Rb brazil report august 2012 v1

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  • 1. REPORT PREPARED FOR RECKITTBENCKISER, BRAZILSAVING CHILDREN’S LIVES IN NORTHEAST BRAZILReporting period: 1st December 2011 to 30th June 2012 Oprazo estabelecido está correto. O relatório descreve as ações pactuadas entre a fundação Abrinq e aSave the Children no sub grant.OUR LIFESAVING PARTNERSHIPWhile Brazil has made progress in reducing child mortality in recent years, over 50,000children under five still die in Brazil each year, and children in the northeast are more thantwice 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 ensureBrazilian children survive, thrive and reach their potential. In June 2011 we held the ReckittBenckiser Global Challenge in Brazil. Employees from 33 countries joined forces to renovatetwo crèches in João de Deus, a community in the northeastern city of Petrolina. Yoursupport has also been instrumental in delivering our pioneering work with the EuropeanCommission which aims to ensure that children under five in Pernambuco and Bahia get thecare, nutrition and stimulating early education and care that they need to thrive. You havealso helped us to raise awareness of children’s rights across Brazil, through cause relatedmarketing on packs of Bom Ar, and through a publication of "Fundação Abrinq - Há 20 anosa voz das crianças no Brasil”, a book celebrating our achievements for Brazilian childrenover the last 20 years.Your support is helping us to reach 18,000 children in Bahia and Pernambuco, ensuring thatthey survive and thrive in their first five years. Your support is helping us roll out ourinnovative child health and nutrition project to a further 17 municipalities, and to launch apioneering 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 achievementstogether for children over the last seven months.EXECUTIVE SUMMARYThe purpose of the Saving Children’s Lives in Northeast Brazil project is tocontribute to reducing maternal and infant mortality for children up to five years of age inthe states of Bahia and Pernambuco. The project works in targeted municipalities to providetechnical support to maternal and infant healthcare services, systematise and disseminateexperiences in comprehensive care services for children, work at the municipal level toencourage exchanges of effective experiences in child and women’s health, as well asstrengthen the participation of civil society in actions addressing child and women’s healthand sexual and reproductive rights.Together with the Fundação Abrinq-Save the Children Executive Manager for Programmesand Projects and the Pernambuco State Coordinator for Programmes, we worked toaddress the key aspects that needed to be structured and implemented within the SavingChildren’s Lives in Northeast Brazil project. This included establishing the projectbaseline, interaction with project partner CNMP (Centro Nordestino de Medicina Popular –Northeast Centre for Popular Medicine), defining adjustments to the project monitoringRegistered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P1
  • 2. plan, establishing the timeline for implementation of project activities and planning activitiesand coordinating efforts with actors engaged in the project.After developing the project baseline, we analysed the municipalities with the highest infantmortality rates and, consequently, those in most urgent need of related interventions. Theproject was structured to work in two phases: the first phase was initiated in 2012, targetingthe municipalities of Ipubí, Trindade, Ouricuri and Cabrobó; and the second phase will beginin 2013, targeting the municipalities of Santa Maria da Boa Vista, Petrolina, Juazeiro, Afrânio,Santa Filomena and Lagoa Grande. Meetings were held with municipal and regionalauthorities/managers and civil society actors to present the project and discuss therespective strategies and activities to be carried out.Preparatory meetings were held with the social service trainers who will carry out activitiesto build the capacities of professionals and leaders to begin implementation. We are alsoworking to produce the informative materials that will be distributed, as well as putting thenecessary logistics into place for conducting training activities.There was however some delay in some activities due to the municipal elections in Brazilthis year, with public health service professionals quite engaged in the election process andhence unavailable to participate in training activities. The communities have been increasinglyreceptive to mobilisation efforts and the election period has helped to increase the level ofimportance given to the need for strengthening public policies and services for children andadolescents, especially in relation to infant mortality.The strategy for the Stork Network initiative is comprised of a series of measures withinthe 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 federalgovernment’s commitment has come in response to an intense mobilisation effort on thepart of civil society to defend early childhood, principally through efforts by the NationalNetwork for Early Childhood, of which Fundação Abrinq-Save the Children and projectpartners are members. The goal now is to ensure implementation of the abovementionedgovernment projects to benefit all children 0-5 years of age in the country and support themunicipalities benefited by the project in order to develop and implement strategies toaddress maternal and infant mortality, thereby guaranteeing a healthy, protected and happychildhood for thousands of children.OUR ACHIEVEMENTSRegistered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P2
