How to Engage Medical Staff Here's how to go about getting medical staff to support a Renascer-type program in their hospital and become part of the referral team: Talk to all levels of staff, and be persistent. Hospital staff generally tend to be untrusting of any initiative involving their patients that comes from outside the public hospital system. Many may feel that a private program will interfere with their work, and expose the hospital and staff to scrutiny. As Dr. Odilon Arrantes, Pediatrics head of Lagoa Hospital explains, "A program like this points out the shortfalls of the care being provided. This can, and does, cause resistance." Cordeiro recommends starting by talking to the director of the hospital and the head of Pediatrics. Explain that, by preventing patient readmission, a program run along the lines of Renascer will actually work toward the overall effectiveness of the hospital's medical services, maximizing their investment. Explain that the program complements, rather than substitutes, hospital care. Hold orientation sessions with the health professionals that answer the question that gnaws at many hospital professionals: What happens after I discharge this child? Refer to success stories of the model. To overcome skepticism, be sure to give examples of successful interventions on the part of hospital staff. According to Cordeiro, the importance of Renascer's visibility is that it helps other organizations gain credibility. Demonstrate how the model works in other hospitals and use impact figures. If possible, encourage the hospital director to talk to staff from other hospitals that are involved with Renascer programs. Involve staff directly. Form a referral team made up of health professionals in the hospital where a Renascer-like program is being implemented. Train the group on how to identify potential candidates for the program, and meet with them regularly. The hospital staff will need to dedicate a small amount of time to the program to meet and discuss cases with Renascer staff but the pay-off is improved patient care. Don't forget to value the work of the doctors, nurses and other staff. You are on their side. You are filling a gap in the system, not questioning the quality of the service they provide as health professionals. Continue to show the model works Once your foot is in the door, continue to highlight to the hospital staff how this model can be successful. Register feedback from the mothers and other family members and share this with the hospital staff. Once the health professionals 'hear' and 'see' families benefiting, your convincing is done.

How to Entice Volunteers Value time and commitment. Cordeiro believes that everyone from the community has something of value to contribute: a journalist may be able to give the right thrust to Renascer's quarterly newsletter; an accountant's expertise can be utilized in double-checking the books. But she also realized that there are many people who do not have a diploma or certification for a certain job but want to help. Cordeiro tapped into a growing middle and upper class, particularly women, in Rio who either worked in jobs they were unsatisfied with, or were unemployed because they had never formally studied a specific field. Some others were retired women, ready to give of themselves to a worthwhile project. They had the time and the inclination, and through orientations and training, Renascer, in return, gave meaning and value to their time. Create opportunities for learning and growth. Promote an environment of mutual respect between volunteers and benefiting families. The volunteer is giving her time, but, in exchange, has the privilege of hearing the stories of these mothers, and learning from them. "These mothers are warriors, most of them. They are inspirations and the volunteers learn a lot from them," says Cordeiro. By training the volunteers to effectively intervene to help these families, Renascer is showing that you don't need to be a health professional to improve the health of a poor family. Training sessions and regular volunteer meetings at Renascer reinforce this philosophy of mutual respect between volunteers and families. Volunteers who show condescending attitudes are "fired." Be transparent and document everything. Cordeiro says that the two things that motivate volunteers are transparency and impact. "Let them see what is being done. If you show impact, no matter how small, you will have volunteers", Cordeiro explains. Renascer documents everything. The mothers sign "receipts" for each food basket, medicine or water filter they receive. "When you are just starting out," Cordeiro says, "you may not have much to give the families but even if it seems small, have the mothers sign for them and you have something to show your volunteers and supporters."

How to Keep People Motivated (Staff, Volunteers, Beneficiaries) Applaud small things. Cordeiro believes that small actions matter. She recalls times "at the beginning" when Renascer's three-member volunteer staff stopped to clap when a phone call generated a donation of a few cans of milk. Celebrating each moment of the institution is fundamental. What can break an institution is non-recognition and apathy. From the staff fundraiser who brings in grants in the tens of thousands, to the volunteer who organizes Renascer's photo archive, Cordeiro sees the value in everyone who contributes to the organization. "Nothing and nobody is too little. The hours of work that go into organizing the photos at Renascer cannot be taken for granted. It is not merely a small archive; it is Susie Hartley Viera, who's spent six years of volunteering at Renascer with all her energy to create the best archive that Renascer has ever had." Democratize information. Give staff and volunteers access to folders and archives to "check up" on the organization. Volunteers are the windows to the institution. When they know that the organization is ethical and dedicated, they will tell others. When they see that it is misusing funds and misleading people, they will tell others too. The founder must be an example. Cordeiro believes that the energy and example that the founder sets is key to the success of any endeavor. In starting a Renascer program, the founder must be entrepreneurial and motivate the whole team with her/his energy.

