By Tolu Ogunlesi.
I spent two weeks in April travelling through Brazil, on a journalism fellowship sponsored by the International Reporting Project (IRP), a program of Johns Hopkins University’s School of Advanced International Studies. I made that trip with Nigeria constantly on my mind; a permanent backdrop to a period of fascinating insight into how Brazil is dealing with its most pressing challenges, in health, education and poverty eradication.
One of the biggest stories out of that country is Bolsa Familia, a conditional cash transfer scheme. The scheme is designed to raise minimum income for Brazil’s poorest families to the World Bank threshold of $1.25 per person per day. The government says that each beneficiary family receives an average of $100 a month (roughly equivalent to Nigeria’s minimum wage). The payment goes mainly to women, because the government believes they are the most prudent custodians of family income, and payouts vary according to the number of children. The cash is paid directly into special bank accounts set up for the program.
Bolsa Familia targets people like Jacqueline, a 27-year-old hairdresser who squats in a row of shacks on the edge of a government housing project in Sao Paolo. She has a 4-year-old daughter, and is four-months pregnant with her second child (she has no idea where the father is). She gets R32 per month for her child. It’s not a lot of money (minimum wage in Brazil is R700 per month; roughly $310 / 50,000 naira), but it makes a difference to the unpredictable R18 she earns on the average per client, as a hairdresser.
And the impact of the money is heightened because payment is conditional – to receive the money beneficiaries have to show evidence of attendance at schools and hospitals. Pregnant women have to go show up at antenatal clinics, nursing mothers have to show evidence of immunization, mothers of older kids have to prove that their kids are attending school. Social Development Minister, Tereza Campello, said children are the biggest beneficiaries of Bolsa Familia. It helps keep them in school and prevents them from being forced to work. “[Bolsa Familia] guarantees that children and teenagers will have access to a life different from their parents.”
It helps that Brazil’s public health and education programs are free. A doctrine of free and universal health coverage is enshrined in the all-important 1988 Constitution. Ana Borges, Assistant Professor of Public Health at the University of Sao Paulo School of Nursing said the Constitution regards health “as a citizen’s right and the state’s duty.” There is a big focus on primary health care, which Borges believes has transformed health outcomes in the country. A Family Health Program launched in 1996 organises health workers into 10-person teams (comprising one doctor, one nurse, 2 auxiliary nurses and 5 – 6 ‘Community Health Agents’) that are assigned to communities across the country. Each team is given responsibility for about 1,000 families, who they’re expected to visit regularly. There are currently about 32,000 teams in operation, covering 26 million Brazilian families.
Combine that ambitious set-up with the way Bolsa Familia is designed to incentivise hospital visits for children and mothers, and you get a sense of just how deep Brazil’s commitment is to the health of its citizens, as well as a solid reason for the 51 per cent fall in maternal mortality rates between 1990 and 2010, and the drop in under-5 mortality from 62 per 1000 live births to 14 per 1000 between 1990 and 2012.
A robust national immunization program exists, providing free coverage to all citizens. In 1980 the government kicked off an annual ‘National Day of Immunization’. State-owned firm Bio-Manguinhos produces all the vaccines the country needs, and exports yellow fever and meningitis vaccines to more than 70 countries across the world. The last case of polio in Brazil was seen in 1990, and since 1999 measles has been kept at negligible levels. Brazil is also now free from congenital rubella, said public health expert, Eder Gatti.
Bolsa Familia is only one of a number of ambitious schemes being run by Brazil’s Federal Government, all contained under the umbrella of the ‘Fome Zero’ (‘Zero Hunger’) program, launched by former President Lula in 2003. There’s also a project targeted at the drought-stricken semi-arid North East, the country’s poorest region (the parallels with Nigeria are striking), focused on providing water cisterns to farmers. The government has invested R1bn in that project over the last fifteen years, resulting in the construction of close to one million cisterns.
The Brazilian government’s welfare programs have helped cut poverty rates significantly. When Bolsa Familia launched in 2003, about 1 in 10 Brazilians lived in extreme poverty, according to World Bank data. By 2009, the number had fallen by 75 per cent. In addition the conditional nature of the grants transforms them into incentives for education and immunization.
But there are those who argue that welfare schemes create a culture of entitlement and permanent dependency. One activist said every now and then there are cases of men pressuring their wives to have more kids, but adds that this is the exception and not the rule. There are also stories of teenage girls who now see a pregnancy as an opportunity to achieve a form of social status. “You go to middle school, you go to high school, and then you get pregnant,” is how one doctor summed it up. “Getting pregnant means leaving the house, getting a life.”
Camilla, a thirty-year-old hairdresser who lives in Coelhos, a poor neighbourhood in Recife, Northeastern Brazil, said she’s observed a rise in the number of teenage girls willing to become mothers. “Maybe it’s because of Bolsa Familia,” she says. “By having kids they will get money.” The government disagrees. Minister Campello says the evidence suggests otherwise: Bolsa Familia does not breed a culture of laziness and work avoidance. She adds that every $1 invested in the programme returns $1.78 to the GDP.
None of the accolades generated by the impressive success of schemes like BolsaFamilias should however obscure the fact that the country still faces grave challenges in many areas. Race-tinted inequality, is one. Poverty affects the black population disproportionately; according to Minister Campello, three-quarters of families on Bolsa Familia are black. Emicida, 28, a well-known rapper recalled that as a black kid growing up in a poor neighbourhood in Sao Paulo, aspiring to a middle-class life was difficult; it wasn’t what people like him hoped for.
Tolu Ogunlesi via Twitter: @toluogunlesi