  • 3. OBJECTIVES & ACTIVITIESPROJECT GOAL: By 2016 to contribute to reductions in under five andmaternal mortality in Pernambuco and Bahia states, Brazil.OBJECTIVE 1: To improve the quality of community health services anduptake of maternal health services in 10 municipalities of Pernambuco andBahia, Brazil1.1 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 incollaboration with research centres located in the region, represented by the FederalUniversity of the San Francisco Valley (UNIVASF – Universidade Federal do Vale do SãoFrancisco).Save the Children, Fundação Abrinq and representatives from the University met in July tojointly develop the assessment and establish the institutional terms and commitments. Fourprofessors from the institution participated in the meeting, representing two researchlaboratories (LETRANS – Trans-disciplinary Health and Education Laboratory – and theEducation 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 groupscoordinated by the respective professors, involving university students in carrying out theactivities. 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, providingon-site observation in regards to situations of vulnerability for expecting mothers andchildren. Also in regards to data, the group determined that indicators for project resultswould 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 mothersRegistered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P3
  • 4. • 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 municipalitiesduring the second semester of 2012, entailing the collection and analysis of data. Datacollection instruments will be evaluated and adjusted as needed in regards to data collectionin the remaining municipalities.The second phase will be carried out in the first semester of 2013 and will cover all tenmunicipalities targeted in the assessment, utilising collection instruments that have beenadjusted as needed. It was proposed that the main objective of the assessment would be todeepen the analysis of public policies at the municipal level in regards to expecting womenand care for newborn children, thereby providing recommendations to municipalauthorities/managers. Finally, it was determined that an agreement would be developed forcollaboration with UNIVASF in order to establish all operational aspects pertaining to theresearch 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 PopularMedicine (CNMP) in Recife to develop the first proposal for the training of healthprofessionals from the Municipal Health Secretariats. We also discussed the SavingChildren’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 andmobilisation efforts with civil society to empower the most vulnerable groups. CNMP has atrack record of implementing actions in partnership with Fundação Abrinq-Save the Childrenthrough the ‘Children with All Their Rights’ programme, working in the consolidation ofnetworks involving civil society actors towards developing public policies for children, aswell as in carrying out health-related actions in areas such as food and nutrition, medicinalplants 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 addressproblems related to infant and maternal health, ensuring that women receive support duringpregnancy 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.Registered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P4
  • 5. Once discussions were finalised, the final version of the abovementioned documents weresubmitted 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 whowill carry out the training of municipal managers in August, and training workshops forhealthcare professionals in September and October. A total of 100 healthcare professionalsworking in maternity hospitals, Basic Health Centres and the Mother Owl Programme1 willbe trained in quarters three and four of 2012.This activity was initially planned for implementation in August, however due to theupcoming Brazilian elections the relevant professionals are heavily engaged in the politicalcampaigns for mayor and legislative councils, making it difficult to establish a feasibleschedule. On several occasions we had to reschedule meetings with municipal managers, inaddition 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 healthcareservices managers, including coordinators of services in Sexually Transmitted Diseases/AIDS,epidemiology, maternity wards, basic care, hospitals, nurses and health secretaries, amongothers. The nurse-obstetrician will conduct workshops to provide municipal healthsecretariats with needed support to develop strategic planning initiatives in healthcare,aiming at increasing targeted services for expecting mothers, mothers in postpartum andtheir 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 materialsInformative materials, such as banners, information material in folders, and posters are beingproduced and will be ready in September. Information highlighted in the folders will addresshealth-related issues to orient expecting mothers on pre-natal, childbirth, postpartum andcaring for newborns.OBJECTIVE 2: To mobilise and raise awareness of maternal and infantmortality and sexual and reproductive rights in ten municipalities ofPernambuco and Bahia, Brazil.2.1 Train 150 Reproductive and Maternal Health PromotersIn June, we began mapping leaders in the targeted municipalities, through the work of aSocial Educator working in collaboration with the CNMP, with a goal to train 60reproductive and maternal health promoters in 2012. We are working to design the trainingin coordination with the Rural Workers Union, women’s movement, church-based childservices and community health agents.The course consists of two modules: the first eight-hour module addresses sexual andreproductive rights, while the second eight-hour module addresses themes related tofamily planning. The first module began in the first week of August in Ouricuri. Theworkshop 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 reproductiverights of women in Brazil and ensuring these rights in the region. The facilitator raised the1 MÃE CORUJA (Mother Owl) is an initiative of the Pernambuco state government which works with pregnant womenthrough SUS (the state health system). In this project, Mäe Coruja will support us to identify pregnant women in thecommunity, support us in delivering maternal and child health awareness, and in our work toimprove municipal health services.Registered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P5
