5) Description of health product/service offering: Renascer was created in 1991 by Dr. Vera Cordeiro, a physician with twenty years of experience at public hospitals. She had a particular insight into the problem of the health system while working in the pediatrics ward of Lagoa’s Hospital in Rio de Janeiro, Brazil: the medical services being provided were inefficient and ineffective in improving the child’s health if that child did not have the basic needs (housing, education, income, food, access to social services) for a healthy lifestyle. Sick children, many with preventable illnesses, were being treated only to return months later with a life-threatening infection. This meant that health professionals were faced with the challenge of not only “curing” the child’s illness but the conditions of poverty this child lived in. Renascer’s main objective is to break a vicious circle of misery/illness/inpatientadmission/release/readmission/death by restructuring these children’s families in five essential areas: Health, Family Income Generation, Housing, Education and Citizenship Access through the development of a “Family Plan”. Our beneficiaries are children treated at Lagoa’s Hospital and their families. Almost all of them are bellow the poverty line: According to data published in 2001 by the National Household Sample Survey from the Brazilian Institute of Geography and Statistics 32% of the population, 54 million people, are poor, 49 million people earn less than half of the monthly minimum wage in Brazil, 5 million have no income whatsoever. As a result, tens of millions of Brazilians live in urban slums that lack decent housing, clean water, or proper sanitation. Millions of children’s growth is stunted from chronic malnutrition. Many diseases, pneumonia, tuberculosis, rheumatic fever, anemia, skin lesions, are caused or exacerbated by extreme poverty. Our work with these children helped to decrease their re- hospitalization in more than 60% and almost ended the re- hospitalization due to social causes.

6) Description of innovation: Traditional medicine, not only in Brazil but all over the world, focuses on the diagnose and treatment of sickness ignoring the psychological and social conditions of the patients. As a result, there are high rates of re- hospitalization because of the same sickness or others due to living conditions of poor families. However, throughout history, many authors like Heraclitus, Hipocrates, Sigmund Freud, Martin Luther King, Frijtof Capra shows the importance of the holistic understanding of being healthy, not limited to traditional “curative” and medical health sectors. By addressing the family’s soci-economic conditions, Renascer makes that theory happen, effectively applying the holistic concept of health. Renascer’s work is to change the terrible conditions of life from those who live below the poverty line in a holistic way in 5 areas: Health, Family Income Generation, Housing, Education and Citizenship. Over nearly 15 years, the services provided to the families have been analyzed, improved and systematized in order to improve its results.

7) Operational model: Renascer focus in family’s restructuring in five essential areas: Health, Family Income Generation, Housing, Education and Citizenship Access through the development of a “Family Plan”. Each child and family is followed during two years, with a case load of 230 to 250 families per month. They are assessed monthly and receive food, and medication until they achieve a set of a very well- defined criteria for “discharge” from the program created by Renascer and refined with the expertise of McKinsey & Co as part of 5.000 pro bono hours of consultancy provided over 5 years. Our main activities are: .Professional training courses for family members. A coordinator implement and monitor the courses. When family members have potential to be entrepreneurs, Renascer helps with acquisition of equipment and materials; .Home refurbishing promoted by Renascer’s Housing Project ; .Physiologic and Psychiatrist support ; .Nutritional support; .Periodic report from the hospital about health conditions of the assisted child; .Legal orientation for obtaining documents, government benefits, legal advice and contact with other supportive institutions, in order to gain basic access to citizenship rights; .Data for each family is registered in Renascer ’s Management Information System Center to assist program implementation and generation of reports and social impact indicators.

8) Human resources: We count with the work or 37 employees and around 140 volunteers. Our team comprises people from many backgrounds. Most of our volunteers are college educated from different areas. We have employees for key areas: social assistants, nutritionist, psychologist, financial and administrative areas, system analyst, fundraising, communication, project coordinators. We also have volunteers in important areas such as lawyers, psychiatrist and others.

9) Key operational partnerships: Renascer was able to built and maintain many partnerships with companies, institutes and foundations. Since 1995 Renascer counts on the support of Unimed, (sponsor all the medicines the families need), Kinder Institute in Brazil (our sponsor and partner for the profissionalization project, a Swiss-Brazilian institute which sponsors social projects in our country.), L’Oreal (a partner in the profissionalization project offering technical support, as well as training opportunities for students and teachers and providing us with products at a discount rate.), Senac( a technical studies institute in Brazil, Queiroz Galvão (sponsor of the housing refurbishing program), UNESCO ( sponsor of food, diapers, school material and medical equipment’s), Johnson & Johnson (sponsor of educational speeches for mothers and for adolescents, meals and transportation) Praxair (strengthening of Renascer and its network). Renascer also counts on the help of more than 1000 individual donors, 200 people acting as godfathers/godmothers for the families and a team of more than 140 volunteers in all areas. These partnerships are essential to Renascer’s initiative as our project is not yet sustainable .

