What is the Network of Healthy Communities?

The Network is a social initiative for equity, health promotion and community development, inspired in the international movement Healthy Communities/Cities, a global program of the World Health Organization. On May 10th, 2004, in the city of Rio de Janeiro, more than 60 communities and the Center for Health Promotion launched the foundation of this movement in a public ceremony with the signing the Declaration of Principles for Healthy Communities of the State of Rio de Janeiro.

The movement was supported by the Dreyfus Health Foundation, the Ministry of Health, the Municipal Health Secretariat, PAHO, Ford Foundation and several universities and NGOs.


How was the Network of Healthy Communities created?

Since 1993, Cedaps has become a technical reference and a supporting organization for groups and associations which represent and promote health in poor communities (favelas). With a vast experience accumulated and the understanding of the value and the importance of strengthening local action for Health Promotion, Cedaps, in partnership with this social movement, creates in 2005 the Network of Healthy Communities of the State of Rio de Janeiro.


Is it possible to talk about “healthy communities” in the context of Rio de Janeiro?

Poor communities (favelas) in Rio de Janeiro suffer from serious problems such as poor housing and environmental conditions, unemployment, lack of recreation and cultural life, and restricted access to basic services such as health and education. In addition, they are severely affected by violence from the organized crime and even from the state.

However, there are many untapped resources in these territories: social networks, trust, solidarity and mutual support, celebration, cultural life, local businesses, informal activities on education, recreation, sports, religion, politics and much more. There are men and women – adults, elderly or youth – that even in the midst of extreme poverty, violence and lack of services, break the isolation of their homes and become agents of a social action that benefits people, families and their neighborhood. Favelas can therefore be called Healthy Communities: when organized residents are engaged to improve their physical environment and their social, cultural and economic life, taking an active role in the solution of their problems, gaining access to rights and social resources.

By providing people with more opportunities to develop their skills, talents, and potentials, offering them more chances of participation and interaction with the civil society and the state, social capital will increase and residents will expand their ability to transform the economic, social, and cultural structure of their communities.


Community Network, Social Participation and Public Policies

In addition to being scarce, public services (especially in health and education) to low-income communities are almost always based on vertical programs, implemented without taking into account local needs, and use directive processes that “teach” participants what their problems are and the best way to solve them. Residents are seen as simple recipients of programs, have few opportunities to participate in public policies, and to contribute to solve their own problems. Thus, many talents, skills, and especially, much of the available resources are wasted. Without the involvement of the community, the effectiveness of social interventions is reduced. The lack of openness of public policies to community involvement also results in reduced ownership and sustainability of social initiatives.

It is thus crucial to increase opportunities to social actors (community members and professionals) to participate in the problem solving of health related issues and in development programs. In this context, networking of community groups can increase their political strength and become an important strategy to develop the autonomy and build the capacity of low-income communities to search for solutions for their development, to participate in the decisions and programs that affect them, and to enable them to obtain more resources and programs from the state.

In the heart of this initiative is our concept that communities are the core of social transformation – active stakeholders that must participate, defining and analyzing problems, planning, implementing and evaluating interventions that generate development and quality of life.

The Network is demonstrating that an organized movement, created in a collective, participatory, and constructive way, will reinforce the effectiveness of each group, and create collective power for broader and more ambitious achievements. It represents a landmark for the improvement of life and health conditions in the communities, strengthening their actions in the field of Health Promotion and generating positive impact on the social determinants of health.


What is Health Promotion?

In the Ottawa Charter, signed during the I International Conference on Health Promotion in 1986, Health Promotion was defined as the process that enables people to increase control over the determinants of health and thereby to improve their health.
In this field, health is defined broadly, as an equivalent of quality of life, resulting from social determinants: a major life resource, and a universal human right.
Health Promotion is a cultural, social, environmental, economic, and political process. It embraces empowering actions undertaken by individuals, groups and communities, together with supportive actions taken by decision-makers to change the social, environmental and economic conditions that affect health, working towards greater equity. It demands, thus, integrated public policies and a broad participation of the community.


What are the initial goals of the Network?

• To strengthen and empower each community group through capacity building, planning and systematization of actions, meetings and exchange of experiences and opportunities;
• As a network, to improve the collective power, the ability to strengthen the capacity of communities to defend their right to health and to negotiate programs and healthy public policies for its territories;
• To increase social participation, so to influence local governance and open ways for communities to become stakeholders in health (and other) public policies;
• To increase the visibility of positive and healthy actions in poor communities, decreasing the concrete and symbolic gap between “favelas” and the city.

