Alfabetizando com Saúde (Learning to Read and Write in Good Health)

Country Profile: Brazil

Population	202,768,562 (2014, IBGE estimation)
Poverty (Population living on less than US$1.25 per day)	6% (2009)
Official language	Portuguese
Youth literacy rate (15 – 24 years, 2015, UIS estimation)	Female: 99.22% Male: 98.60% Both sexes: 98.91%
Adult literacy rate (15+ years, 2015, UIS estimation)	Female: 92.90% Male: 92.24% Both sexes: 92.58%
Statistical sources	Instituto Brasileiro de Geografia e Estatística UNESCO Institute for Statistics (UIS) UNESCO: EFA Global Monitoring Report UNICEF: Info by Country World Bank: World Development Indicators database

Programme Overview

Programme Title	Alfabetizando com Saúde (Learning to Read and Write in Good Health)
Implementing Organization	Curitiba City Council (Health Department)
Language of Instruction	Portuguese
Programme Partners	Curitiba Education Department ; Foundation for Social Action ; Curitiba Voluntary Action Centre
Date of Inception	2004 –

Contextual Overview

The Alfabetizando com Saúde programme was initiated by the Curitiba City Council (Department of Health) in 2002 and continues to be funded by the city council's departments of Health and Education. It is an integrated programme that is built on and reinforces Curitiba’s inter-sectoral (inter-departmental) collaboration between the Centre for Health Education (CES), the Department of Education’s Agency of Youths and Adults (EJA) and local communities.

The programme stemmed from the realisation that improving people’s literacy levels is crucial to promoting good health and functional societies. The need for literacy and health education programmes in Curitiba was underscored by several base-line studies. For example, the National Household Research (PNAD) estimated that there are over 40 000 illiterate people in the entire Curitiba metropolitan area. Furthermore, a study by the Curitiba Municipal Health Department (based on an analysis of the Hospital Discharge Surveillance System) concluded that infants born to mothers with few or no literacy skills or education were at increased risk (1.52%) of being hospitalised during the first year of their lives than infants born to literate or educated mothers. The study thus concluded that high infant mortality rates in and around the city were associated with high rates of illiteracy among women as the principal care givers. These studies therefore recommended intensifying literacy and health education programmes.

In light of this, the «Alfabetizando com Saúde» programme was developed. Its aim is to provide adult literacy programmes that simultaneously promote health awareness, help prevent outbreaks of disease, increase environmental awareness and advocate for healthy living (nutrition).

Since its inception, the programme has received a number of accolades. In 2004, the programme was officially acknowledged by the Brazilian Ministry of Health at the 2nd National Family Health Conference. In 2007, the city of Curitiba won the «Free from Illiteracy» certificate, which indicates an illiteracy rate of less than 4%. However, despite these positive trends, the benefits of the activities currently being carried out have yet to spread to the wider population. Furthermore, levels of illiteracy and low education remain high. Hence, there is still a great demand for and need to continue with programmes that promote both literacy and health issues.

Programme Objectives

The programme endeavours to:

implement and promote the Council's health and adult literacy policies through effective community mobilisation programmes;
help prevent the outbreak and spread of acute and chronic diseases as well as reduce infant mortality rates through improved adult literacy and health education; and
promote adult literacy as a vehicle for autonomous socio-economic empowerment as well as a means of improving people’s quality of life.

Programme Implementation

Target Groups and Area of Operation

The programme targets youth and adults (male and female) aged 15 years and above – including out-of-school youth – from the fifty-five (55) Municipal Health Units in the city of Curitiba. However, most of the participants are women who remain the most socially and economically disadvantaged and vulnerable group within most communities as a result of traditional and ongoing cultural practices that deprive them of socio-economic opportunities, in general, and formal education, in particular.

Programme Content

From the outset (2002), it was decided, for strategic reasons, that the programme should address local people’s immediate health concerns. Consequently, the programme has been designed to improve literacy levels as well as to address a variety of health issues and problems that are prevalent in the city including:

Hygiene and health issues (e.g. cancer, worm infections, leptospirosis, dengue fever, cholera, vaccination, osteoporosis, HIV/AIDS, diabetes, sexually transmitted diseases)
Healthy eating and nutrition
Family planning and child care
Environment and health
The administration of medicines

The programme is implemented with a great degree of flexibility and most lessons target current health issues and problems in the communities. For example, the first booklet (2002) focused on diseases caused by Loxosceles reclusa (a venomous brown spider which is very common in the city). HIV/AIDS is also included in most lectures because, despite the declining rates of AIDS infections in Curitiba, the disease still poses a major threat as peoples’ sexual life styles have not changed dramatically. Furthermore, high rates of inter-city migration means that rates of AIDS infection can increase at any time. The programme’s Psychosocial Units for Alcohol and Drug Addiction (CAPSad) also emphasises assistance to chemical dependents and those suffering from mental disorders. As severe social challenges, particularly poverty and unemployment, can lead to substance (drug) abuse, the programme additionally endeavours to channel the energies of the youth into productive activities.

