Introduction

In October 2016, Brazil’s Minister of Social and Agrarian Development, ¹ Osmar Terra, introduced a collaborative early childhood development intervention called the Criança Feliz Program (PCF). In the preceding 11 years, Brazil had reduced poverty from 22.4% in 2004 to 8.7% in 2015 and extreme poverty from 7.6% in 2004 to 2.4% in 2015 thanks to the conditional cash transfer program Bolsa Familia (Annex 1). However, even though research had found that children from families benefitting from Bolsa Familia had a cognitive development 65% above average, cash transfers were not enough to break the poverty cycle and overcome the challenges of violence in the country in the long run. With 15 million children under the age of four and high rates of poverty (Annex 1 & 2), there was a great need for a transformational intervention like PCF which involved regular home visitations as the basis for multisectoral early childhood development support. Now operating at full scale after just two years, PCF has made it possible for nearly 500,000 children and 85,000 pregnant women in Brazil to receive home visits every week, a total of almost 2.4 million visits a month in over 2,000 municipalities.

To implement such an instrumental program in such a short period of time, Terra relied on his ‘educational’ political style. He believed that by explaining the evidence underlying policymaking to people, he could gain their support for his cause. However, he knew that this would take time and so he began laying the groundwork for what would become PCF more than a decade prior, in 2000.

Using Evidence to Create Opportunity

The year 2000 was a turning point for research on early childhood development. James J. Heckman won the Nobel Prize of Economics for his work demonstrating long-term returns on investment in early childhood programs for children under five and Carlsson, Greengard, and Kandel won the Nobel Prize of Medicine for their research on the critical neural connections and learning formed during early childhood. These new advances laid an evidence-based foundation for investment in stimulation, quality care, and security of children to support their emotional and cognitive development, and ultimately their education and economic attainment as adults.

At this time, Osmar Terra was the coordinator of the social development program Comunidade Solidária under President Cardoso. There was a clear opportunity for Brazil to take note of this research, as local studies had shown that child-recipients of social aid were 35% less cognitively developed than the average Brazilian child and only 8% of poor families in Brazil had any books in their homes. In response, he seized the opportunity to create the Committee on Integral Development of Early Childhood (CODIPI), where he brought together actors from civil society and across government to educate every single relevant stakeholder on the importance of early childhood interventions. The process for building a movement for early childhood in Brazil (that would eventually lead to PCF) had begun.

¹ This ministry was combined with the Ministry of Sports and the Ministry of Culture to form the new Ministry of Citizenship in January 2019 that continues to manage PCF and is led by Minister Terra.

Prioritizing a Common Goal Together

By 2002, Terra had not succeeded in building as much support for his ideas as he had hoped and due to a change in government, the CODIPI was dissolved. Nevertheless, Terra kept his vision in the back of his mind, and when he became Secretary of Health of Rio Grande do Sul state in 2003, he knew it would be his priority. In April 2003, Terra launched a new version of the CODIPI for his state, which included 17 large civil society organizations and representatives from the Secretariats of Culture, Education, Health, Work, Citizenship, and Social Assistance. He knew that intersectoral collaboration was key to his effort and bringing different actors on board from the beginning, particularly his secretarial counterparts, would be critical to his success.

With the help of the new CODIPI, Terra launched the Primeira Infancia Melhor (PIM) program, the first home visitation program in Brazil (Annex 3). Intersectoral and inter-ministerial collaboration was at the center of this initiative since any home visit could yield a variety of challenges. If, during a home visit, a child was found with a medical condition, the Secretariat of Health had to intervene. If a child had a learning disability, the Secretariat of Education had to get involved. If the family belonged to a particular ethnic group, the Secretariat of Culture would ensure that the home visitor had culturally relevant activities for the child. If a family struggled with employment, then the Secretariat of Work needed to act. The underlying idea was that the government would not act in siloes, but rather work in a deeply coordinated way, since any child in an underprivileged environment would need the concerted efforts of different parts of government to achieve his or her full potential.

The spirit of collaboration was also present in the partnership that Terra started with Celep. They were the center responsible for implementing Educa a tu Hijo, the Cuban program that had inspired PIM. This partnership provided both technical support and legitimacy to the undertaking of PIM.

Institutionalizing Collaborative Efforts

To date, PIM has survived governments from four different political parties and continues to serve around 65,000 children every week. Building on such a successful in-country intervention was critical to further expand support and collaboration for early childhood development interventions across Brazil. In 2006, national legislators passed the State Policy for the Promotion and Development of Early Childhood (Ley Estatal no. 12.544) and in 2007, thanks to the leadership efforts of the Bernard van Leer Foundation, the National Network for Early Childhood (RNPI) was created. It brought together a number of civil society organizations, government agencies, private sector entities, and others. It was a massive coalition with far-reaching technical and political power all across the country. The coalition demonstrated this power in 2010 when it managed to pass the National Plan for Early Childhood (PNPI) at the National Council for the Rights of the Child and Adolescent (Conanda).

