
Petrolina.
In talking about her pregnancy, she said:
“It was an unplanned pregnancy, but I accepted it, you know, he (her husband)
was the one who kind of didn’t accept it…but now he loves her so much”.
Simone is 25 years old, has two daughters (the other one is five years old), and has been
pregnant four times and aborted two times. She studied till the fifth grade and is currently a
stay-at-home mother. She is married to Jhonatan, who is 21 years old and works as a bus
fare collector, working only one shift (he alternates weeks working mornings and
afternoons) and is responsible for the monthly family income equal to one minimum wage.
Jhonatan is only the father of Joana, as Simone’s other daughter, whose name is Itawana, is
from a previous marriage that lasted six years with a man from the municipality of Serra
Talhada. He was murdered when Simone was seven months pregnant and Simone did not
register her daughter’s birth under the father’s name. Simone came to Cabrobó after the
incident and still keeps in touch with the family in Serra Talhada. She also has an aunt and
cousin who live in Petrolina and with whom she keeps in closer contact. Her little five-year
old does not go to a day care centre, but she is enrolled in a neighbourhood day care and,
according to Simone, her current husband recognises the child as his daughter and has an
excellent relationship with her. The family of Itawana’s biological father does not maintain
any contact with her, nor do they help financially or emotionally in raising the child.
The family lives in a house on a street, where they share five rooms and live close to
members of Jhonatan’s family (aunt, uncle, stepfather, mother and sister). Upon entering the
grandmother’s house, the first thing you see is a beautiful photo of the two children hanging
on the wall.
In regards to Joana, she continues to be breastfed – she was breastfed exclusively through
the first three months. Presently, in addition to mother’s milk, her diet consists of porridge

P13

and blended fruits five times a day, according to her mother. The child continues to have
low weight, weighing five kilos at five months of age (the last time she was weighed),
constantly has a cold and utilises a nebuliser to treat the “wheezing in her chest”. Her
mother does not participate in postpartum check-ups for the child at the healthcare centre,
taking the baby there on a sporadic basis. When she gets sick, Simone buys medication on
her own at the pharmacy. She had the Guthrie test done on the baby, but has yet to receive
the results. Her vaccinations are up to date, with the exception of the vaccination against
meningitis. In regards to family planning, Simone is not using any contraceptive methods,
stating that she has tried them but because she was unable to get to the doctor for
assistance, she gave up.
As such, the Saving Children’s Lives in Northeast Brazil Project, funded by Reckitt Benckiser, is
working to complement actions carried out through the Children with All Their Rights
Programme, defending and promoting the rights of children and adolescents, with a key
component targeting maternal and infant mortality. Our activities are divided in two phases:
the first phase entails interventions in four municipalities and the second phase will target
another six municipalities, with the objective of working in conjunction with these
municipalities in order to guarantee the right to life for expecting mothers and children. Our
work is aimed at improving access to healthcare services, especially pre-natal, childbirth and
postpartum, as well as early childhood care services. To do so, we are investing in the
training of healthcare professionals, teachers, parents and community leaders, also providing
educational material to the general public, promoting participation and providing support to
sexual and reproductive healthcare for women.
It is our conviction that with this contribution we will foment changes in public policies and
services in the municipalities targeted by the project and in turn be a catalyst for
modifications in their healthcare systems, ensuring improved access for expecting mothers
like Simone and more quality care for children like Joana.

FINANCIAL REPORT
Year 1 - Spending
Description GBP to date Observations:
1.1 Develop a situation analysis of
maternal and infant mortality 7,194 0
1.2 Train 250 health professionals 7,194 0
1.3 Support 10 municipal health
departments 5,791 0
1.4 Produce health and hygiene awareness
raising materials to distribute to families 5,396 0
Subtotal 25,576 0
2.1 Train 150 Reproductive and Maternal
Health Promoters 7,194 0
2.2 Carry out 40 community drama events
& 20 radio programmes on maternal and
infant child health 7,194 0
Subtotal 14,388 0
3.1 Develop maternal and infant mortality
reporting and notification systems. - -
3.2 Train and support 200 Community
Maternal and Infant Health Advocates and
create 10 Community Health Committees 5,396 0

P14

3.3 Set up or improve 10 Municipal Infant
and Maternal Mortality Committees - -
3.5 Share project learning and best
practice. - -
Subtotal 5,396 0
4.1 Train community health workers - -
4.2 Train teachers and carers 15,333 8,668
4.3 Carry out health, hygiene and well-
being education programmes for mothers,
families and community leaders 6,667 4,704
4.4 Facilitate the establishment of
community groups 6,000 1,984
4.5 Build government capacity 6,947 1,883
Subtotal 34,947 17,239
Travel costs for monitoring visits
(Maternal and infant health) 2,158 1,393
Final and mid-term evaluation (maternal
and infant health) - -
Save the Children UK project monitoring
visits (maternal and infant health) 1,665
Project monitoring and evaluation (under
five health and nutrition) 667 600
Subtotal 4,490 1,993
Project Coordinator (Maternal and Infant
Health) 30,396 11,641
Project Assistant (Maternal and Infant
Health) 7,014 6,436
Project Officer (Under five health and
nutrition) 4,000 2,719
Monitoring and Evaluation Officer 10,000
Subtotal 51,410 20,796
Project Officer 1 - CNMP 14,029 0
Project Officer 2- CNMP 14,029 0
Administration/Finance Assistant - CNMP 3,058 0
Subtotal 31,115 0
Field Office - Save the Children Brazil 2,158 1,375
Office Costs - CNMP 1,799 0
Finance, Grant Management and Project
Management from Sao Paulo office 7,200 0
Subtotal 11,157 1,375
Total project costs 178,479
UK technical expertise and support 19,437
GRAND TOTAL 197,915

THANK YOU FOR YOUR ONGOING SUPPORT.
TOGETHER, WE ARE HELPING SAVE LIVES.

P15

Rb brazil report august 2012 v1

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