  • 6. serious dilemmas related to infant and maternal health in the municipality and in the state ofPernambuco, helping these women to better understand their rights and in turn make betterdecisions 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 theirrespective communities to raise people’s awareness on the serious problems related toinfant 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 incommunities through street theatre methodologies, and met with two representatives inJuly from theatre groups working in the region in order to begin negotiations for thedevelopment of interventions with populations targeted by the project. Presentations weremade on the themes (sexual and reproductive health, the importance of pre-natal care,childbirth, postpartum, risks during pregnancy, caring for newborns and exclusivebreastfeeding), that should be addressed with the population, locations where theseactivities can be carried out and definition of municipalities. We then requested the theatrecompany to provide information on all related aspects pertaining to logistics, administrationand finances in order to implement these activities.To finalise the development of the theatre proposal, we will analyse the content of thetheatrical presentation once it is ready and adapt the language in order facilitateunderstanding by the general public, as well as identify the areas that tend to attract a largeconcentration of people in the municipalities and plan the logistics for conducting theactivity. We intend to initiate activities in the second half of August in the four municipalitiestargeted for the first year of project implementation. Three presentations will be made ineach location through to November 2012.2.3 Deliver 20 radio programmes on issues related to maternal and child healthFollowing are the themes to be addressed in radio presentations which are being developedin 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 childrenOBJECTIVE 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 services3.1 Develop state-level maternal and infant mortality reporting systems in Pernambuco.Registered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P6
  • 7. This activity is planned for Year two of the project, building on a set of experiences thathave proved successful and been developed in the municipalities as a result of training forcommittees, technical work groups and healthcare services teams. As in the case ofdeveloping new expertise in the municipalities, we will organise workshops that are capableof 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 communitiesIn conjunction with Activity 2.1, we will initiate a phase to collect information on theinstitutions and leaders in the municipalities targeted by the project, through the work ofthe Social Educator, working with CNMP in the training of 60 health defenders in 2012. Weare working to provide training through the Rural Workers Union, women’s movement,church-based child services (pastoral) and community health agents. Training meetings willbe held in communities, union facilities and community residents’ associations, addressingissues related to women’s rights, healthcare policies, public protection services, community-driven oversight, conflict mediation and development of the social protection networks. Thiswill enable women to understand their rights and make better decisions in relation topreparing for childbirth and in regards to family planning.Activities for this action are planned to take place in August in Ouricuri and Ipubimunicipalities, led by the Social Educator. 15 women representing their communities willparticipate in the training, which will strengthen civil society oversight efforts by CommunityHealth Committees towards defending the sexual and reproductive rights of women. Thesecommittees will work as focal points for identifying and bringing to light problems existing inthe public healthcare system, including the Municipal Maternal and Infant MortalityCommittees (see section 3.3).3.3 Set up or improve ten Municipal Infant and Maternal Mortality CommitteesThe Infant Mortality Committees are inter-institutional entities of a predominantlyeducational nature, comprised of governmental institutions and civil society organisationsand with multiple professions represented. Their function is to identify stillbirths and infantdeaths and provide visibility and oversight, as well as monitor cases. They constitute animportant instrument for evaluating healthcare services, as well as providing guidance andinput on public policies and service interventions, contributing to improved knowledgeregarding deaths and reducing mortality.In July, we participated in a meeting of the IX Regional Health Administration (IX GERES) inthe city of Ouricuri, together with 11 Municipal Health Secretaries, the Regional HealthDirector, the Regional Coordinator for the Mother Owl Programme and ten technical staffmembers working on child health in these municipalities. Along with our presentation of theSaving Children’s Lives in Northeast Brazil project, the meeting agenda focussed onanalysing data on infant mortality in this region and the project’s investment in developingthe Municipal Infant Mortality Committees.We were informed at the beginning of the meeting that these municipalities do not havetheir own committees due to the lack of paediatric physicians in the respective areas (this isa standard requirement that must be met to officially institute the Municipal Committee).Each municipality has alternatively established a Technical Work Group, which analysesreported deaths, though not in an in-depth manner, and follows up by submittingobservations to the Regional Infant Mortality Committee, whose role is to bring the cases toclosure and report the causes of death.Registered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P7