The institutionalization of RNPI created conditions that would later allow for PCF to be successful.

Thus, in 2011, with early childhood already as a national priority, Terra began setting the ground for PCF. In May 2011, he created the Parliamentary Front for Early Childhood, a cross-party group with over 2000 deputies. The Parliamentary Front’s main goal was to achieve a Legal Framework for Early Childhood that would guarantee the rights of children in different public policy sectors, aiming to promote the integral development of the child. This would ensure that every municipality and every state would have an action plan, a budget, rules, and laws to guarantee the rights of children. With this goal in mind, the Parliamentary Front organized the 1st International Seminar: Legal Framework for Early Childhood in April 2013 to spread awareness and spark conversation across society. By December of that year, they were able to pass the Legal Project for Early Childhood (Projeto de Lei 6.998/2013). In the words of Minister Terra, “Everybody’s mandate is limited, but policies should be passed to stay.”

Using Evidence and Communication to Galvanize Support

Concurrently, Terra was working on developing an executive leadership course on early childhood development in partnership with the Maria Cecília Souto Vidigal Foundation, the INSPER business school and the University of Saõ Paulo, to be held at the Center for the Developing Child at Harvard University. His idea was that if politicians and senior technicians from the administration learned about early childhood from world experts, they would come back to Brazil as serious advocates. In most cases, the course was free of charge for Brazilian politicians and therefore few renounced the opportunity to receive training from Harvard.

Participants were required to stay at Harvard for a week during which time they designed a project that they were meant to present to Parliament and implement upon their return to Brazil. This single initiative proved to be incredibly effective. In the words of the spokesperson of the Parliamentary Front, “Everybody changed at Harvard.” Over the course of a few years, around 400 Brazilian politicians and bureaucrats went to Harvard and came back as champions for early childhood development.

In the following years, the RNPI, the Parliamentary Front, and a growing number of administrators and politicians advocated for early childhood programming – organizing a second international seminar with broad participation from civil society, four regional seminars and two interactive public audiences, among other initiatives. At the same time, there was a media campaign that was staged in partnership with national television channels to raise awareness about the importance of early childhood care. For instance, the Maria Cecília Souto Vidigal Foundation sponsored a documentary, O Começo da Vida (The Beginning of Life), which was screened in cinemas across 21 Brazilian cities in 2016 to more than 21,000 viewers. Bem Estar, a popular daytime television show, decided to increase parental awareness by dedicating five minutes of their show to early childhood education.

With such broad support and building on the ongoing success of PIM, the Legal Framework for Early Childhood was finally passed through the Federal Law no 13.257/16. Five years after creating the Parliamentary Front, and three years after launching the Legal Project for Early Childhood (Projeto de Lei 6.998/2013), the rights of the child were now hard law thanks to this Legal Framework. PCF began in October 2016 as a direct consequence of this Federal Law.

² This program continues to this day with approximately 50 politicians participating every year.

Collaborating for Implementation across Government

Minister Terra knew that enacting a policy was just the beginning, implementation was the real test. He also knew that for PCF to really have an impact, he needed the involvement of different parts of government and different sectors of society (Annex 4). The Ministry of Social and Agrarian Development (now Ministry of Citizenship) would coordinate the efforts through the Secretariat for the Promotion of Human Development. However, to be implemented collaboratively, PCF needed a shared management structure. As such, a number of ad-hoc management committees were created at the national, state and municipal levels.

The National Management Committee housed representatives from the Ministries of Education, Health, Human Rights, Culture and Social Development in what they called the ‘interministerial government space.’ This space was a place where everyone was on board with the mission of implementing PCF and thus it served as a place to coordinate and solve technical issues, rather than arguing about objectives. This intersectoral committee was created by presidential decree, giving it the formality and gravitas to ensure that each ministry would take it seriously. The management committee had high-level representation from each ministry, and it was therefore a place for decision-making, rather than day-to-day collaboration. To get things done, they created the Technical Group, under which a number of inter-ministerial working groups would coordinate efforts.

An example of collaboration that has been achieved by the Technical Group and the National Management Committee is the redesign of the notebook that mothers receive when they have children. Traditionally, the Ministry of Health would give a notebook to the mother with child health tips. Now, since the creation of the National Management Committee, these notebooks include information about child development milestones and cultural specificities contributed by other ministries. Other examples of collaboration include a guide for visitors for children with disabilities and the development of training materials and workshops for both visitors and families.

