In 2021, the Integrated Plan for Health in the Favelas carried out its first public call, the result of an unprecedented inter-institutional articulation led by Fiocruz, together with other teaching and research institutions, scientific associations, associations of health professionals and favela organizations. This mobilization had begun in 2020, in a critical context caused by the Covid-19 pandemic, with the aim of tackling the social and health emergency in the favelas and peripheries of Rio de Janeiro.
The emergency plan then received an initial budget donation of BRL 25 million and all the funds were directed to the public call for proposals that financed community projects between 2021 and 2023. At the moment, Fiotec is joining the effort to speed up civil society's access to these resources, which come from a public fund. As a result, the Integrated Plan was able to implement in practice the principle of social participation and territorially and popularly based epidemiological surveillance actions, through collectives and organizations that had a history of working in their territories.
In 2021, the first call for proposals invited 41 projects. The following year, 13 more projects, bringing the total to 54. In 2023, another 36 projects were awarded. The Integrated Plan became known as 90x Favela.
Today, the Integrated Health Plan in the Favelas is a reality of an institutionalized process, fostering initiatives that go far beyond the emergency response to a disease. There are 146 projects, from the II Public Call, putting into practice the promotion of integral health in the favelas in 33 cities in the state of Rio de Janeiro.
We spoke to the Plan's executive coordinator and PhD in Collective Health, Richarlls Martins, about the achievements already made and the next steps for 146x Favela. Check it out:
Within the area of "Health in Favelas", what are the main strands that the selected projects follow? What do most of them propose to fight?
In the first stage of the implementation of these projects, the focus of the actions was on fighting hunger and ensuring food and nutritional security. It is important to consider that the pandemic, even in 2020 and 2021, directly affected the most impoverished population, increasing vulnerability in terms of income and guaranteeing the right to food.
What we've noticed is that the actions, which at first involved the direct delivery of food, have changed over time in an attempt to think about the quality of this food. So community kitchens, community gardens, strategies to link the issue of agroecology and the production of healthy food within the favelas are being built, calling into question modes of production and consumption, within the framework of an expanded network of solidarity.
Other central fields are certainly education and discussions associated with mental health and mental suffering, which have been incorporated into the agenda of these community-based organizations. In addition to very significant actions in numerous areas linking health and education, and popular communication in health.
Beyond the execution of the projects themselves, over the years can it be said that the Integrated Plan has really contributed to strengthening and empowering the Brazilians who live in these communities?
The external diagnosis presented by researchers from PUC-Rio and UFRJ evaluated the first 90 initiatives supported under the public call. The research provides some data that helps to corroborate the extent to which this strategy of transferring public funds via public notices expands the right to social participation in health. This, in itself, is an element in strengthening the empowerment of the most vulnerable population in the health agenda. However, the impacts described are linked to other aspects.
The construction of coordinated and qualified actions in health must be based on the engagement of society, which is a structuring principle of our Unified Health System (SUS). So, perhaps the first significant contribution of these actions, beyond the objectives of each of these projects, is to understand that when they are thought of as a network, they make it possible to broaden social participation in health and this is fundamental for the organization of all public health policies in their intersectorality. The favelas have taught us and are teaching us this in our daily work in the field of health.
These projects increase the possibility of inducting subjects into the 'health' agenda, incorporating voices not read as 'experts'. This, without a shadow of a doubt, is the main effect of an action like this in the medium term: it has the potential to make us think about the way we construct health actions, for whom and how. It's about producing an agenda, expanding a culture of social participation in health in order to implement and induce truly coordinated agendas that make real sense to people in their territories.
What are the next steps for the Plan? Will there be new public calls?
We are currently supporting the implementation of another 56 projects selected in the second public call for proposals carried out by the Plan in 2024. In addition, in 2025 we are going to launch an unprecedented course to strengthen the institutional capacities of these favela organizations to act in the field of health, with the idea that they will have more structural elements to enable them to induce truly coordinated actions in this field.
Later this year, we will be building a process of continuing training for human resources in health, aimed specifically at primary health care professionals in the municipalities of Rio de Janeiro, so that they can work with and get up to speed on the themes of health training in the favelas. In addition to structuring an unprecedented popular health communication plan in the favelas of the state.
With 2026 in mind, we plan to receive new financial resources to be applied in a third public call. With the aim of strengthening networking to induce action in favelas in all 92 municipalities in Rio de Janeiro, since we have now reached 33 cities, a third of Rio de Janeiro's territory.
How exactly does Fiotec participate in this articulation, and how important is it for the sustainable implementation of the Plan?
From the construction of the principles of what this health strategy in the favelas would be, back in 2020, until today, we have all the administrative work of the Fiotec professionals who think along with us about the operationalization of the daily carrying out of these actions.
I often say that we wouldn't have been able to be so successful without the qualified induction of Fiotec as a support foundation, not just in the transfer of resources, but in the perspective of joint and coordinated work on a humanized basis. That's why the Fiotec teams are present at all our activities in the territories, as a way of thinking about this direct integration in qualified, partnership work.
This work consists of initiating projects with social organizations, supporting the implementation of purchases, analyzing the rendering of accounts, approving and finalizing the financial executions carried out, as well as monitoring meetings. Having Fiotec with us guarantees the operational and administrative quality of this whole process.