  • 8. As a result, it will not be possible to meet the goal of creating ten Mortality Committees inmunicipalities targeted by the project. Instead, we will work to strengthen the TechnicalWork Groups and strengthen/enhance the effectiveness of the Regional Committee.Several actions and planned activities within the scope of the Regional Committee werepresented at this meeting, such as training of Technical Work Groups in each municipalityand workshops with healthcare professionals regarding the death notification process. Inorder to avoid duplication of activities planned by the government, we reached anagreement with meeting participants that the Saving Children’s Lives in NortheastBrazil project would strengthen activities already planned, including, encourage andstimulate improvements to the quality of information on mortality, with increased coveragefor information systems, improved records on death reports and birth records anddeveloping proposals to create public policies aimed at reducing infant and peri-natalmortality at the municipal level.We will participate in the next Regional Committee meeting in August to organise aschedule of activities.3.4 Share learning and best practice developed in the projectThis activity is planned for November 2012, with the objective of broadening the debate oninfant mortality, its causes and possible intervention strategies. We will carry out a seminarin collaboration with civil society and government in order to present and discuss diversepractices related to the theme, as well as present proposals for Year two of projectimplementation.OBJECTIVE 4: To improve the quality of early childhood health, nutrition andeducation services for 13,000 children under five in 17 municipalities ofPernambuco and Bahia. Leveraging funds from the European Commission, thisobjective will be fulfilled in phase one of the project. We will then deliver our maternaland infant health programme in six of these municipalities in phase two.This section needs to summarise the activities and achievements of the whole ECprogramme, not just the budget lines funded by RB4.1 Train community health professionalsWe began training for municipal technical teams in the Mother Owl Programme onproviding 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 SerraTalhada, each comprised of 32 professionals – including two technical staff from the MotherOwl Programme and one teacher from the Education and Culture Circles in the cases ofmunicipalities where there was no Mother Owl Programme in place. Two professionalsfrom the Basic Healthcare System were invited to participate from sites where there was nosuch programme. Local Coordinators also participated in both classes. In addition torepresentatives from the 16 new municipalities, these classes are also comprised of newtechnical staff that was hired in municipalities from the first phase of the programme (as aresult of the public employee hiring process for staffing the Mother Owl Programme, whichled to several substitutions).These professionals will receive training from January to October (ten months) and will takeon the commitment to work during this period as multipliers, training an additional 20 basichealthcare professionals in their municipalities. These professionals will thus be able toimprove the quality of services to children up to five years of age and incorporateRegistered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P8
  • 9. methodologies such as the International Child Development Programme (ICDP) andNutritional Education for families receiving services.The positive results from the training of professionals in municipalities from the first phaseof the ‘Children with All Their Rights’ programme has led the General Coordinator of theMother Owl Programme to invite the ‘Children with All Their Rights’ programme to train allof the professionals and incorporating the ICDP and Nutrition Education methodologies inthe 105 municipalities in Pernambuco where the Mother Owl Programme is operating.4.2 Train teachers and carersAn evaluation of the ICDP was carried out in November 2011 and identified severalchallenges for providing continuity in disseminating the methodology to professionals andfamilies engaged in the Mother Owl Programme. The ICDP methodology seeks tostrengthen relations within families and interactions between adults and children,encouraging a family environment that ensures a greater level of protection, safety andaffection.Despite the positive results achieved in 2011, the evaluation brought out the need tointensify training for healthcare professionals, including nurses, professionals from the FamilyHealth Support Centres and community health agents, as well as teachers from theEducation and Culture Circles who provide literacy training to mothers reached by theMother Owl Programme. The purpose of the abovementioned training is to ensure that theutilisation of the ICDP methodology with families is incorporated into the routines of theseprofessionals, as opposed to being limited to periodic interventions.A planning meeting took place in April with technical teams from the Mother OwlProgramme in each municipality to organise a complementary training session with newhealthcare professionals and staff from the Education and Culture Circles. The trainingfocusses on the ICDP and nutrition education methodologies, seeking to increase thenumber of professionals from these areas with the capacity to utilise these methodologieswith the families to whom they provide services. Based on the previous experience workingwith families, there was a need to adapt the ICDP and Nutrition Education methodologiesfor services that are provided in homes, given that these methodologies