Program Makes Policy: Children First in São Paulo, Brazil 

With guest, Prof. Ana Estela Haddad, São Paulo Carinhosa 

Maria Conceição do Rosário: I am Maria Conceição do Rosário, Associate Professor at the Federal University of São Paulo, Brazil, and adjunct professor at the Yale Child Study Center. I’m interviewing for the Early Childhood Peace Consortium online platform and today I have the pleasure and great honor of speaking with professor Ana Estela Haddad.

Professor Ana Estela Haddad is an associate professor of the department of Orthodontics and Pediatric Dentistry at the University of São Paulo and she holds a PhD from the same university. From 2003 to 2005, she worked as an advisor at the Ministry of Education. From 2005 to 2010, she worked at the Brazilian Ministry of Health, in the department of labor management and health education. Currently, professor Ana Estela Haddad is the former first lady of the city of São Paulo, in the state of São Paulo, and she is the coordinator of the early childhood development program that is named São Paulo Carinhosa (i.e. “Affectionate/ Loving São Paulo” in English) composed by 14 municipal departments joined to promote childhood care.

Professor Ana Estela, we are now going to start and continue the interview in Portuguese.

Dr. Rosario: Good Afternoon, Professor Ana Estela! It is a great pleasure and honor to speak with you now.

Professor Ana Estela Haddad: Good afternoon, Professor Conceição. I would also like to thank you very much for the invitation, for the opportunity of doing this interview, in which we can talk with the listeners there, at Yale University.

Rosario: I wanted to start by asking how your interest in early childhood development began.

Haddad: My interest emerged in the beginning of my professional actuation as a dentist. I chose the specialty of pediatric dentistry, thus I have always attended to, worked with and researched children’s oral health and always in the perspective of relating oral health issues to the growth and general development of the child. Therefore, I studied, for example, dental eruption, weight, height and, later, the area of emotional and psychological development, which are all important factors for us to be successful in child care.

From the point of view of the theme, my first choice (to work on this area) was that of my own professional activity. Later on, after I got involved with public policies in other areas of Health and in Education in general, is when I integrated these two things. I arrived here in the municipality of São Paulo and, then, started working on public policies and early childhood development

Rosario: In general terms, what is the São Paulo Carinhosa program and how was it conceived and implemented?

Haddad: The program São Paulo Carinhosa is the municipal policy that aims to promote whole child development in early childhood. The idea is that we can not only act in the most structuring areas that already have systems – such as health, education and social security– but, having these 3 areas as axes, amplify the actions and all the policies the municipality has been developing, with the purpose of creating bridges, connections, joints and causing the multiple interactions of the child’s relationships– bonds with the school, family and community– to be promoters of childhood development. We aim to strengthen the family’s bond with the child since the beginning, indeed, since even family planning, when a woman and a man decide they will have a child.

Rosario: Since its implementation, in your opinion, how effective has the program generally been to promote more healthy and structured families and children?

Haddad: One important matter was that we, the model of governance of the program, established an administrative committee for São Paulo Carinhosa that is composed by the main secretariats of the municipality. There are 14 secretariats composing the administrative committee, so that actions that have an incidence and that can direct goals for the matter of childhood development in each secretariat could be identified in the general government goals plan.

The city (government), for example, in the 2013-2016 administration, greatly amplified its cultural activities, not only in specific dates – the way it was before – but throughout the year. There is a cultural circuit (Paulista Cultural Circuit) with free activities and of high cultural quality that happens in many of the city’s facilities as well as in the cities’ own public spaces. These activities, in the past, used to be planned in the perspective of adults, with almost no activities for the children. With São Paulo Carinhosa, we designated people to be part of the board for cultural events planning, which allowed us to conquer around 20% of every cultural schedule and budget for children-oriented activities. This generated a big impact and was really successful. A very big demand for these events was noticed. Families from diverse social classes started to attend these activities, including a population that we started to tend to in a more important way: the refugee population.

We had a substantial quota of Syrians arriving from the war. When the (refugee) children get here, they are many times too traumatized due to what they experienced in the war zone. In the beginning, they are really scared. They don’t socialize with ease. One of the first experiences we had (with this group) was that of taking a group of children with their families to a cultural activity happening throughout the day in public squares. When they arrived, the children didn’t even want to exit the bus. They were really frightened. Slowly, (though,) they started to ease down and, by the end of the day, they were already joyful, integrated, playing. The Syrian interpreter accompanying them was even overwhelmed on that day. She said, “Look, since they arrived, this is the first time that I am seeing them smile”. Thus, having culture as a space for integration, repair and retelling one’s own story, is an experience that for us, in Sao Paulo Carinhosa, has been very rich and for the refugee children, has made a difference.

