2003 winner
Recife, PE
The Public Management and Citizenship Programme in Brazil
The Public Management and Citizenship Programme in Brazil

More information in Portuguese about this award-winning program.

Due to its large number of islets and channels, Recife is known as the Brazilian Venice. However, the degradation of the marshlands and rivers brought serious public health problems to the municipality, worsened by its tropical location. Water supply in the Pernambuco capital is among the worst in Brazil and although the supply network covers almost the entire city, many areas receive water only two times per week. The poor quality of the water gives the state one of the highest cholera rates in the country as the supply shortage leads people to stock up water at their homes, creating an ideal breeding environment for disease-transmitting mosquitoes.

Only 21% of residences are linked to the sewage system, which means that over 1.1 million inhabitants dump sewage into channels, rivers and ditches. Consequently, Recife is one of the few cities in the world with high rates of Filariasis (elephantiasis) and Dengue fever. Until 2002 there were also high levels of incidence of Hepatitis A, Rabies and Leptospirosis. Scorpion and other insect bites were common, due to the accumulated garbage. In rainy seasons, mudslides were a routine occurrence.

Efficient and effective solutions to overcome this scenario depended on preventive actions, which led to the creation of the Environmental Health Program at the end of 2001.The aim is to create a universal health policy, with focus on the environment, by means of the identification and the elimination or reduction of risks. To achieve this end, four lines of action were set up: fauna, water, soil and housing. The Program counts on cooperation between the several governmental departments and works at central, district and local levels.

At the local level, environmental health agents distributed throughout Recife's 97 neighborhoods identify and seek to solve environmental problems that could bring health risks. If these problems cannot be solved by the agents themselves, the Program has a support network of operational agents and supervisors. Before the Program began, there were eight employees monitoring the environmental health of the entire municipality. After the PSA was implemented, the number rose to 921 employees.

The 716 health agents work as a link between the communities and the municipal government, identifying "strategic points" that need improvement, transmitting information and helping implement public policies. The population, in turn, uses the agents as a means of communicating problems such as gas leaks, which may otherwise have gone unnoticed by the central administration. The agents also provide a means for the communities to follow up on demands and complaints.

By August 2003, the Environmental Health Program had monitored over 3.4 million homes and public spaces, provided 500 thousand anti-mosquito treatments, cleaned seven channels, vaccinated 260 thousand animals against rabies, monitored 100% of the water supply and carried out ten thousand visits to homes considered at risk from mudslides.

The capital of Pernambuco now counts on a broad public health policy with a universal reach, working all year round and in all parts of the municipality. With the recognition that public health requires a coordinated effort, taking into account environmental issues, the PSA has managed to involve the municipal departments of health, planning, sewage, public services and social policies, besides the municipal companies of solid waste disposal and water supply, the civil defense agency and the City Hall itself. The Program's success rates prove the importance of preventive and integrated actions.

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