How to Raise Funds for Your Program Have a membership-based organization. According to Cordeiro, many members – all playing small amounts – are key to creating a local base of support for the organization's activities. Today, Renascer has around 1,200 members who contribute financially to the organization on a regular basis. Many members also serve as volunteers, and contribute to a range of activities, from working directly with the mothers and giving informational talks on important themes, to helping organize a high-profile fundraising event. Members receive a regular newsletter that not only provides information on the cases and progress of the organization, but also reports on all funds that are received and spent. "You can start out small," Cordeiro says. "If you start out like I did with 10 members contributing – half of whom were my own family! – you still need to tell these 10 members how you are spending their money." An important part of reporting is highlighting success stories. Renascer's newsletter includes a "family case" section. "It's like a weight-loss story. 'I was like this, I did this and now I'm like this.' It tells the story of how a family came in and how it left and all it received in between. When you read this part, you know why Renascer exists," emphasizes Cordeiro. Link the families with sponsors. Currently 90% of the families being served by Renascer have their basic food and medicines covered by family sponsors. "But to make it work, you need to have someone really skilled to run the sponsorship program," Cordeiro cautions. "They need to be attentive and transparent to the sponsors. Personal attention and regular reporting is important. Their desire to know where their support is going is only natural." Use a broad base of support to attract the big fish. As Cordeiro says, having a large number of members and sponsors will have a multiplier effect. Good news travels fast and if companies know you are serious, they will come to you. By having a large number of people in your city directly involved in supporting the organization, many doors will open easily because a secretary or the daughter of the president is a sponsor. Let potential supporters feel the energy. Cordeiro has a tactic for introducing potential donors to Renascer. First, she takes them to the volunteer room when the mothers are meeting with their volunteer caseworkers. This allows them to feel the energy passing between them, and they experience first-hand how everything is tied together. Next, she asks a mother coming in or leaving the building to talk about the program and what it means to her and her family. Only then does she take the potential donor to a meeting room to explain Renascer and offer a space for asking questions. Cordeiro cautions that it is important to be clear about where the needs of the organization lie. She reports that a high 97% of the potential donors who approached Renascer have contributed.

How to Involve the Families of Patients Respect the parent. When an AIDS afflicted woman arrives at Renascer with five children in tow, three of whom have AIDS, show respect for the mother of the child (it's almost always the mother, and not the father, who bears responsibility for the children). You can tell right away that the mother is a fighter; otherwise she wouldn't be there. Volunteers take special care to thank the women for sharing their stories. Cordeiro recognizes the importance of respecting the mother's intelligence and helping her improve her access to information. At Renascer, they hold lectures and information sessions on key issues affecting the family's health and well-being. Before the afternoon meeting between mothers and their caseworkers commence, Renascer invites the mothers scheduled for that day to come in early to attend an information session. Topics include domestic violence, nutrition, school involvement, etc. In a feedback questionnaire, mothers listed the following as the two most important contributions made by Renascer: improved health of their child and, the information sessions. Have humility. "When we talk about restructuring the family, we are not talking an overhaul of what they have already built," Cordeiro says. "We provide interventions in accordance with what the family needs and wants." Renascer volunteers start with the question: "What are your dreams for the future?" Be firm. In rare cases, a family is "dropped-out" of Renascer, if a mother displays a lack of commitment. Renascer provides a structure for supporting the family after their child is discharged. The monthly meetings with the caseworker are key to working with the family toward the goals set together in the Family Action Plan. If the mother misses the meeting three times without calling ahead, she is given a warning. If she continues to play truant, she is pulled out of the program. Renascer relies on a partnership relationship with the family and has clear and firm rules.

Vera Cordeiro's Effective Management Tips Give due recognition to people working with you. Make it a point to show your appreciation to everyone in your organization, up and down the line. Designate a leader in every department – be it fundraising, direct service, or administration – who is responsible for planned outcomes. This is doubly important in a volunteer-led organization, where a "boss figure" goes a long way in ensuring accountability. If a person does not fit the needs of the institution, it is better to be open and let them go than to keep someone on who will not contribute in the necessary way. Desist from keeping people on as staff out of kindness. Democratize information and make access to information easy. Information should never be the prerogative of a chosen few. From time to time, take people out of their daily functions. Hold workshops that help reinforce their work but let them take a break and look in from a different angle. Everyone wants to think, be creative and get out of the day-to-day. At meetings, form circles. Hold meetings once a month with the whole staff. Sit around in a circle so that everyone can look each other in the eye. Never work only with volunteers. While volunteers are key to Renascer, for example, permanent, professional staff are fundamental to any organization. Keep focused, and don't forget your mission. Paint it on the wall of the office and be constantly aware it's up there.

Go to the Changemakers Library for selected Internet resources on Designing Health Delivery Systems That Work