were originallydesigned for direct application with mothers groups to foment the exchange of experiencesand peer education.However, we have found that for families living in rural areas or in communities located inremote areas, it is very difficult for them to get to the town centres, thus making itimpossible for them to participate in meetings with healthcare professionals and otherfamilies. Based on this finding, the technical teams from ICDP and CNMP that areresponsible for the entire Nutrition Education action are adapting their methodologies tohome-based services, such that community health agents can work with families on anindividual basis during their monthly visits to each residence. This has also provided anopportunity 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 canfacilitate the activities that already comprise their daily routines.The ICDP and CNMP teams worked extensively from January to April 2012 to revise themethodology 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. TheICDP team conducted visits to nine different municipalities (Petrolina, Santa Maria da BoaVista, Santa Filomena, Exu, Cabrobó, Orocó, Parnamirim, Araripina, Ouricuri) during themonths of April and May in order to carry out planning for these activities. Meetings wereRegistered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P9
  • 10. held with local technical professionals from the Mother Owl Programme, seeking toestablish strategies for ensuring multiplication among new professionals and families, takinginto consideration the peculiarities of each municipality. A consensus was built among all themunicipalities around three issues that represent challenges for this activity in the comingperiod: 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 theMother Owl Programme management team are working together to seek strategies that canminimise these risks and increase this action’s potential for professionals working withfamilies, so as to guarantee that a maximum number of families can be benefited by theactivities that are underway.Plans for the coming semester are to train an additional 260 professionals (13 municipalitiesx 20 professionals), thereby disseminating the methodologies to 6,500 individuals (260professionals x 25 families) and achieving the target established for the project.It is important to emphasise that the professionals who have already been trained throughthe programme during 2010 and 2011 have been undergoing a monitoring process. Whenasked about the principal changes that have occurred as a result of the training, 59% of theprofessionals interviewed expressed that the most significant changes are related toimprovements in their own individual professional methods. At the same time, 18% indicatedthat the most positive results are related to families that benefit from a greater amount ofinformation, contributing to positive changes in family relations, which is reflected in greatercare and attention to the health and well-being of their small children. Further, 9% of theprofessionals 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 withintheir own professional activities. 43% affirmed that their on-going care services to childrenhave intensified, thereby guaranteeing basic rights, whereas 18% broadened their activities inthe promotion of the health and well-being of children, such as vaccinations and nutritionalmonitoring. In addition, 14% of the professionals affirmed that they are seeking to provideearly 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 tothe achievement of one of the programme goals to be reached through traininginterventions – specifically, the expansion of the capacities of professionals in providing careservices to children up to five years of age and thereby improving the quality of care servicestowards providing comprehensive care. In other words, guaranteeing integrated actions inhealth, education, nutrition and protection.4.3 Carry out health, hygiene and well-being education programmes for mothers, families and community leadersThis activity was planned for the month of July, however, it has been delayed as thematerials to be provided by the Reckitt Benckser group have not yet been provided. Thisactivity will be undertaken as soon as these materials are made available.4.4 Facilitate the establishment of community groupsRegistered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P10
  • 11. This activity is underway for mapping the potential for mobilising civil society. A documentwas produced based on the data collected in the 16 new municipalities. This data wastabulated and analysed and will be presented in the next TAG meeting. Results from themapping exercise will be utilised to orient the mobilisation strategy and networking of civilsociety for fomenting a municipal early childhood network.4.5 Build government capacityThe Saving Children’s Lives in Northeast Brazil project is incorporating mappingactivities on the potential of civil society mobilisation that is underway through the Childrenwith 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 thechild rights system, such as: Guardianship Councils, Child and Adolescent Rights Councils,Church-based Child Services, Day Care Centres, Unions (Rural Workers Union - STR – andthe Family Agriculture Workers Union – SINTRAFE) and NGOs.An instrument is being produced for data collection in 16 municipalities, where data willtabulated and analysed for presentation during the next TAG meeting. Results from themapping exercise will be utilised to orient the mobilisation strategy and networking of civilsociety for fomenting a municipal early childhood network.The ‘Children with All Their Rights’ programme has been supporting and advocating forgovernments, society, care providers, mothers and fathers take on and fulfil theircommitments pertaining to early childhood, contributing to the improvement of conditionsfor the development and survival