The Problem Solving for Better Health® (PSBH®) program in Brazil, or Construcao Compartilhada de Solucoes em Saude (Shared Solutions in Health), is coordinated by the Centro de Promocao da Saude (Center for Health Promotion, CEDAPS). The mission of CEDAPS is to improve the health status and the quality of life of Brazil’s population, with a focus on its impoverished sectors. Its main strategies are the development and implementation of better health care models and appropriate technology in primary health care; health promotion, prevention, education, and communication programs; professional training and qualification; and integrated sustainable development programs. The organization actively collaborates with the Ministry of Health and the Municipal Health Secretariat of Rio de Janeiro, and has created partnerships for the PSBH program from various state agencies, universities, and other NGOs. CEDAPS has replicated the process in Santos, Sao Paulo, and the Amazon, always focusing on the low-income communities at those locations.
The main goal of the program is to empower professionals and community leaders, helping them to develop and implement interventions that will solve broad health problems affecting their institutions and communities. PSBH methodology promotes the better use of available resources, innovation, individual responsibility, and collaborative networking.
Over 1,000 projects have been developed, many of them effectively impacting relevant health and social problems. The projects are benefiting approximately 200,000 people in Brazil, the large majority of them residents of impoverished communities. CEDAPS follows up on every project, providing technical support, networking, seed funding (in some cases), and evaluation.
The Problem Solving for Better Health Initiative™ (PSBHI™) program is coordinated in conjunction with the Center for Health Promotion (CEDAPS). The first area to benefit was Santa Cruz, a region in Rio de Janeiro with severe poverty, violence, and ill health. Activists from various government, private, and community sectors were brought together to work collaboratively on an intersectoral approach called The Santa Cruz Initiative.
During the next year, they discussed priority issues and chose to focus on youth and childhood at risk, education, community organization and environment, access to the work market, and women’s health. In August 2000, 90 selected participants gathered at a workshop with several international guests and observers; including DHF’s director and representatives from five countries, PAHO/WHO, the Berkeley School of Public Health, the Healthy Cities Coalition, and two Brazilian public health schools. Forty-seven projects were developed.
This first wave of the Initiative impacted the lives of at least 15,000 people in the region. The follow-up phase focused on the support, networking, and cooperation for projects; feedback and dissemination; involvement of the private sector; and evaluation of impact. New problems were analyzed and new projects implemented.
Sustainability strategies include the strengthening of the local committee, absorption of programs by public services and private institutions, and the continuous mobilization of the community. A community inside Santa Cruz called Favela do Aco, the poorest area of the region with the most severe problems, was chosen as the site of the second PSBHI program.