Overall, the key roles of the National Management Committee are to strengthen the intersectionality of the program, to approve training and program resources, to make decisions about the stages of the program, and to agree on regulatory instruments that distribute responsibilities for different policies. One of its main responsibilities is to set the intersectoral budget. As coordinator of the program, the Ministry of Citizenship decides the home-visiting budget, which it distributes to the municipalities through the National Fund of Social Assistance. They decided to use this fund so that the funds would flow directly from the ministry to each municipality, avoiding intermediaries and countless individual contracts.

However, a budget for home-visiting is not enough to ensure the success of PCF. It is important that each ministry allocates funds to collaborate on the intersectoral needs that emerge from the visits. The National Management Committee is the place where the ministries negotiate the allocations that each ministry will contribute to PCF.

At the state level, similar Management Committees exist but are composed of representatives from State Secretariats. The role of States is to monitor the implementation and to give technical assistance to the municipalities. To achieve this goal, States hire multiplicadores (there are 89 across the country). They are professionals who are trained by National trainers, who in turn go on to train local coordinators, who train the local visitors. This modality of waterfall training has led to a number of implementation problems; however, it was the only way that Brazil could scale the program to over 2000 municipalities in just one and a half years.

At the municipal level, Municipal Management Committees are much more operational in scope. They discuss, support, and approve operational issues of the program. For instance, they identify the beneficiaries of home visits, hire and organize local training for visitors, follow up with different sectoral responses on the demands that they identify, and coordinate with local NGO networks. At the municipal level, intersectoral collaboration is often informal and they escalate any challenges to the state level.

A final component of Brazil’s interministerial implementation effort is its integrated information system, Cadastro Único, which allows different ministries to identify families and work from the same data. This has been an important tool because without it the registries of potential beneficiaries housed by each ministry varied, thereby leading to coordination problems and leaving people unattended. This has also allowed for more effective monitoring and evaluation of implementation across ministries.

Ongoing Challenges

No program is perfect and despite the strong inter-ministerial implementation structure in place, PCF continues to face some challenges. At the municipal level, some committees are more effective than others at implementation. One of the reasons for this is insufficient preparation. Brazil’s waterfall method of training managed by each State has created some disconnect between the original ideas and the actual practice, resulting in resistance from some municipalities. In one case, Terra’s involvement of civil society meant that NGOs like the Pitagoras Foundation were willing to collaborate with municipalities to support implementation. Another idea to bridge the informational gap between those at the core of PCF and each municipality is to develop an online education system that educates on the evidence base behind PCF and effectively communicates the different roles of actors across sectors and levels to allow for more effective and collaborative implementation.

Similarly, PCF has encountered some resistance from families themselves who thought they would lose their Bolsa Familia cash transfer or they suspected control from the Conselho Tutelar, an organizational structure that looks after the rights of children. Given the size and scale of Brazil’s 5,575 municipalities, this is likely to be an ongoing challenge, but it makes clear that communication is a critical component of successful implementation and that effective communication strategies must continue alongside implementation.

Conclusion

The successful implementation of PCF has been the consequence of a long-term undertaking. The ingredients for success were the following: a passionate, knowledgeable and energetic leader; a robust body of scientific evidence that backed the intervention; a number of successful in-country local home-visiting programs;³ a broad civil society coalition organized as a formal network; a parliamentary coalition with representatives from all political groups; constant efforts to align society under the flag of early childhood advocacy; and the articulation of shared management structures.

Minister Terra used a number of methods to create buy-in for his ideas such as organizing seminars and public audiences, developing courses, and creating audiovisual materials. The allies that he gained by opening up decision-making structures to stakeholders, as in the case of CODIPI, allowed him to achieve the necessary milestones that he needed, such as a legal framework, to implement PCF successfully.

Today, after almost three years, PCF has survived a change of president in Brazil and it grows day by day as more and more municipalities voluntarily sign up for the program (Annex 5). PCF has demonstrated the power of ideas and collaboration and as Brazil as a whole, both within and outside of government, grows more accustomed to debating ideas, building coalitions, and acting together, it is expected that more and more, different parts of government, NGOs, and the private sector will work together towards solving Brazil’s greatest challenges.

³ Although this case only mentioned PIM, several other state and local programs were implemented after PIM.

References

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3. Decreto No 42.199/2003, de 07 de abril. Estado Rio Grande do Sul, Secretaria da Saúde, Primeira Infância Melhor.
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6. Harvard Kennedy School Multimedia Case on Criança Feliz.
7. Interview with Ely Harasawa, head of the Secretariat for the Promotion of Human Development in Brazil (2019).
8. Interview with Gilvani Pereira Grangeiro, director at the Secretariat for the Promotion of Human Development in Brazil (2019).
9. Ministério do Desenvolvimento Social e Agrario. (2017). Programa Criança Feliz, A intersetorialidade na visita familiar.
10. Secretaria de Avaliação e Gestão da Informação. (2019). Avaliação de implementação do programa criança feliz relatório final. Ministério da Cidadania.
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Annex 1⁴

Annex 2

Annex 3

Annex 4