Lessons learned from over three decades fighting poverty

While I was working in the paediatric ward of a public hospital in Rio de Janeiro, in the late 1980s, I observed that many patients' mothers were single parents, without child support, living in shacks falling apart.

The children would be admitted to the hospital, treated, and discharged – and then they would be readmitted, sometimes within weeks. It was a grim cycle and it was also very clear that, in many cases, the root cause of these children’s diseases was poverty.

As a physician, I understood I had to go beyond the hospital walls and founded the Dara Institute in 1991. This is a social organization that works with a pioneering methodology to restructure and promote the self-support of vulnerable families who are referred from public health units, public schools and social assistance reference centres.

After listening and assisting many mothers and understanding their socioeconomic living conditions along the years, with the help of several volunteers, we developed an integrated and multidisciplinary approach to combating poverty – the Family Action Plan.

The Family Action Plan is a participatory set of goals and actions in the areas of health, housing, income, civil rights and education through which families collaborate and are empowered to take charge of their own development.

Addressing the work that was done, we understood the importance of concretely working with the social determinants of health, and to integrate social justice to this new health paradigm.

This approach has impacted thousands of people around the world. Scientific American considered our approach one the most influential health programmes in the world and Muhammad Yunnus, winner of the 2006 Nobel Peace Prize, considered the Family Action Plan “a powerful social methodology for the inclusion of the poorest among the poor”.

The three of the most important lessons I learned from more than 32 years of research and work on the ground are:

Brazil is the ninth largest economy in the world and has one of the greatest social inequalities. Nearly 30% of the Brazilian population deals with famine or food insecurity to some degree.

Poverty can also be discussed from a gender perspective, as the number of single mothers, who are solely responsible for taking care of their children, is increasing in Brazil.

We all know that the impact of food insecurity has long-term consequences in health, especially in early childhood (0 to 6 years). The lack of a healthy diet or even a complete lack of nutrition affects all physical and cognitive development.

Amongst the effects of food insecurity are apathy, delay in language acquisition and memory problems, among others. In other words, the impact on educational development is severe and can compromise a child’s entire future.

Since educational level also affects income, a perverse cycle of poverty is created.

Poverty subtracts people from the sense of belonging to society and being a subject of rights. The UN estimates that 1.2 billion people are multi-dimensionally poor, with women and ethnic groups being the most affected.

Hunger is a chronic and endemic problem in Africa and some regions of Asia, the Middle East and South America affecting about 735 million people in 2022.

Meanwhile in Brazil, the modern citizen sector has been growing and developing since the end of the dictatorship and the signing of the 1988 constitution. The sector has been a key force in the consolidation of Brazilian democracy and in projecting the primacy of civil and human rights.

Civil society organizations have informed society, as a whole, of its diversity, have increased awareness of the inequities, the need to protect the environment, and have tested innovations that help solve a broad range of problems that affect the lives of citizens, especially those most underserved.

Amongst the many civil society organizations in Brazil, social entrepreneurial organizations and their leadership represent a group whose social change models and experience have created enormous impact on the lives of the populations for whom they work, replicated their model in many geographies and helped promote the implementation of new public policies.

Upon arrival at the Dara Institute, families undergo a series of interviews with staff – physicians, psychologists, social workers, nutritionist, architect, lawyers, pedagogues – and volunteers, and receive an initial home visit to determine each family’s needs.

Together, the staff and each head of family agree and design a programme of goals and actions in health, education, housing, income generation and citizenship.

Families then come to Dara once a month for meetings to discuss the progress of their Family Action Plan journey and at other occasions to participate in income generating courses, to bring their children to specifically designed programmes for children and adolescents, for individual psychological support and other extra-programme activities or services that may be offered by partner organizations.

The control of each family’s progress is done together with each family at six-month intervals during the two-year journey and monitored by a system where every information concerning the family is recorded.

During the meetings and at other events when the families come to Dara, the interpersonal links that are established between the families, the staff and volunteers ensure the adherence and optimization of the programme.

Families arrive at Dara completely vulnerable, hopeless and destitute, but leave self-sufficient, with self dignity and agents of their own destiny.

Since poverty is multidimensional and an extremely complex problem, it requires the engagement of various actors, and should be the mission of many – civil society organizations, governments, corporations, academia and the press, to name a few.

Civil society is a key actor in promoting collaboration, creating networks, and stimulating ecosystems that promote social inclusion in an integrated and effective way.

HubEP (Poverty Alleviation Hub) is the network of Brazilian civil society organizations that Dara convened to work together to mobilize society in a united effort to fight poverty in Brazil.

Its work highlights how sharing information and experience and by connecting with other actors and sectors, civil society gains greater capacity to scale their impact, influence public policies and contribute to a fairer, healthier, more sustainable and inclusive world.

Vera Cordeiro's book, The Power of Beginning, shows the 32-year journey from facing a problem, identifying a solution and continuously findings ways to transform the lives of more and more vulnerable people.