A Discussion with Clovis Adalberto Boufleur, Manager of Institutional Relations, Pastoral da Criança, Curitiba, Parana, Brazil
With: Clovis Adalberto Boufleur Berkley Center Profile
June 11, 2014
Background: As part of the Education and Social Justice Project,
undergraduate student Adam Barton interviewed Clovis Adalberto Boufleur, Pastoral da Criança’s manager of institutional relations. In 1996, he was invited by Dr. Nelson Arns Neumann to join Pastoral
to lead their first foray into the public policy sphere. In this
interview, he reflects on the evolution of Pastoral and the current state of public
health in Brazil.
Can you tell me a little about your past? How did you come to work for
Pastoral?
I actually went to seminary until 1996, studying to be a priest. After receiving a master’s degree in Pastoral Studies from the Catholic Theological Union in Chicago, though, I was faced with the decision of whether to stay in the States and work with a homeless ministry or return to Brazil to work. By that time, I was already friends with Dr. Nelson after having met him at the Campo Largo seminary in Paraná, so I sent him an email, telling him about my situation. He suggested that I return to Brazil and work with Pastoral in the public policy sphere, an area of Pastoral that did not formally exist at the time and was in need of a founding coordinator. So I came to Pastoral with for the purpose of developing a network, called the Brazilian Network for Information and Documentation about Infancy and Adolescence, as well as training Pastoral volunteers to work in public policy. And then I started travelling with Dr. Zilda [Arns Neumann] to Brasilia each month for the National Health Department’s meetings, advising her on matters of public policy. Today, I am in charge of institutional relations for Pastoral.
What was Dr. Zilda’s mission when creating Pastoral da Criança?
More than anything else, Pastoral’s mission is to defend the rights of children and promote the public policies necessary for their care and their rights—all peoples need the conditions to make this care a reality. Dr. Zilda always thought of the volunteer and their role as the base from which we fulfill this mission; that we need to focus on the recruitment of volunteers who can strengthen family and foster the valuing of a child’s life beginning at gestation.The other great focus when thinking about how to achieve this mission was that of communication and adaptation. Dr. Zilda always said that there is no use in having good ideas if they do not reach those who need them—hence the need for both personal contact and mass communication. And part of that communication is the idea that one must tailor knowledge to meet local realities. Throughout her journey, she was always told things like “that stuff that you have will not work for those communities living within the Amazon.” But you know what? Pastoral expanded, and the ideas still worked. That is because our material deals with that which is common to any human being, anywhere in the world.
Pastoral respects culture, and it is successful for that reason. Dr. Zilda always made it very clear that our mission is never to impose, and always to respect. That is the secret to our international success.
What has Pastoral’s evolution been like during your 17 years at the national office?
The first step in evolution for Pastoral has always been to establish a goal. In that vein, we decided in 1997 that our mission was to reach all of the poor children in Brazil. Following that, we saw a period of incredible growth, something over 10 percent by the year 2000. Following that, we grew in the range of two to five percent per year. Beginning in 2007, however, we began to see a slowing which culminated in a trend of negative growth since the year 2010. The numbers have decreased slightly due to a few factors. The first is our insistence that each leader follow no more than 12 families. This, when combined with the fact that Brazilians are having half the number of children than they did 20 years ago—or 1.8 per couple—means that we have to find more families, and thus more leaders, in order to reach the same number of children that we once did. The opening of the labor market for Brazilian women compounds this issue, significantly reducing the number of leaders in our communities. In this period marked by domestic growth difficulties, though, we have managed monumental international expansion.
I recently heard someone say that Pastoral must think only about the community that it serves, “stepping over the government” in the process. Could you tell me, then, about the nature of the relationship between Pastoral and the government?
The first thing to make clear is that Pastoral has received public funding—funds that, as Dr. Zilda would stress, are meant to go to the people—since the third year of its existence, 1987. Despite receiving public resources, however, Pastoral does not depend in any way on the government. Though collaboration and legal partnership exist, Pastoral is free to position itself in any way it chooses, even if that position is in direct conflict with the government. And this conflict has happened in the past. In 1994, for example, when our IT system picked up that the mortality rate in Brazil—a strong indicator of the status of healthcare—had increased, the Ministry of Health came out and said that our data was incorrect in order to save face. We immediately went to the press and confirmed that our data was, in fact, accurate, provoking a crisis in the ministry.
A more recent example occurred back in 2003, when there was a clash between Dr. Zilda and the federal government over Lula’s [then president Luiz Inácio Lula da Silva] legendary “Zero Hunger” policy. The Zero Hunger program gave money to Brazil’s poor on the condition that they are able to provide the government with receipts showing how the money was used. Well, receipts were not available in much of Brazil. especially the poorer regions that this policy was aimed at. Deeming this policy unworkable, Dr. Zilda went to the press, provoking yet another federal crisis.
I am telling you all of this to demonstrate our independence from the federal government, and also to highlight the importance of our relationship to public policy. If someone says that we need to “step over” the government, it means that, because our goal is service for the common good, we must sometimes utilize avenues apart from the federal government to pursue justice—the media, for example. Collaboration is always our first plan, but we are not intimidated by conflict.