Approaches and Methodologies

Training of Trainers

The programme is developed and implemented through a network of qualified community volunteer educators (facilitators) who are mobilised through the local Municipal Health Unit (UMS). These volunteers are professionally trained as community educators or facilitators through the train-the-trainer programme. This programme trains educators in basic adult education methodologies as well as covering the general programme curriculum. After the initial training, community educators participate in monthly training sessions to enable them to keep abreast with the programme and current developments in the field.

Since the inception of the programme, three hundred (300) community educators have been trained, 163 of whom have worked in the programme. As of 2008, 48 community educators were working in 31 different localities catering for 338 learners. One major challenge, however, is that community educators are not as motivated as might be expected due to the fact that they receive no remuneration for their voluntary services. The programme only provides a few educators with free tickets for public transport (offered by the Curitiba Education Department).

Training of Participants/Learners

Programme participants/learners are recruited by Community Health Agents (CHA) who are the link between the local Municipal Health Unit (UMS) and the wider community. Classes, with up to 20 students/learners, are held at least twice a week for two hours, although alternative and extra schedules are often arranged. Each class lasts between six and 12 months depending on the learners’ performance and progress. The language of instruction is Portuguese.

Instruction materials such as booklets, audio-visual materials, educational music CDs, magazines and posters have been custom designed and professionally produced by the Curitiba Departments of Education (Youth and Adult Education sector) and Health (Health Education Centre). The contents of these educational materials reflect the communities’ social and epidemiological profile and educational (literacy) demands.

Most lessons are conducted using participatory methods such as simulations, drama, question and answer sessions and debates. These methods are built on and thus reflect the learners’ daily lives. This is essential because it assists the learners, most of whom are barely literate, to better understand the issues being discussed. Furthermore, participatory methods also motivate the learners to participate actively in the learning process as they are able to integrate their personal experiences and knowledge into the “new” learning programme. The strategy as a whole re-affirms Paulo Freire’s observation that: “Nobody educates anybody, as nobody educates him or herself: men and women educate each other in community, mediated by the world”. In this context, the teacher (volunteer facilitator) and learners educate one another using their different experiences, knowledge and roles. This has the added advantage of building the learners’ skills and self-esteem as active participants in the learning process.

A further innovative method links literacy education to practical and relevant health issues. For example, one excellent approach teaches learners the alphabet while at the same time raising their awareness of illnesses and health risks. Hence, the letter “A” teaches them about AIDS, how it is caused, how it spreads, how to identify symptoms how to prevent it. For the letter “C”, learners find out about cholesterol and what they can do to combat it. “H” stands for hypertension (high blood pressure), while “D” teaches them about diabetes, and so on. By linking the provision of basic literacy skills to the promotion of good health, the programme aims to reduce infant mortality and the misuse of medicines, and to improve the beneficiaries’ health and living conditions.

Funding and Costs

The programme is funded by the local government through the city of Curitiba (Departments of Health and Education). It is an integral part of the local government's Municipal Plan. Although the running costs fluctuate depending on the number of students/learners enrolled, the average programme costs at the time of writing were as follows:

Total costs for the training courses per semester: R$ 189.26 (Brazil reais) $75.40 (US dollars)
Total costs of equipping the classrooms: R$ 159.83/US$ 63.80
Total monthly costs for transport tickets for the volunteers: R$ 1,836.00/US$ 732.56
Annual cost per learner: R$ 20.14/US$ 8.00
Approx. exchange rate: 1 US$ = 2.50525 BRL

Monitoring and Evaluation

A committee was formed to oversee the continuous monitoring and evaluation of the programme, comprising representatives from the Health Department (coordinators), a teacher specialised in Youth and Adult Education, two education professionals from the Department of Education and the Heads of the Health Units. These representatives undertake occasional visits to the communities to assess and evaluate the progress and impact of the programme on beneficiaries and their local communities. In addition, volunteer educators also submit monthly progress reports on their activities to the central office. Furthermore, on-going field monitoring and evaluation is conducted through e-mail and telephone communication. At the end of each year, quantitative field research is carried out in order to provide a comprehensive and professional evaluation of the programme. This report is distributed to all stakeholders and helps to inform the structure and content of the programme in the following year. Impact and Achievements

The following results have been noticed:

The table below shows how the number of programme participants has been increasing since the inception of the programme:

Year	Number of Participants
2002	167
2003	404
2004	420
2005	349
2006	389
2007	406

However, part of this increase can be attributed to the fact that some students enrolled to attend the programme for a second time due to learning difficulties.