Who are the groups participating in the Network of Healthy Communities?

Organized groups and associations that work in poor communities (favelas) and districts in the outskirts of cities in the State of Rio de Janeiro that work for the development and health promotion of their territories.

• There are currently 106 community groups and organizations participating in the Network, most located in the Metropolitan Area of Rio de Janeiro, representing a population of more than 1.3 million people.
• 31% of them are Women’s Associations, 20% Resident’s Associations, and other cultural, religious or citizen rights groups. Women are the majority among the leaders (68%); most of them are middle-aged and 75% are African-Brazilian.
• What motivates them for this kind of work is the “absence of the state”, the serious problems they identify, and the desire for change.
• 92% of the leaders use their own resources (including personal finances) to develop their activities. They engage in all kinds of participatory activities, forums, committees on different themes, using every opportunity to obtain resources to their communities and to voice their problems and needs.
• Their work reaches directly 130,000 people, and benefits many more indirectly.

The Network and Cedaps

The Network is an initiative of Cedaps, an organization committed to work for the consolidation and strengthening of this broad movement for health in low-income communities.

Cedaps acts as a technical and political reference for support, channeling its resources, projects, and institutional partnerships to the Network. It builds the capacity of organizations to plan strategically and develop local actions, helps them to produce educational material and activities, articulates integrated actions among its members, promotes partnerships, strengthens the network to negotiate with the government and the private sector, and increases the visibility of the work and the causes that belong to the organized popular movement.


The Network’s Social Technology

The Network of Healthy Communities is built on the basis of a social technology called “Shared Construction of Solutions”, developed by Cedaps throughout its 14 years experience. It is based on the Problem Solving for Better Health program, developed by the Dreyfus Health Foundation (NY) in more than 30 countries worldwide. And received additional elements from diverse well known methodologies (Healthy Cities, from WHO; Carlos Matus’ Strategic Planning; Local Development, Paulo Freire’s Popular Education, Empowerment and others).

This social technology creates opportunities for direct participation of individuals (community leaders, professionals) and groups, enabling them to contribute in the solution of social problems, through interventions developed from their own vision and based on their action, using available resources. The results are the mobilization of the community and its resources; and a network of social projects, with creative, concrete solutions, that generate direct impacts in the life of the communities. Interventions are carried through by the very people who live the problems, leaving behind their passive attitude and becoming social players, acting to change the social determinants of health. The collective construction systematizes and organizes local actions, promoting ownership and sustainability to the development process initiated.

Cedaps’ team uses participatory techniques to enable participants to define, prioritize and analyze problems and available resources, and then to elaborate, implement, and evaluate action projects. A follow-up process supports the projects for at least 12 months, through several activities (meetings, visits, database, capacity building workshops, systematization, events, networking and others). The aim is to help participants to reach the defined goals and evaluate the benefits generated, promoting the formation of networks, the exchange of experiences and replication and expansion when appropriate.

Community-based interventions contributed to minimize many different kinds of problems, tackling issues such as domestic, street, and school violence, lack of cultural and sport activities, prevention of HIV/Aids and other infectious diseases, lack of hygiene and good nutrition, adolescent pregnancy, income generation, environmental problems such as lack of green areas, garbage accumulation and lack of sanitation, low self-esteem in youth, learning difficulties, smoking, hypertension and diabetes, community organization and representation, activities for the elderly, and joint activities with schools, day care centers and health units.

When applied to territorial interventions, such as in the Network of Communities, the methodology involves the population since the first steps, with capacity building and mobilization activities. A Community Participatory Diagnostics is the next step, helping the community to know itself better, looking at their problems, resources and abilities, and also to become a stakeholder in the development process, defining priorities, implementing the main interventions, and participating in its evaluation. This results in individual and collective empowerment, and the mobilization of communities and organizations for change, generating deep social and economic sustainability.

How does the Network of Healthy Communities work?

Providing opportunities and facilitating the exchange of experiences and the development of collective actions through

• General, local, and regional meetings;
• Development of health promotion plans at local and regional levels;
• Capacity building and workshops;
• Meetings, seminars, symposiums, conferences;
• Newsletters, Internet, communications with the media, publicity campaigns;
• Theme-based and strategic committees;
• Joint actions, advocacy and mass media campaigns;
• Surveys and publications.