Could you speak to me a bit about Brazil’s Family Health (Saúde da Familia) program and the role of community health workers?
The government was actually inspired by the work of Pastoral da Criança when creating the Family Health program. Seeing our enormous success in the community, leaders knew that the best way of improving health outcomes is to train individuals to enter family homes to talk to about health. This individual, much like our leader, would not be a doctor or a nurse, and would attend to the whole family. The original training of these workers was done using our Leader’s Guide and, later, materials to which Dr. Zilda greatly contributed at the request of the Ministry of Health. This program is a great example of how Pastoral has helped to directly shape the national healthcare system.
So, if these governmental programs exist, why do we still need the work of Pastoral?
While similar, there is a big difference between the work of Pastoral and that of the government. The main feature that cannot be replicated by the government is the aspect of charity. Through volunteering, leaders build relationships based on trust and human emotions. How families relate to the volunteer, then, will be fundamentally different from how they relate to a government official; we will never replace the government, and the government can never replace us.
Can you talk to me about the role of articulators in Pastoral and how they came to be?
Up until 2006, we had a form of public policy training that focused on four areas: health, social work, children’s rights, and education. What we began to realize, though, was that this approach was very scattered. Given our mission, we decided that we would try out a pilot program here in Paraná to train volunteers to serve specifically as health advisors with the goal of serving on the local boards of health that exist in every Brazilian municipality. These boards of health, responsible for the formulation of health policies, are comprised of community members and government officials, elected every four years.
Because members must be elected, we could not count on Pastoral volunteers always having a seat on each board. So we dreamed up and created training materials for a worker who would be linked to this area of public policy without necessarily being a board member.
Three monthly functions were established for this articulator to follow. The first is to investigate child mortality—the articulator must go to the secretary of health and research each case in which a child dies in their municipality, whether that child is part of Pastoral or not, and bring that case to the board’s attention in the hopes of changing policy to avoid more deaths. The second is to attend monthly Pastoral meetings in their community. The third is to go to local clinics and document whether or not every child who enters with pneumonia receives the first dose of antibiotics before they leave.
What have you learned about best practices in community health education during your 17 years at Pastoral?
I had no experience in the world of healthcare before coming to Pastoral, but I had a fantastic teacher in the form of Dr. Zilda. First and foremost, she taught me the importance of patience; of not acting out of frustration, but rather learning to settle in and talk things through. Second, she taught me how to use my political knowledge in a strategic way. And third, perhaps most important, was the importance of always measuring the results. I have learned that you need to have results for people to believe in you, that a pretty ideological discourse does not keep people motivated. As the Bible says, you cannot hide your light underneath a table, but must display it for all to see.
If you could communicate any one message about Pastoral to the international audience, what would you say?
We have always been accustomed to think of children as part of the future. Pastoral exists to show that children are very much a part of humanity’s present. It is the way in which we care for our children today that will determine the quality of our future.
I actually went to seminary until 1996, studying to be a priest. After receiving a master’s degree in Pastoral Studies from the Catholic Theological Union in Chicago, though, I was faced with the decision of whether to stay in the States and work with a homeless ministry or return to Brazil to work. By that time, I was already friends with Dr. Nelson after having met him at the Campo Largo seminary in Paraná, so I sent him an email, telling him about my situation. He suggested that I return to Brazil and work with Pastoral in the public policy sphere, an area of Pastoral that did not formally exist at the time and was in need of a founding coordinator. So I came to Pastoral with for the purpose of developing a network, called the Brazilian Network for Information and Documentation about Infancy and Adolescence, as well as training Pastoral volunteers to work in public policy. And then I started travelling with Dr. Zilda [Arns Neumann] to Brasilia each month for the National Health Department’s meetings, advising her on matters of public policy. Today, I am in charge of institutional relations for Pastoral.
What was Dr. Zilda’s mission when creating Pastoral da Criança?
More than anything else, Pastoral’s mission is to defend the rights of children and promote the public policies necessary for their care and their rights—all peoples need the conditions to make this care a reality. Dr. Zilda always thought of the volunteer and their role as the base from which we fulfill this mission; that we need to focus on the recruitment of volunteers who can strengthen family and foster the valuing of a child’s life beginning at gestation.The other great focus when thinking about how to achieve this mission was that of communication and adaptation. Dr. Zilda always said that there is no use in having good ideas if they do not reach those who need them—hence the need for both personal contact and mass communication. And part of that communication is the idea that one must tailor knowledge to meet local realities. Throughout her journey, she was always told things like “that stuff that you have will not work for those communities living within the Amazon.” But you know what? Pastoral expanded, and the ideas still worked. That is because our material deals with that which is common to any human being, anywhere in the world.
Pastoral respects culture, and it is successful for that reason. Dr. Zilda always made it very clear that our mission is never to impose, and always to respect. That is the secret to our international success.
What has Pastoral’s evolution been like during your 17 years at the national office?
