INFORMES TÉCNICO-INSTITUCIONAIS TECHNICAL INSTITUTIONAL REPORTS
Children Health Programs and Projects: shared responsibilities to benefit Brazilian children
Ministério da Saúde. Secretaria de Políticas de Saúde. Área da Saúde da Criança
Esplanada dos Ministérios, Bloco G, 6o andar, sala 636, Brasília, DF, Brasil. CEP 70.068.900. E-mail: comin@saude.gov.br Site: www.saude.gov.br
For over ten years, Brazil and other 160 signatory countries signed the "World Declaration of Survival, Protection and Development of Children" during the United Nation Meeting of the Children's Summit in New York in September 30, 1990. In this meeting, World leaders committed themselves to advocate for health and rights of children and mothers, to fight malnutrition and illiteracy and to eradicate diseases that have caused the death of millions of children every year, stating that they would "make a joint commitment and a vehement universal appeal: to give each child a better future."
In Brazil, in the last years, many efforts were made to improve children's health which resulted in significant reduction not only of child mortality rates but of malnutrition as well. In this last decade the reduction observed in child mortality was of 38% as well as a reduction of child mortality from 48/1.000 live births in 1990 to 29.6/1.000 in 2000. Notwithstanding this improvement, there are still major contrasts in the chances of child survival among different Brazilian regions. The Northeast region concentrates half of the infantile deaths in the country, requiring intensive actions enabling the conciliation of education, income generation, basic sanitation, adequate nourishment and offer of quality healthcare assistance to achieve human development in its full potential.
The Ministry of Health (MS) has been supporting the development of strategies for the effective and gradual reduction of child mortality, principally based on agreements between States and municipalities and the commitment of managing agents in adopting an agenda oriented towards child survival. As reinforcement to these actions, the MS has promoted multidisciplinary training to the professionals of the Universal Health System Network (SUS) at the basic services and medium and high complexity services level always prioritizing a humane approach in addition to establishing important partnerships with different national organizations - both governmental and non-governmental - international institutions and organized civil society.
To face the issue of child morbidity and mortality, new public policies have been designed and investments were increased to promote the organization of basic care in the municipalities, defining the Programs of Health Community Agents (PACS) and Family Health Program (PSF) as priority strategies capable of retrieving the link of co-responsibility between services and population, favoring not only the cure and prevention of diseases, but the valuing of people, families and communities role in improving their life and health conditions in the perspective of health promotion. Currently, over 15 thousand teams of the Family Health Program service 50 million people and the over 160 thousand Community Health Agents cover 4.600 Brazilian municipalities, therefore improving the health of the assisted population.
The Ministry of Health since 1984 has been prioritizing basic health care actions which have proven to be efficient in reducing child morbidity and mortality: the attention to the newborns, the promotion of breastfeeding, the follow-up of growth and development of children, vaccination and prevention of diarrhea and acute respiratory infections, aiming at incrementing the resolving capacity of children's health services. In this sense, some initiatives have been developed successfully in Brazil.
Breastfeeding Promotion Policy
Brazil has currently been awarded international recognition for its breastfeeding promotion policy. The work of partnerships and society has been a very important factor for the success of the Brazilian policy. The sum of efforts has resulted in creative, efficient and scientifically proven efforts. In addition, they have contributed to significantly increase the rates of breastfeeding. Breastfeeding has grown from 5,5 months, in 1989 to 9,9 months in 1999.
Another important achievement has been the approval of the Brazilian recommendation on breastfeeding, which should be exclusively done until the child reaches six months old, in the 54th World Health Assembly held in Geneva, Switzerland in 2001. Following, some of the projects implemented in the area of breastfeeding that are outstanding.
Friendly Postman
This project is one of the strategies to reduce child mortality and malnutrition in Brazil. The postmen are trained to work as multiplying agents of an educational campaign to encourage breastfeeding. Only in Fortaleza, Ceará, with this proposal the number of mothers breastfeeding their children has duplicated. The idea emerged from the State government of Ceará - Secretariat of Health - in partnership with the Regional Board of Mail Services of Ceará and was adopted by the Federal Government through Protocols of Joint Actions between the ministries of Health and Communication. Work counts with the partnership of the Empresa Brasileira de Correios e Telégrafos (ECT) amplifying the participation of this institution in the social area.
The work of mailmen has been essential to increase the level of knowledge of mothers of the benefits of breastfeeding, preventing early weaning in addition to orienting on the value of exclusive breastfeeding to six months of life and continuing up to two years old. In 2001, approximately 17 thousand mailmen trained in the health area conveying information and educational material for over two million pregnant women and mothers of children under one year of age.
With the Friendly Postman experience the mailmen distributing information to the citizens, the Ministry of Health was one of the 20 contemplated with the Hélio Beltrão Award in 2001, during the Innovation in the Federal Public Managemnt contest, annually promoted through the National School of Public Administration (ENAP), Ministry of Planning, Budget and Management and the Hélio Beltrão Institute.
Human Milk Banks
Among initiatives of promoting breastfeeding accomplished by the Health Ministry, the National Network of Human Banks is considered the largest in the World with national and international recognition. Human Milk Banks play an important role in assisting mothers and children, for the milk furnished is pasteurized and receive a very high quality control. These Banks possess a caster of donators, which are systematically followed-up. These women donate a volume of milk sufficient to meet the demands of premature newborns of low weight, as well as hospitalized babies. Currently there are 156 Milk Banks in the whole country collecting and distributing around 100 thousand litters of human milk, benefiting thousands of premature and low weight children.