The Network is also planning activities involving youth, to reinforce the empowerment and the capacity of organizations, and to promote leadership renewal; children and adolescent protection; participation of leaders in the development of physical activity programs for the communities; and the elaboration of income generation programs.

To expand and support the social movement created, Cedaps intends to coordinate a group of organizations of the civil society acting as partners at a local, city, state, national and international level.


What are the results of the Network so far?

The Network of Communities was created in 2005, but many organizations have been working with Cedaps for several years. Some of the results achieved so far are:

• 13 HIV/Aids Prevention Centers managed by community members with thousand of users;
• More than 120 educational agents trained and working;
• Almost 400,000 condoms distributed every year;
• More than 1,200 educational events and activities with thousands of participants yearly;
• Several prevention and health promotion activities developed by leaders, according to the perceived needs and priorities of each community;
• Participation in several advocacy fronts, seminars and conferences;
• Creation of innovative prevention strategies and educational material;
• 700 adolescents in 11 communities participating in programs that promote autonomy, self-esteem, social and cultural formation and social entrepreneurship (teen-led projects that solve community problems); 80% of them express better understanding of citizenship, better self care, social responsibility, and better perspectives for the future;
• Local development programs that engage residents since the diagnostics phase, including participatory planning, and capacity building, and creating networks of community projects to solve local problems of health, environment, leisure, education, and income generation.

The Network of Healthy Communities represents an important change in the community movement and in the ability of these populations to obtain better public policies. Our work recognized that there are community leaders – true grassroots entrepreneurs – that strive for better conditions of life in the favelas, and that these abilities need to be reinforced. We technically support these groups to strengthen their local action. Results reflect the empowerment process and the building of social capital. Those leaders:

• Learn to develop projects, organize their actions and physical space;
• Establish partnerships;
• Circulate in academic and political articulation environments;
• Learn to speak in public, give interviews;
• Negotiate public policies, take positions in social programs, participate in several political forums;
• Obtain services and projects for the community, participate in the implementation and participatory management of governmental and non-governmental social projects;
• Return to school, attend universities, participate inn research programs;
• Develop health promotion actions – reducing the incidence of HIV/Aids; promoting educational, recreational, cultural, environmental, and social activities; support to the sick; access to health services; solving emergency problems and much more.

The perspective of a network organization, in addition to strengthening local actions, is also important to break the isolation and engage in collective and solidarity actions:

• Leaders support the actions of their peers, disseminate information and opportunities, exchange experiences, get organized to fight for collective causes, gain visibility and public acknowledgement;
• Media coverage and campaigns also help to break the symbolic isolation of the favelas, bringing them closer to the city with positive actions.
• Broaden their horizons – participating in meetings, conferences, and councils.

The Network’s communities are directly involved in partnerships with public policies in Brazil. They participate in programs such as the Family Health Program (massive comprehensive Primary Health Care), the Pan-American Games in Rio de Janeiro, public schools improvements, and others.


Broader Perspectives

The work of the Network is integrated in the Dreyfus Health Foundation’s global PSBH community, encompassing more than 30 countries that work with similar methodologies. Other countries where the program is active have similar initiatives, and there are plans to integrate them into an international network of communities.

The Network has been drawing attention nationally and internationally. It was presented to the International Union on Health Promotion and Education, where Cedaps joined the Global Consortium for Community Health Promotion; it is part of the Brazilian Network of Healthy Communities and Municipalities. Cedaps has also been invited to participate in the Knowledge Network for Urban Settings of the High Commission for Social Determinants of Health, a WHO initiative. The network participates in a MOH network of research on Effectiveness of Health Promotion. Articles about the Network were published in book chapters and Brazilian and International Public Health journals.


Network of Healthy Communities – future directions

The leaders of the Network of Healthy Communities are attentive to the problems of low-income communities, but work with optimism and realism – a striking feature of the Brazilian soul.

The construction of a democratic and participatory public space contributes to the achievement of the universal right to health. Communities must be able to participate in the decisions affecting their health and life conditions. In our country, this process still has a long way to go, and the Network represents an initiative of the civil society that brings us closer to this vision.

The Network already has 103 members, as of December 2006, with new groups subscribing each month. The total population of affiliated communities is approximately 1.3 million people. There are initiatives to take it to other states of Brazil and even other countries of Latin America.

We all seek utopia – an integrated, equitable, and healthy city. But as Mário Quintana, a Brazilian poet, used to say, “certain things cannot be achieved, but this is not a reason to give up seeking them”. The Network of Healthy Communities wants utopia, and works to achieve it.