Improvements in literacy levels of participants

At the end of their «semester» class, participants had noticeably improved their reading, writing and counting skills (literacy and numeracy). This achievement indicates that the initial demands that participants had when joining the programme had been met. The following testimonies demonstrate the joy of being literate and the attendant social benefits:
«I came to consult the doctor and needed to sign a document. The nurse noticed my difficulty and she suggested that I participate in the programme. I began to study the same day.» (T. dos S. S., 42 years, UMS. Vila Leonice).
«My companion said that if I learned how to read, to write and to sign my very beautiful name, he would marry me.» (D. M. S. 38 years, user of UMS Concórdia).

Improved sense of self-esteem, identity, empowerment and positive future perspectives among learners

Participants were able to engage in other livelihood activities without asking for assistance and thus felt liberated from the yoke of illiteracy, as the following testimony shows:

A nursing auxiliary and a volunteer educator: «D. (a student enrolled in the programme) suffered from chronic depression and did not know how to take the bus ... now that she has learned how to read, she knows how to take the right bus, she no longer stays at home all the time; instead, she visits her relatives’ house more often and without depending on help from other people.»
Improvements in family and social relationships: the programme improved the learners’ social networking skills and as a result, some were able to establish functional relationships with members of the wider community. Learners use these relationships for collaborative work and general social assistance.
Volunteer educators also attested to noticeable behavioural changes in learners (e.g. reduced levels of aggressiveness) that occurred progressively during the training process.
Changes in habits and lifestyle: for example, a volunteer, Educatro, reported the story of a 49 year-old student with cholesterol and high triglycerides who changed her eating habits after attending the class on cholesterol and is now buying foods that reduce cholesterol as well as eating more green vegetables.
After completion of the programme, some relatives of learners suffering from psychological problems or depression (e.g. due to substance abuse) have reported changes in the learner’s behaviour, such as a decrease in drug-taking and an improved ability to form functional relationships.
The linkages between health education and the provision of health services have also helped some participants to become aware (i.e. from the description of disease symptoms in class) of health problems of which they were previously unaware and to seek treatment. This was particularly true of diabetic patients who were referred for treatment and were also able to self-administer drugs.
As further testimony to its success and potential, the programme has been adapted to Mozambique and implemented there since 2006.

Challenges and Constraints

The main challenges and constraints faced by the programme are:

Limited resources: the programme is currently funded by the Curitiba City Council with occasional funding from outside groups such as the Rotary Club. This has hindered the expansion of the programme and has also affected the motivation of community volunteers who, despite sacrificing their time from other livelihood activities, receive no remuneration. The procurement of teaching resources is similarly affected.
The train-the-trainer component is complicated because volunteers’ educational backgrounds vary widely, making it difficult to standardise the curriculum.
It is also difficult to motivate adults accustomed to a specific way of life to return to the classroom.
The lack of formal accreditation potentially weakens participants' motivation and undermines the marketability of the programme.

Programme Sustainability

Despite these challenges, the programme is, nonetheless, sustainable in the long term because the running/implementation costs are very low. This is due to:

the commitment of members of the public as demonstrated by the outstanding and critical role played by volunteers who receive no remuneration for their work;
the fact that programme is implemented in venues that are either cheap to rent or are provided free of charge by the community; and
the public funding provided by Curitiba City Council for teaching materials and transport allowances for volunteers. Furthermore, the programmes are supervised, attended and evaluated by officers funded by the city council.

Moreover, there is still a huge demand from members of the community wishing to participate in training programmes.

References

Contact Details

Coordinator
Marisa Marini Giacomini
Rua Francisco Torres, 830-Cristo Rei-CEP-80-060-130
Curitiba-Paraná- Brazil
Tel. 0055 41-33509428
Fax 0055 41-3350-9320
E-mail: User: mmgiacomini
Host: (at) uol.com.br / User: marisa
Host: (at) sms.curitiba.pr.gov.br
http://www.curitiba.pr.gov.br

Last update: 6 February 2011