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A health worker on the front line of reducing child mortality in Brazil

Watch how the care of a community health agent has helped a family survive and thrive over the course of three generations.  Watch in RealPlayer


By Kent Page

On 13 September, UNICEF and partners reveal new numbers on global progress towards ending preventable child deaths. The organization’s 2013 Progress Report on Committing to Child Survival: A Promise Renewed, which examines trends in child mortality since 1990, analyses the main causes of under-5 deaths and highlights national and global efforts to save children’s lives.

In 2012, Brazil reached Millennium Development Goal 4 – reducing the under-5 mortality rate by two thirds. Disparities across Brazil mean that work remains to be done, particularly in some impoverished communities and among marginalized groups, including Afro-Brazilians and indigenous people. As demonstrated by the Social Mothers programme, the Stork Network, the Mother Kangaroo programme and Super Child Health Agents, Brazil continues to innovate and make progress in addressing under-5 and maternal health.

Since the 1990s, Brazil’s highly effective Community Health Agent programme – which started in Ceará State in 1988 – has been one of the most important factors in reducing under-5 child mortality across the country. By visiting families and teaching them about the importance of breastfeeding, hygiene and vaccinations, health agents like Graça have been critical in reducing child deaths caused by pneumonia, diarrhoea, malnutrition, measles and other preventable diseases.

EUSEBIO, Brazil, 11 September 2013 – At 56, and after 23 years of visits to families across her impoverished community, Graça Campos is on the front line of reducing child mortality in Brazil. And, in spite of Brazil’s impressive progress so far on that front, she shows no sign of slowing down.

“Bom Dia!” she calls through a rusted iron gate, announcing her arrival at the home of six families living together in close quarters without running water. Dogs, cats, rabbits and chickens run between the cramped living spaces. Seven children live in the home; five are under the age of 5, and, in just two months, another baby will join the family.

“We call her ‘Tia Graça’ (Auntie Graça),” says Erica, 17, who is seven months pregnant. “She’s been visiting us for a long time and is helping me understand how to have a healthy pregnancy.”

Three generations of care

In fact, as a community health agent, Graça has been helping this family over three generations. “This is Erica’s first pregnancy, and she’s very young, so we really need to take care of her,” she says.

Graça sits down with Erica and goes through her list of questions, but it’s more like a friendly conversation with a family member. Erica is feeling pretty good overall, but she is also starting to feel more and more tired, and her ankles have recently started to swell. Graça takes a look and makes notes on Erica’s chart. Since Erica became pregnant, Graça has made sure that she is aware of the importance of prenatal care during her pregnancy and has been carefully monitoring all of her prenatal care visits.

© UNICEF Video
Erica, left, is pregnant, and community health agent Graça Campos is monitoring her prenatal care visits. Lidiane, right, is concerned because Emily has diarrhoea, and Graça shows her how to make oral rehydration solution.

“I’d like you to come to the health clinic tomorrow to see the nurse,” says Graça. “There might not be a problem, but I’d feel better if the nurse and doctor took a look at the swelling. In the last three months of pregnancy, you really need to eat well and rest a lot, okay?”

Erica agrees to go to the health clinic; it’s only about 1 km away.

Lidiane, 21, also lives in the home. Graça has known her mother Heloisa since Lidiane was born. She helped Heloisa’s children grow up healthy from birth and is now helping a third generation: Lidiane’s children, and the children of her brothers and sisters.

Lidiane’s hands are full, with 3-year-old Beniçio and 1-year-old Emily, who is happily breastfeeding. Graça reviews Emily´s health chart with Lidiane, talks to her about Beniçio, then takes a look at him; he seems to be in fine, mischievous form.

Graça then turns her attention to Emily, checking her height and weight against her chart. She shows Lidiane the chart and says, “Everything looks good so far. There’s no problem, but just be sure to keep breastfeeding Emily to keep her healthy.”

A simple solution that saves lives

“What do I do when Emily gets diarrhoea?” Lidiane asks. “Does she have diarrhoea now?” says Graça. “Yes, she’s been having it for two days.” “Diarrhoea can be very dangerous for a young child because they can quickly become dehydrated,” explains Graça. “So you have to keep breastfeeding Emily, even when she has diarrhoea.

“You also need to make sure to keep her hands clean and your hands clean, as well. Do you remember how we make the homemade oral rehydration solution?”

Graça shows Lidiane and Erica again how to make the oral rehydration solution. “This is one of the most important, life-saving pieces of information that health workers like me have been able to share with all the families we are responsible for,” says Graça. “When I first started as a community health agent, diarrhoea was killing many children, but when we started teaching families how to make their own homemade oral rehydration solutions with just water, salt and sugar, it really helped to save children’s lives.

“Of course, today children continue to get diarrhoea, but, in my community, it’s no longer a problem that results in a child dying.

“When I started,” continues Graça, “the big killers of children here were pneumonia, diarrhoea, measles and malnutrition. But we have made a lot of progress on all of these, including through vaccinations and helping everyone understand how important breastfeeding is.”  


A Promise Renewed is a movement based on shared responsibility for child survival, and is mobilizing and bringing together governments, civil society, the private sector and individuals in the cause of ending preventable child deaths within a generation. The movement seeks to advance Every Woman Every Child — a strategy launched by United Nations Secretary-General Ban Ki-moon to improve the health of women and children —  through action and advocacy to accelerate reductions in preventable maternal, newborn and child deaths.

Since its launch, 176 governments have signed the Committing to Child Survival: A Promise Renewed pledge, and thousands of civil society groups and private individuals have mobilized actions and resources in support of the goal. A diverse array of governments are setting bold new targets for maternal, newborn and child survival, while, around the world, civil society is increasingly holding governments accountable for their promises, facilitated by new communication technologies and tools.

A Promise Renewed recognizes that leadership, commitment and accountability are vital if we are to end preventable child deaths. And because child survival is increasingly recognized as a shared responsibility, everyone has a role to play.



UNICEF Photography: Committing to child survival

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