Municipality of Sapeaçu
This blog was originally published in December 2015 by Ariel Sim, a researcher for the Bolsa Familia Project. You can read more from her at her blog here.
Lesson: When it comes to policy, everyone is a user. From manager to beneficiary, every conversation is a use case.
Today we took a road trip to Sapeaçu. Traveling 300km round trip from Salvador city center, we got a taste of horizontal management of social programs. Our meetings included a local health clinic, the Municipal Coordinator of Bolsa Familia, community health workers (CHW) and the former Sub-Secretary of Health/President of the Municipal Health Council. On the ground, you really see how Bolsa Familia interacts with the larger suite of social programs in Brazil targeting health and education.
We visited three offices: Sapeaçu City Hall, Sapeaçu Health Clinic, and the Municipal Secretariat for Social Assistance (headquarters for Bolsa Familia management at the municipal level). The takeaways from today's conversations are vast and varied, but I'd first like to point out the connections and interplay among people and systems. At one point in our 12-hour day, I found myself drawing a series of feedback loops that inform the anatomy of the social benefits system. This may not be true in all cases, but it (seems so) for Sapeaçu. It is an imperfect map of relationships, but it points to the circularity of relationships in the delivery of social services. I think this is why it's so hard to disaggregate social policy. There are so many moving parts, personalities, and contexts.
Sapeaçu is success case for Bolsa Familia, particularly in health conditionalities (vaccines, check-ups, etc.). With a 99.41% compliance rate, it is 29% over the the national average of 70%. It is at par with the national average for school attendance (86.7%). We still don't entirely understand why Sapeacu is performing so well, but we did learn about some municipal initiatives that have helped. First is the Mobile City Hall, where municipal workers travel around the community on weekends to bring education and health information to community members. This helps with awareness and registration. Second is this year's revival of the Municipal Health Council. After many years of inaction, the former Sub-Secretary of Health (now municipal auditor), accepted an offer from Sapeaçu mayor to apply best practices from her studies in neighboring municipalities back into her home city's municipal council. The strategy pulled from active methodologies of participation to make the municipal council more visible to the community through social media, radio shows, and invitations to attend meetings. To encourage participation, she invited one member from the rural area to come voice their needs every time the council met, and tasked the municipal council members to accompany community health workers on home visits to better understand the process of community engagement in practice. Her 'active methodology of participation' is in many ways human-centered design at its best, focusing on empathy and communication across 'users' of the social benefits system.
The role of technology also took center stage this year. WhatsApp groups were created for the social council to keep in touch, community organization was consistently promoted on social media, and community health workers (CHWs) started using tablets to record information during their home visits. Of course, technology does have its limits. The CHWs face issues with maintaining a relaxed and trusting environment when using the tablets at some home visits, and have been targeted for theft since community members know they are carrying tablets when working. Finally, a video was produced about the different between primary health care and hospital visits. This video was screened at pre-conferences before the state health conference, as well as at the conference itself to spur discussion around community education about when and how to use the appropriate social service.
This is just a sampling of the conversations today, but enough to show that good design tries to draw in users at all levels of service delivery. The more you engage, the more you can distribute responsibility across the social safety net.
Lead Photo, from Left to Right: Nina DaNobrega Garcia (research), Dr. Joseph Wong (Ralph and Roz Halbert Professor of Innovation and Canada Research Chair), Flavio Fontenelli (research), Community Health Worker, Community Health Worker/President of LGBT Council, Ariel Sim (research), two municipal health professionals, and Municipal Auditor/Former Sub-Secretary of Health/Former President of the Municipal Health Council (Photo Credit: A Sim).