Rosario: In the work with refugee children and families, in your opinion, what have been the greatest challenges and the greatest achievements?

Haddad: The challenge is very big in all ways. It’s already a violence to leave your homeland –where you were born– and, many times, leave everything behind. Then, you arrive elsewhere, but in some way there is something that breaks– bonds, emotions – and then, you have to start over in a new culture, learn a new language. Sometimes families come broken, with part of the family lost. It is a situation of high complexity. What we could observe from the different populations is that one of the important matters– also inside the governance model– is that in this municipal administration, from 2013-2016, Mayor Haddad created inside the Human Rights Secretariat a specific commission in the area of immigration, an area for immigrants. This (creation) allowed the development of important public policies by integrating the other secretariats.

When the immigrant families arrived, for example, we would open resource-raisings in churches, in public spaces of the municipality, in the weekend, to welcome these families, to do health check-ups, verify vaccinations, enable the adults to receive a work permit and check if their documentation is in place so that they could also integrate themselves professionally. Later, there is the process of learning the language. In the case of Syrians, we could observe that those who arrive here are distinguished people, who had the opportunity of education, many times professionals with higher education. Therefore, by giving this initial support, they were able to integrate themselves socially. It is a bit different with other populations, such as the Bolivians and Haitians, that sometimes have a lower educational level and need to return to the education cycle to become qualified. But, whichever situation, the city hall gives this support, so that they can find a job, an employment and a home – there are temporary shelters where they are welcomed.

It’s an extensive, challenging, intersectoral work, but working for the adults is also important to enable them to support their own children. In the schools as well the experience has been very interesting. Some schools of the municipality were prepared to welcome well these children. We even had a television coverage by a big station, in which children in the parts that received Syrian refugee children were feeling privileged for having the opportunity to interact with another culture, of meeting children of another culture. So this matter of diversity, as long as it is well worked, is very positive for both sides. I think that both sides benefit. The city of São Paulo, in many phases of its history, was composed by different migration waves. All of us here in some way have immigrant descent. It’s as if we are now receiving some new migration waves, not without challenges, not without difficulties, but it’s something that has been worked on and that has been positive.

Rosario: In your opinion and by your description, the program São Paulo Carinhosa involves many sectors, in other words, it’s a very intersectoral program. What strategies have been more efficient to reach this intersectoral approach?

Haddad: I think that, in first place, it is the governance structure itself that we instituted: trying to aggregate and bring the majority of the municipal secretariats, but at the same time, not only bring them, but also go to them. Also, we tried to appropriate and know the sectorial policy of each area, looking to identify, with that secretariat, a strength that is already in the agenda that could be amplified and worked on. A new perspective that considers the perspective of childhood and of the children as well might be seen in an already planned action. Else, if we design a program specific for children that can be perfect from the perspective of principles, guidelines, with evidence in science and in public policies and simply try to bring in the other secretariats to do what we planned, many times, we may not be so successful, since one of the greatest challenges of public administration is to simultaneously take care (of the public agenda and) of the sectorial agenda– which we can’t forfeit. Every sector has its own agenda, budget, and function, competence that needs to be addressed to its population. We need a space of leadership that can articulate all these actions, without forcing each secretariat to change or double its agenda so that it can implement another action. Therefore, finding the best moment, the best way and building together are the important aspects that allow you to work an intersectoral approach.

Rosario: In your opinion, what is the role of São Paulo Carinhosa specifically in preventing violence and in promoting a culture of peace?

Haddad: In so far as we try to work family empowerment and strong family bonds since the beginning of family planning, pregnancy and newborn care, one of the most successful actions that we developed in the area of health-related home visits was the father’s prenatal care.

Much of the violence that will later happen in the city, as well as many situations of vulnerability and difficulties, sometimes starts at home with domestic violence. What we were able to observe –there are also studies that prove what we experienced– is that when the father, for example, participates and is able to make a bond with the child since early on in the child’s life, the situations of family violence are also reduced, (because) you create a different type of bond. This father prenatal experience started inside the system itself. It was an initiative of some professionals in the area of public service (i.e. National Healthcare System) and, then, we too started working with that perspective. I think a possible success factor might have been having a program ready for the workers to implement and understanding that the public services in Health, Education and Social Security have history, potency and successful experiences that the professionals themselves build in their practice and that can be valorized, interchanged, exchanged as experience with other services and replicated inside the system. This gives them a feeling of belonging, that what they do, develop and create has potency and value as well. Thus, it is also important not to bring something ready. Obviously we bring our experiences that have previously succeeded to be incorporated, but they end up being combined with that in which the system already has potency.