of children up to five years of age from excludedpopulations in the semi-arid region of Northeast Brazil. The mapping exercise has providedan instrument for facilitating actions carried out by partners in the municipalities – towardsbuilding a fundamental understanding of the reality faced by institutions responsible forguaranteeing the rights of children during early childhood.CHALLENGES AND LESSONS LEARNEDWe 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 HealthSecretariats to participate in project activities. We are working with managers in order toarrange these meetings, wherever possible. The strategic approach adopted has been tofocus mobilisations at the community level, as the election period has heightened theimportance 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 andactivities targeting the population at large. Priority will be given to the training of healthpromoters and community leaders, along with health-related social marketing. Once newlyelected administrations are in place in Year two of project implementation, traininginterventions 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.Registered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P11
  • 12. 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 KINDGifts in Kind which have been receivedGifts in kind distributedPhoto of distributionUPDATE ON CRECHESRegistered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P12
  • 13. CASE STUDYJOANA’S STORY, CABROBÓ, PERNAMBUCO STATEJoana was born on March 15, 2012 in the city ofCabrobó, located in the interior region of PernambucoState, in the semi-arid Sertão region of Northeast Brazil.Joana came into the world by caesarean childbirth, bornprematurely and with a low birth weight (1,315 grams).She remained hospitalised for 30 days and upon beingdischarged from the hospital her weight was 1,580grams.During pregnancy, her mother – Simone – only went tothree pre-natal medical consultations, since hermenstruation cycle was usually irregular and she thusonly discovered she was pregnant after three months. Inthe fifth month of her pregnancy, she developed swellingin almost her entire body and it was only at this pointthat she pursued medical assistance. She also sufferedfrom pre-eclampsia and the risk of aborting during pregnancy, and was hospitalised for threedays in the ICU prior to going into labour at the HDM/IMIP Hospital in the town ofPetrolina.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 beenpregnant four times and aborted two times. She studied till the fifth grade and is currently astay-at-home mother. She is married to Jhonatan, who is 21 years old and works as a busfare collector, working only one shift (he alternates weeks working mornings andafternoons) 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, isfrom a previous marriage that lasted six years with a man from the municipality of SerraTalhada. He was murdered when Simone was seven months pregnant and Simone did notregister her daughter’s birth under the father’s name. Simone came to Cabrobó after theincident and still keeps in touch with the family in Serra Talhada. She also has an aunt andcousin who live in Petrolina and with whom she keeps in closer contact. Her little five-yearold 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 anexcellent relationship with her. The family of Itawana’s biological father does not maintainany 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 tomembers of Jhonatan’s family (aunt, uncle, stepfather, mother and sister). Upon entering thegrandmother’s house, the first thing you see is a beautiful photo of the two children hangingon the wall.In regards to Joana, she continues to be breastfed – she was breastfed exclusively throughthe first three months. Presently, in addition to mother’s milk, her diet consists of porridgeRegistered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P13
  • 14. and blended fruits five times a day, according to her mother. The child continues to havelow 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”. Hermother 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 onher own at the pharmacy. She had the Guthrie test done on the baby, but has yet to receivethe results. Her vaccinations are up to date, with the exception of the vaccination againstmeningitis. 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 forassistance, she gave up.As such, the Saving Children’s Lives in Northeast Brazil Project, funded by Reckitt Benckiser, isworking to complement actions carried out through the Children with All Their RightsProgramme, defending and promoting the rights of children and adolescents, with a keycomponent 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 targetanother six municipalities, with the objective of working in conjunction with thesemunicipalities in order to guarantee the right to life for expecting mothers and children. Ourwork is aimed at improving access to healthcare services, especially pre-natal, childbirth andpostpartum, as well as early childhood care services. To do so, we are investing in thetraining of healthcare professionals, teachers, parents and community leaders, also providingeducational material to the general public, promoting participation and providing support tosexual and reproductive healthcare for women.It is our conviction that with this contribution we will foment changes in public policies andservices in the municipalities targeted by the project and in turn be a catalyst formodifications in their healthcare systems, ensuring improved access for expecting motherslike 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 0Registered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P14
  • 15. 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 197,915THANK YOU FOR YOUR ONGOING SUPPORT.TOGETHER, WE ARE HELPING SAVE LIVES.Registered charity England and Wales (213890) Scotland (SC039570) - Produced August 2012 P15