10) Financial Sustainability

          • Fees charged to clients?: No

          • How do you assure affordability?: We don't charge our beneficiaries, we cover our expenses by maintaining an individual donor/member base, holding high- profile events and fundraisers.Renascer has also developed an revenue-generating project , called the Fish Hook Project.

          • Earned incomes as a percentage of operating costs: 11%

          • Other funding sources: Renascer has worked to raise visibility and create clear strategies for sustainability. These include diversify funding by maintaining an individual donor/member base, holding high-profile events and fundraisers including Friends of Renascer in USA. We are also implementing a trust fund to ensure Renascer’s future. A key success in Renascer’s history has been maintaining a large base of local support for core programs thus reducing dependence on external funding sources.

          • Strategy for long-term sustainability: Renascer has developed an revenue-generating project , called the Fish Hook Project, to reduce Renascer’s dependency on donations. Through this project, Renascer has developed an original clothing line (including T-shirts, cloth dolls, bags, and accessories), jewelry line and other products bearing the Renascer logo. Products are sold through donated store space in a popular Rio’s shopping mall. This project has advanced significantly in the last year providing money to cover the costs of 49% of all medicines and 27% of all special milk that were donated to the families. Last year we began another project the Fish Hook Gourmet project, selling chocolates developed for Renascer with 3 recipes donated by famous Brazilian’s chefs The profit generated is all reinvested in other projects run by Renascer.

11) Current and Future Impact

          • Total number of clients: 7821

          • Clients in the past year: 748

          • Percentage of low-income clients: 99%

          • Impact: The women, most of the heads of the families who participate in our project are in some way inserted into society. They are informed about their rights , helped in acquiring documents and government benefits , improvements are made in their houses. In our lectures they learn about hygienic ,sexual disease prevention and pregnancy control. In the professionalization courses they acquire a way to self sustain their families. They grow from feeling helpless to being productive which has great impact in their positioning. As they notice this, their self-esteem grows, they begin to take care of themselves and see themselves in a different light. We believe this change can impact even their families, which brings us back to our initial concern - the child.

          • Overall "market": The demand for such a model is striking when considering the levels of poverty in Brazil and the country’s highly skewed distribution of wealth. Renascer is a center of reference that fosters the replication of the program’s model in other parts of the country, its model has already inspired founding 16 programs and two more are in process of founding at other hospitals following quite a similar methodology and forming the Child’s Health Network We also believe that Renascer has the potential to be replicated in other countries as well. In July 2000, a group of UN representatives visited Renascer. During the visit, Graça Machel (Nelson Mandela?s wife) said : “This is the most complete health care model I have ever seen throughout the world” She expressed her desire to implement Renascer?s model in South Africa. Renascer has directly assisted more than 2000 families totaling more than 7000 children. Currently Renascer supports: 249 families and 897 children. The Child Health Network attends 600 families and 2.400 children monthly, the number of beneficiaries of the model to date is around 20,000 people.

12) Scaling up strategy

          • Stage of the initiative: Mature stage.

          • Expansion plan: Renascer?s long term goal is to have a similar institution attached to each public hospital in Brazil serving as model in the world. To accomplish this Renascer holds workshops, produces replication materials describing the steps to found a new institution, maintains a network development program, with training and periodic progress reviews, and offers financial support for the replicated institutions. In the next three to five years our goal is to assist the development of four institutions in each year. To achieve that Renascer wants to expand its replication program which includes: staff to investigate possible new institutions, help these achieve visibility in their location and assist in developing a resource base. In order to facilitate the spread of her model beyond Brazil, as well as increase funding resources, Dr. Cordeiro founded the U.S.-based organization Friends of Renascer in New York in 2000. Now with tax-exempt status, Dr. Cordeiro sees a great opportunity for increasing investment in the Child’s Health Network and visibility for the idea.

13) Policy change: The top policy change needed to accelerate social change in our field is that donations to social projects should be deductible from taxes.

14) Origin of the initiative: The initiative started in 1991 with Dr.Vera Cordeiro, born in Rio de Janeiro graduated in Medicine in 1975 as a clinical doctor. In her 20 years working as a pediatrician in Lagoa's Hospital, a public hospital in Rio de Janeiro, Brazil, Dr. Vera Cordeiro perceived that health professionals were faced with the challenge of not only “curing” the child’s illness but the conditions of poverty this child lives in. To address this problem, she created Renascer. Dr Cordeiro was elected an Ashoka fellow in 1992, an Avina leader in 2000, and a Schwab Social Entrepreneur in 2001. Renascer won several national and international awards including, the Global Development Network’s Award for the world’s ”Most Innovative Development Project” in 2003 and in 2006, “Skoll Award for Social Entrepreneurship”. Vera’s work in Renascer is one of the chapters of David Bornstein book: “How to change the world”

Contact Information:
Vera  Cordeiro
Ashoka Fellow
Founder
Associação Saúde Criança Renascer
(NGO)
Rua Jardim Botanico 86
Brazil
Tel: (55-21)2266-1446
Fax: (55-21)2266-1446
Email: vera@criancarenascer.org.br
Website: www.criancarenascer.org.br