Home visiting services scale up in Brazil

After just 18 months, home visitors from Brazil’s national Criança Feliz home visiting programme were reaching over half a million children, and more than half of all municipalities across the country had signed up – an impressive rate of progress from a standing start. The challenges, successes, failures and lessons of scaling up Criança Feliz have been documented in a book: Da ciência à prática – Os programas de apoio ao desenvolvimento infantil na América Latina (From science to practice – Programmes supporting child development in Latin America).

Home visit, Criança Feliz programme. Pacatuba, Brazil. Photo: Courtesy of Ratao Diniz.

Supporting parents means working through local-level government

Scaling up home visiting programmes is a challenge in Brazil. The country’s structure of government puts decision-making power with state-level governors and municipal-level mayors, and each state and municipality that decides to offer home visiting then needs to customise the model to fit their financial, geographical and institutional capacities. The challenges in rural, semi-urban and urban areas are all very different.

The Foundation learned valuable lessons from several years of support for home visiting projects in the Amazon basin through United Way – a region with especially difficult logistics, high levels of poverty and rich cultural diversity. In particular, these experiences made clear that it is possible for community health workers, whose main role is to work on preventing diseases such as malaria, to be trained to coach parents in areas such as nutrition, early learning and birth registration.

Ambitions to cover millions of children across Brazil

Criança Feliz was set up by the Ministry of Social Development with support from the Bernard van Leer Foundation, drawing on our experience of home visiting projects in the country. The programme is aiming to reach over 3 million children by 2020, making it one of the largest-scale efforts of its kind in the world.

Around half of all families in Brazil meet conditions of social vulnerability that will make them eligible for Criança Feliz, which involves weekly home visits from before birth for the child’s first thousand days, followed by less frequent visits until the child can start preschool at the age of 4 years. The methodology for the home visits is based on the UNICEF/WHO Care for Child Development programme.

Osmar Terra, a former physician who led the Parliamentary Early Childhood Front before becoming Minister of Social Development, commented:

‘The more the public understands the importance of the first years of a child’s life, the more support the programme will have and the greater its impact will be. There is no social programme with a better ratio of benefits to costs than this one. It is a long-term investment that will change the future of families, offering pathways out of lives marked by violence and poverty.’