This month left me mulling over the degree to which direct benefits for families, whether in cash or in kind (food, clothes etc.) are barriers to the internal motivation that families need to truly transform their situation.

20 new families signed up to the full Saúde Criança support programme in the last six months.  This is almost double the number of families that signed up in 2009.   This is largely due to our new partnership with the local public health centre/GP surgery, which attends to people living in the five communities surrounding the children´s hospital.  Like Rio de Janeiro, these communities grow informally, clutching to the hills for survival.  They are characterized by financial poverty, drug-related violence, families continuously moving in and moving out and precarious housing and sanitation. 

In the same six months however, 9 families have either left or been asked to leave the programme.    This is almost double the drop-out rate of 2009.  When I sat down with the social worker and psychologist to understand the reasons behind this, I stumbled on a situation reminiscent of social policies and anti-poverty initiatives in Ireland and England.  

Most of those dropping out are local families from Agronomica, which is near to the centre of Florianopolis and there are a number of social programmes offered there.  These social programmes are largely focused on providing direct services to children and adolescents.  They include public and NGO crèches and homes for abandoned children, health services for children and programmes with monthly stipends for adolescents.  The main family supports are small government cash benefits for those on extremely low-incomes and a religious organization that offers monthly food baskets.  The requirement for all of these benefits both governmental and religious is simply poverty.  The government´s small cash benefit Bolsa Família (around EURO 20 year month per child) is conditional on the child attending school at least 75% of the academic year and being up-to-date with vaccines.     

Our programme has a much higher level of conditionality.  The families receive direct benefits of food, housing support, hygiene kits, clothes on the condition that they take part in a monthly support session, which includes advice and support from the social worker, the nutritionist, the psychologist, the lawyer and the dentist; professionals continually questioning their often chaotic and unconscious ways of living their lives and providing them with information and encouragement to change.  The mothers must also participate in the handicraft workshops, unless they are in another course or employment.   They must show commitment to improve their families´ situation.  They need to adhere to the treatment of their children and take care of their own health, with annual smear tests (a frequency recommended in Brazil) and show up to doctor, ophthalmologist and other health-related appointments that we make for them.  They get materials to improve their housing, but they must provide some of the work if they can. 

For some families, it would seem, it is easier to live from unconditional or low-condition payments.  They entered the programme looking for the easy benefits they are used to and found too much asked in return.   So, despite the encouragement of the social worker and psychologist, they drop out.  Perhaps it is easier for them to leave their children in full-time crèche or abandon them to live in institutions, to rotate from charitable donation to charitable donation and to receive any benefits that the government is offering rather than truly try to transform their life situation.       Getting by may be preferable to improving their lives, especially if that´s all they´ve ever known and they have neither sufficient confidence in their abilities nor motivation to break out of the rut they are in. 

Some families do try to change their situations but the benefits actively discourage it.  One mother from the programme was going to be employed by the NGO but decided against it when she learnt that she would then lose an almost equivalent benefit for her child, who has a weak heart.   My cleaner asked me to write a letter stating that her salary was half of what I pay, so she would not lose her child´s free crèche place.   Ireland and the UK are rife with examples of the counteractive incentives of benefits too: benefits that encourage couples with children not to marry or live together, benefits that are greater than the salary they are able to earn, benefits that encourage single mothers to stay out of any kind of work for over twenty years and then are thrown unprepared into the workforce once their youngest child reaches 18. 

When I think of my own actions and those of my middle-class counterparts, I remember how often the road of least effort and lazy passivity has been chosen over the braver and more exacting road of self and life-improvement.  Maybe we all only really change when there is no other real option.  When we can´t handle the situation any more.   Perhaps the unconditional or low-condition benefits provide an anesthetic to make the situation just bearable enough for the person living in poverty, to rob him of the necessary internal motivation to make changes in his live.  

So what is the alternative? 

Do we move our programme to a poorer area that has less easy government and charitable support, to make recruiting and maintaining families easier?  Do we suggest that government reduces or cuts benefits entirely to force families into improving their material living standards on their own?  This has happened to a degree with the welfare to work programmes in the US and there is lots of controversy over them. 

Or do we just accept the dependency culture and appease our own charitable urges and guilt complexes by providing people with what they seem to want: easy and generous benefits, no conditions attached?

I remember an experience I had when I was in my early twenties in Dublin with a friend of mine, after we left the pub one night.  We came across a homeless guy who was sitting wrapped in a sleeping bag, trying to escape the cold in the doorway of a shop.   I bought him a cup of tea, asking him first if he wanted milk and sugar.  My friend gave him a pound note.  As we walked up Grafton Street, I turned to my friend and questioned her actions, saying that it was clear that a hot cup of tea would do him good on a cold night but he could spend the money she gave him on drugs, which would be worse for him.  She shrugged and replied humbly, ´who I am to tell him what he needs?´ 

This experience still swirls, unresolved, in my mind. 

For the most part, efforts like the Saúde Criança programme seem to make sense.  They provide immediate support, both in-kind and cash, but focus on helping the family to be self-sufficient.  The length of the programme depends on the needs of the family, given that each situation and family is different.   I know that in Ireland and the UK there are increasing efforts to provide time-limited benefits, while providing parallel training and encouragement to promote cultural change.  But they are facing significant barriers by a prevailing dependency culture.  

And what of the families that don´t make it?  Families that can´t rise above their upbringing or their own limitations or just plain don´t want to jump through our middle-class hoops?  Do we leave them, and their children, to live in poverty without support, in the hope that they will hit rock bottom and the illusive motivation will appear? 

Or do we let the government continue to provide undemanding benefits, accepting the additional barriers it creates for families and those who support them in transforming their own situations?  

Perhaps, in our extremely limited influence, this is all we can do here at Saúde Criança.   Do the best job we can, accept our limitations and the counter-culture nature of what we are doing and celebrate the times when what we offer chimes with what the family really needs and is willing to take on.  We can also look to expanding only into areas that have less support services of any kind.   Depending on the demonstrable success of our experience, we can offer what we have learnt to government and help them to replicate it, if they are interested.   For now, that feels like a pretty full plate.

Not saving the world, but making a small contribution to what we believe is its improvement: and helping one child and receptive family at a time.