This same experience is seen when we capacitate professionals to do home visits. Sometimes, they visit more vulnerable families, in which the situation is more difficult. Sometimes, there’s no adequate food, no adequate home. If when the agent arrives, he/she simply notices everything that is wrong and that needs to improve, he/she will not be able to create a good bond and connection. In addition, this family also needs the self-esteem to make the bond and to properly take care of the child, so that they can have a good relationship. Thus, the idea is to focus on what we identify as a strength, as positive, from which we can begin to strengthen and give power to this family, this mother, the community and the protection network that has been formed around it, so that the bond can be positive. These are matters that have been well worked in the program.

Back to the father’s prenatal care, the idea was born out of another necessity and ended up being positive when working on connections. In prenatal care – we already have in the city of São Paulo a great coverage of prenatal care in out public system, with more than 90% of the pregnant women having at least the 5 required prenatal appointments – it was observed that there had been an increased incidence of syphilis in pregnancy, increasing the risk of congenital syphilis and all of its negative repercussions. However, even when the pregnant women were treated, they were still being reinfected because the partner was not being treated at the same time. Thus, because of the need to bring the partner –and men don’t usually spontaneously go treat their health as frequently as women– to health services; the strategy of man’s prenatal care was idealized. It was important that he, as a father, also had all the training: how to give baths, how to hold the baby, how to feed, so that he could be a more active and participating father. It was also important that he knew he had to take care of his own health. The program ended up being very successful. We have, actually, some videos showing statements of dads that really liked the experience and had their family harmony improved due to this work. This was another example of a successful strategy.

Rosario: Considering your experience with the much successful initiative of São Paulo Carinhosa, what advice would you give to government leaders in cities both in Brazil and in other parts of the world on implementation of municipal policies focused on improving the lives of children in their early years?

Haddad: I think that there are some aspects. Firstly, children don’t come to the world by themselves and in the first 3 years – the period most decisive to their full development, in other words, their physical, emotional, cognitive, social developments as a whole – they depend greatly on the good relationships that they are able to establish with their adult caretakers– affective adults, resilient, with good self-esteem, capable of stimulating the child, of protecting them, of feeding them- which are fundamental for a child to develop well. There are studies showing the difference, for example, of children that are institutionalized in their first 3 years of life compared with those that have a family, in the sense of having an affective nucleus to which they can report. Sometimes, it was not that traditional family with a father, mother and siblings, but a family that was a space where the child could develop individuality.

An affective situation is really important, thus, every social policy that prioritizes young families (families that have young children) is important. When we work on social public policies, there is an impact in child development as well, but, sometimes, we make something too focused only on the child and forget to work on other aspects. When we had in Brazil a great achievement in the reduction of child mortality and were able to reach the World Health Organization’s goal even before the deadline, upfront, we were able to study the factors that impacted these results. It was noticed that, even though actions such as basic sanitation and specific health actions, for instance prenatal care, were very important, the indicator that had the most significant importance and greater impact was the mother’s schooling. Therefore, making sure that children, especially girls, are not out of school, don’t have a teenage pregnancy – interrupting their educational cycle and their development possibilities – are aspects of social policy that are also very important for the promotion of childhood development, though in an indirect way.

A possibly easy advice to any administrator in a big city, in a metropolitan region in any part of the world is that, when they conceive and think of a new policy, in whichever area– even in urban development, infrastructure, mobility, housing – if this new policy is good and benefic to the children, it will be good for society as a whole. Therefore, putting children on the day’s agenda of the main policies can be a good strategy. Many times, we don’t need to create new different things, that are more laborious and take up more public resources, but only bring an agenda of priorities that is already in effect and have the city as meeting place, a humanization space of exchange between people, and add children to that agenda as well.

Rosario: Professor Haddad, thank you very much for coming today to speak for this very important initiative that is the Early Childhood Peace Consortium. I can only thank you for your work, for your initiative to develop São Paulo Carinhosa and for all your effort to implement this program, that is so relevant to the children, not only of São Paulo, but also, as an example for other cities in the world. Thank you.

Haddad: Professor, thank you for the opportunity of being in this very important space and for your welcoming, in the sense of doing this interview, knowing of your commitment, of your work of extreme relevance, extreme importance, of your partnership in many of the actions that we are able to develop here. Thus, thank you very much for the opportunity.