The first step in evolution for Pastoral has always been to establish a goal. In that vein, we decided in 1997 that our mission was to reach all of the poor children in Brazil. Following that, we saw a period of incredible growth, something over 10 percent by the year 2000. Following that, we grew in the range of two to five percent per year. Beginning in 2007, however, we began to see a slowing which culminated in a trend of negative growth since the year 2010. The numbers have decreased slightly due to a few factors. The first is our insistence that each leader follow no more than 12 families. This, when combined with the fact that Brazilians are having half the number of children than they did 20 years ago—or 1.8 per couple—means that we have to find more families, and thus more leaders, in order to reach the same number of children that we once did. The opening of the labor market for Brazilian women compounds this issue, significantly reducing the number of leaders in our communities. In this period marked by domestic growth difficulties, though, we have managed monumental international expansion.
I recently heard someone say that Pastoral must think only about the community that it serves, “stepping over the government” in the process. Could you tell me, then, about the nature of the relationship between Pastoral and the government?
The first thing to make clear is that Pastoral has received public funding—funds that, as Dr. Zilda would stress, are meant to go to the people—since the third year of its existence, 1987. Despite receiving public resources, however, Pastoral does not depend in any way on the government. Though collaboration and legal partnership exist, Pastoral is free to position itself in any way it chooses, even if that position is in direct conflict with the government. And this conflict has happened in the past. In 1994, for example, when our IT system picked up that the mortality rate in Brazil—a strong indicator of the status of healthcare—had increased, the Ministry of Health came out and said that our data was incorrect in order to save face. We immediately went to the press and confirmed that our data was, in fact, accurate, provoking a crisis in the ministry.
A more recent example occurred back in 2003, when there was a clash between Dr. Zilda and the federal government over Lula’s [then president Luiz Inácio Lula da Silva] legendary “Zero Hunger” policy. The Zero Hunger program gave money to Brazil’s poor on the condition that they are able to provide the government with receipts showing how the money was used. Well, receipts were not available in much of Brazil. especially the poorer regions that this policy was aimed at. Deeming this policy unworkable, Dr. Zilda went to the press, provoking yet another federal crisis.
I am telling you all of this to demonstrate our independence from the federal government, and also to highlight the importance of our relationship to public policy. If someone says that we need to “step over” the government, it means that, because our goal is service for the common good, we must sometimes utilize avenues apart from the federal government to pursue justice—the media, for example. Collaboration is always our first plan, but we are not intimidated by conflict.
Could you speak to me a bit about Brazil’s Family Health (Saúde da Familia) program and the role of community health workers?
The government was actually inspired by the work of Pastoral da Criança when creating the Family Health program. Seeing our enormous success in the community, leaders knew that the best way of improving health outcomes is to train individuals to enter family homes to talk to about health. This individual, much like our leader, would not be a doctor or a nurse, and would attend to the whole family. The original training of these workers was done using our Leader’s Guide and, later, materials to which Dr. Zilda greatly contributed at the request of the Ministry of Health. This program is a great example of how Pastoral has helped to directly shape the national healthcare system.
So, if these governmental programs exist, why do we still need the work of Pastoral?
While similar, there is a big difference between the work of Pastoral and that of the government. The main feature that cannot be replicated by the government is the aspect of charity. Through volunteering, leaders build relationships based on trust and human emotions. How families relate to the volunteer, then, will be fundamentally different from how they relate to a government official; we will never replace the government, and the government can never replace us.
Can you talk to me about the role of articulators in Pastoral and how they came to be?
Up until 2006, we had a form of public policy training that focused on four areas: health, social work, children’s rights, and education. What we began to realize, though, was that this approach was very scattered. Given our mission, we decided that we would try out a pilot program here in Paraná to train volunteers to serve specifically as health advisors with the goal of serving on the local boards of health that exist in every Brazilian municipality. These boards of health, responsible for the formulation of health policies, are comprised of community members and government officials, elected every four years.
Because members must be elected, we could not count on Pastoral volunteers always having a seat on each board. So we dreamed up and created training materials for a worker who would be linked to this area of public policy without necessarily being a board member.
Three monthly functions were established for this articulator to follow. The first is to investigate child mortality—the articulator must go to the secretary of health and research each case in which a child dies in their municipality, whether that child is part of Pastoral or not, and bring that case to the board’s attention in the hopes of changing policy to avoid more deaths. The second is to attend monthly Pastoral meetings in their community. The third is to go to local clinics and document whether or not every child who enters with pneumonia receives the first dose of antibiotics before they leave.
What have you learned about best practices in community health education during your 17 years at Pastoral?
I had no experience in the world of healthcare before coming to Pastoral, but I had a fantastic teacher in the form of Dr. Zilda. First and foremost, she taught me the importance of patience; of not acting out of frustration, but rather learning to settle in and talk things through. Second, she taught me how to use my political knowledge in a strategic way. And third, perhaps most important, was the importance of always measuring the results. I have learned that you need to have results for people to believe in you, that a pretty ideological discourse does not keep people motivated. As the Bible says, you cannot hide your light underneath a table, but must display it for all to see.
If you could communicate any one message about Pastoral to the international audience, what would you say?
We have always been accustomed to think of children as part of the future. Pastoral exists to show that children are very much a part of humanity’s present. It is the way in which we care for our children today that will determine the quality of our future.
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