The State of the World's Children 1998: Focus on Nutrition

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Panel 10

Celebrating gains in children's health in Brazil

Photo: In Brazil, Child Pastorate volunteers weigh a young girl during a growth monitoring session.

Residents of the Morro de CÇu slum in Rio de Janeiro normally have little time for celebrations. But on a recent Saturday afternoon, 40 mothers, their children and community leaders affiliated with the Brazilian Child Pastorate gathered under the trees outside a parish hall. The community leaders set the children one by one on a scale, re cording their weight in notebooks and consulting with the mothers on any nutrition or health problems. The weighing over, the occasion turned festive. Community leaders brought out trays of home-baked cakes and cookies; the yard filled with conversation and laughter and the happy shrieks of children at play.

The Child Pastorate's success in protecting the health and development of poor children in Brazil is definitely cause for celebration. The Pastorate estimates that in the communities where the programme is in place, the malnutrition rate among children under five does not exceed 8 per cent, compared to 16.3 per cent nationally as found in a 1996 Dem ographic and Health Survey applying the same criteria*. Additionally, the Child Pastorate estimates that the incidence of low birthweight babies is 6 per cent in communities it assists, while the incidence is 9.2 per cent nationally.

The Child Pastorate is one of the largest NGOs in the world devoted to child health, nutrition and development. Its aim is to empower the poor both to improve their children's lives and to participate in transforming their communities and their country.

The National Conference of Brazil ian Bishops founded the NGO in 1983, with efforts beginning in one community in ParanÝ state. Now the Child Pastorate operates in 22,000 communities, in cities large and small, as well as in rural areas, and serves 2.1 million families, including over 3.1 million children under the age of six and nearly 144,000 pregnant women.

The Pastorate's nearly 83,000 com munity volunteers, mainly women, are the backbone of the programme, working directly with 10 to 20 families in their neighbourhoods. "They are like shepherds, looking after their communities," says Dr. Zilda Arns Neumann, a paediatrician and the national coordinator of the NGO since its inception. Community leaders are trained in basic child and maternal nutrition and health skills, including monitoring growth, tracking immunizations, supporting breastfeeding, treating diarrhoea with oral rehydration therapy (ORT) and preventing and detecting pneumonia.

The Pastorate makes nutrition a community issue: Families get help, encouragement and support from neighbours in improving their children's well-being. Community leaders visit the homes of children who are malnourished, monitoring their weight frequently and referring families to local health facilities if necessary. They screen pregnant women for indications of malnutrition and refer them to medical facilities for pre natal care and delivery, and after birth, support for breastfeeding is a main priority. Families also learn how to prepare nutritious meals with low-cost ingredients that are available locally. The Pastorate promotes child development through play and activities to improve speech and motor skills; its basic education programme serves 46,000 teenagers and adults.

The Child Pastorate's work is guided by a four-part methodology. The first three - 'see' (observe the situation), 'judge' (define the causes) and 'act' (take action based on the causes) - are similar to UNICEF's triple A approach. The fourth is 'celebrate' (rejoice in the gains made in children's nutrition and health).

The Child Pastorate uses its partnerships - with the Government at all levels, with other NGOs and with the media - to maximum effect, planning budget and activities to complement those of the Ministry of Health. It works through municipal councils to help maintain public services in communities, from the quality of tap water to health services to education.

The broadcast media are strong allies. Nutrition and health messages developed by the Child Pastorate are aired on a 15-minute radio programme, Viva a Vida (Enjoy Life), once or twice a week by 910 radio stations. Since 1995, the Child Pas torate has received about one quar ter of the proceeds of the annual fund-raising television campaign 'Crianáa Esperanáa' (Child Hope), sponsored by UNICEF and Globo TV, to assist municipalities with high infant mortality rates through out the country. The Pas tor ate estimates that in the campaign's first year, malnutrition declined by 14 per cent in the municipalities featured on the programme.

The Child Pastorate is able to operate at low cost, in part because of the considerable efforts of its volunteers and the logistical net provided by the Catholic Church. Training, transportation and other support for the programme's community leaders are among the main expenses. The Child Pastorate received assistance from UNICEF in its early years. Since 1987, the Brazilian Ministry of Health has provided support, with additional funds raised from the private sector.

* Percentage of children below the 10th percentile of the National Center for Health Sta tistics (US) reference weight-for-age standard.

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