Project Firefighters of Life
This is partnership between the Ministry of Health and the State Fire Fighting Corp. The project aims at increasing the stock of Human Milk Banks in the country through home collection of milk donated.
Child-Friendly Hospital Initiative (IHAC)
Hospitals/maternities of the network and the Universal Healthcare System are redirecting their practices and routines aiming at the promotion, protection, support to breastfeeding, and is a reference in the humane attention rendered to mother and newborn babies. The IHAC establishes ten steps and five criteria to meet the requirements internationally esta-blished by the World Health Organization (WHO) and United Nations Children's Fund (UNICEF).
The Ministry of Health is training professionals and supporting hospitals in this initiative, increasing the financial support and transferring incentives for obstetrical procedures accomplished in hospitals accredited as Child Friendly Hospitals. Up to the moment, Brazil already has 213 hospitals accredited as Child-Friendly Hospital. In June of 2001, the Regulation n. 29 was published establishing new requisites for accreditation and a new evaluation of hospitals. Other actions head the strategies amplifying the work of Child Health Program.
Integrated Management of Childhood Ilness (AIDPI)
AIDPI is an strategy aiming at integrating health promotion and prevention with assistance and treatment activities for the most frequent diseases in childhood, reducing deaths and the most common diseases in children under five years old. This strategy strengthens and organizes the basic attention enabling the PACS and PSF teams to render quality attention to children.
Humane attention to the low weight newborn: the Mother Kangaroo Method
The adoption of the Humane Attention Norms for the low weight newborn children (the Kangaroo method) at high-risk patients maternities of the Universal Health System (SUS) substantially improves the chances of survival of low weight or premature newborn children. The strategy is essential in promoting an institutional change in the pursue to healthcare attention centered on the humane quality of assistance and on the principle of family citizenship. The Kangaroo method is a type of neonatal assistance freely chosen by the family and aims an adequate, humane care to low weight newborn children. In addition to a more close family-baby relationship and encouragement to breastfeeding, reduces hospital stays and the risk of hospital infection. More than 2.000 profissionals in 240 maternities of SUS were habilited in Brazil.
Civil Registration (Birth Certificate)
The Civil Registration Campaign result of a partnerships of the Executive, Legislative and Judiciary branches of power and with the support of civil society has shown the real dimension of the absence of the first citizenship document of the Brazilian child, the Birth Certificate. Progress in Legislation, such as the Gratuity Law number 9.534/1997, that assures the gratuity for the birth and death certificates; the Law of Fees 10.169/2000 that allows reimbursing the registrants for their services by mean of specific funds. The Law 9.997/2000 waiving the need for two witness when delivery happens in a hospital unit or clinic and the Law 10.215/2001, fine exemption for late registration, benefit the population.
The operation of Outposts for Birth Records in SUS maternities is a step forward to service mothers and children. The Ministry of Health considering the need of adopting measures destined to assure the information related to neonatal services, established through Regulation 938/GM from the Minister's Office/Ministry of Health the inclusion in the Table of Special Procedures of Hospital Information (SIH/SUS) the incentive of R$5,00 to hospitals who furnish birth registration prior to hospital discharge, to be filled in the Authorization of Hospital Internment (AIH form) of the delivery.
Accident Prevention and Violence in Childhood
This is an action that has been worked in partnership with technical areas of the Ministry of Health, Brazilian Society of Pediatrics, Secretariat of Human Rights in the Judiciary System prioritizing preventive measures, concerning questions about children accidents and violence. The Protocol of Attention to Violence in the Health Basic Network was designed for Family Health teams and the Booklet of Violence in the Family and Human Rights for community healthcare agents, offering input for the recognition of people in situations of domestic violence, as well as education for referral to judicial services and others working with this problem.
Live Library Program
This is a partnership between the Ministry of Health and the Abrinq Foundation for the Rights of Children and Citibank. The project aims at the quality of attention in while children are in the hospital or assisted in medical offices. Children and their families are provided with time that can be agreeable to all. The idea is to minimize the pain, the anguish and the waiting of all participating of health services and health recovery. This process has reading supervisors who are trained to implement the project Live Library (BV) in hospitals and to facilitate reading through children's and juvenile books and fairy tales. This initiative has the finality of contributing to reduce tensions and to integrate the child and their families to the clinical staff of the hospital in a more humane environment creating a practice of incentive to reading in families serviced by the project. Currently there are 26 units located in the Southern, Southeast, Midwest and Northeast developing reading monitoring activities benefiting almost 300 thousand children and adolescents.
Follow-up of Growth and Development (CD)
The CD (Growth and Development) is the central axis of children's assistance for it focuses children in their growing and development process. This activity assures the quality of life of the child and enables the early diagnosis of ailments affecting health, nutrition, and mental and social life. It enables a global vision of the children in the context they live, allo-wing for humane assistance to the extent that children and their relationships and family environment are better known. The Child Card is the basic tool for CD follow-up and should always be kept by the family.
Submitted on May 19, 2002
Approved on July 20, 2002
Publication Dates
-
Publication in this collection
19 May 2006 -
Date of issue
Aug 2002
