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How Brazil’s COVID-19 response has fallen to community leaders

‘Measures like these will be definitive for containing the virus, not only in Brazilian cities, but in cities across the world.’

Amanda Perobelli/REUTERS
Ambulances are stationed in Paraisópolis, São Paulo's biggest slum, on 30 March. Brazilian President Jair Bolsonaro's defiant COVID-19 response has shifted the weight of response to communities.

With Brazilian President Jair Bolsonaro railing against lockdowns and imploring his citizens to ignore social distancing measures, it has been left up to community organisations, local officials, and private donors to take the lead in responding to COVID-19.

Two months after Bolsonaro dismissed the virus as a “little cold”, Brazil has the second highest caseload in the world after the United States, and critics accuse the right-wing populist of having allowed COVID-19 to decimate the health service and the economy.

But this doesn’t mean Brazilians aren’t trying to treat and contain the virus, which has now claimed more than 23,000 lives: community groups, health workers, private donors, and local officials have all mounted campaigns to combat the virus in Brazil’s complex urban centres.

In the Paraisópolis favela of São Paulo, “block presidents” monitor the health of 50 families each, 240 volunteers have been trained as emergency first responders, and sick residents are instructed on how to receive care via telemedicine.

Paraisópolis community leader Gilson Rodrigues told The New Humanitarian that more than 365 other informal settlements across Brazil are similarly adopting these and other response measures.

One physician advising a quarantine centre in Paraisópolis recently shared updates about the project with a nationwide forum that connects some 40,000 community-based government doctors.

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Jessica Andrade, 27, received care at the Paraisópolis quarantine centre. When she tested positive for COVID-19, the result came with an invitation to recover at a public school retrofitted for the purpose rather than being sent home to the two-room space she shares with her husband Edson.

Seven days earlier, Andrade’s mother Zita had died from the virus, making her all the more concerned about infecting a loved one. 

She spent 10 days at the centre, including an afternoon when worsening symptoms prompted a hospital visit to be examined and get antibiotics. Now, Andrade is home with her husband, who is so far symptom-free.

“My isolation may have saved him and our neighbours,” she said.

The quarantine centre – a type of measure praised by Pan American Health Organisation (PAHO) Assistant Director Jarbas Barbosa – is a partnership between the Paraisópolis residents’ association, city health workers, the NGO Parceiros da Educação, and São Paulo’s Albert Einstein Medical School. It’s part of a large number of virus prevention and treatment measures being workshopped in Brazilian favelas, which house more than 13 million people in dense conditions that pose unique challenges to the pandemic response. 

Of the 10 Brazilian states with the highest proportion of residents in such informal settlements, eight are also among the country’s most-infected with coronavirus, according to the Brazilian Institute for Geography and Statistics and official epidemiological reports tracked by the open data platform Brasil.IO.

“This is unlike anything else since the country re-democratised in the 1980s.” 

In the face of presidential obstruction, discussions about how to tailor coronavirus responses for these areas are thrumming across Brazil between community leaders, local officials, and staff of the country’s vast public healthcare system. Donors have stepped up with record-breaking gifts.

“Measures like these will be definitive for containing the virus, not only in Brazilian cities, but in cities across the world,” Barbosa told TNH.

Brazilian and international private-sector donors have contributed much of their aid to community prevention, opening new grants and gift-matching initiatives for favela-based actions, and mapping donations in near real-time in a public Google spreadsheet and a series of reports that urge a wide distribution of donations.

COVID-19’s urban advance

The novel coronavirus spread through all of Brazil’s major cities after it was first detected in the country on 26 February. Patchwork social distancing measures were decreed by city and state governments beginning in mid-March. That’s when activists and community leaders from favelas nationwide began executing virus prevention campaigns and crowdfunding food and hygiene supplies

Civil society also mobilised en masse to lobby for a federal stipend for low-income self-employed and unemployed workers, winning payments of 600 Brazilian reaisl ($112) per month that have been bumpily rolled out. Authorities are also being petitioned to stop evictions, guarantee water, and halt militarised anti-drug police raids.

The measures are in line with recommendations from PAHO’s Barbosa and from UN-Habitat for slowing COVID-19 in informal settlements. Both institutions advocate for providing social assistance to labourers who can’t work from home, providing water access, and establishing community-specific techniques for isolating the sick and reducing physical contact.

Calls for assistance from favela organisers have caught the attention of both past donors and new contributors.

Brazilian companies, philanthropies, and crowdfunding campaigns have donated over $1 billion so far to COVID-19 response, according to the Brazilian Association of Fundraisers. The philanthropy coalition GIFE found that economic and social support for vulnerable groups has been a top focus. Usually, Brazilian donors give just over half that amount over the course of a year. 

“This is unlike anything else since the country re-democratised in the 1980s,” said GIFE’s Erika Sanchez Saez. 

Donors who previously insisted on having full control of charity programmes are now contributing directly to local organisations in low-income communities and donating funds to cover supply shortages in the country’s free universal healthcare system, Saez said. That’s the only healthcare option for 78 percent of Brazilians. One of the largest such systems in the world by population served, it has faced deep austerity cuts in recent years.   

Amplified by the social media hashtags #CoronaNasPeriferias and #Covid19NasFavelas, at least 461 response initiatives have been launched in low-income or informal areas of cities around the country, according to Instituto Marielle Franco, an NGO focusing on supporting the rights of favela residents.

Brazil’s epidemic “would be much worse without these mobilisations,” said Miguel Lago, director of the Rio de Janeiro-based Institute for Health Policy Studies (IEPS). “They have been fundamental.”

Some of the campaigns are run by long-standing favela-based NGOs, such as CUFA’s national food aid drive for favela mothers, or the radio, musical, and video virus prevention messages made in partnership between NGO Redes da Maré, several nearby community groups, and the health research institute Fundação Oswaldo Cruz. Others are run by young activists and ad hoc coalitions of concerned residents.

In Rio’s impoverished far west zone, 16 volunteers from different educational, cultural, and environmental projects united to distribute food and hygiene kits to more than 2,000 families.

“Our operation was only possible because we were on the radar of larger citywide and national fundraising efforts,” said one organiser, João Luis Pereira. The director of a university entrance exam prep course, Pereira has spent the last two months “learning as we go” about the logistics of coronavirus relief.

Like many grassroots COVID-19 forces, the Collective Union for the West Zone published a report of how they spent their funds.    

“Effective measures that are not expensive are possible if you are well-coordinated.”

International actors, too, have amplified virus response efforts across Brazilian favelas. UNESCO is sponsoring CUFA’s “Favela Mothers” project; UN-Habitat projects in four cities have helped governments gather and share health information for low-income households; and PAHO’s Brazil representative recently moderated a virtual forum of favela-based doctors.

The Ford Foundation has made funding available for favela-based virus response projects, while Oxfam has organised virtual debates featuring favela community leaders. Oxfam Brazil Director Katia Maia said the organisation aims to sound an “alert about the responsibilities of public officials” in confronting the virus because its spread in favelas reflects “existing inequalities in Brazil”.

Patrícia Chueiri, a doctor with Paraisópolis’s quarantine centre, said the new partnership has required “constant dialogue”, especially because trust from community members has frayed with government inaction. Crisis, however, has spurred openness to new alliances.

Still, immense challenges remain for favela-based campaigns. Some 31 million Brazilians lack access to running water and the World Food Programme expects 5.4 million people to fall into extreme poverty due to the pandemic. 

And Bolsonaro’s rhetoric on the virus is repeated even in some of the country’s most severely ravaged neighborhoods. On the poor outskirts of Manaus, an Amazonian city where mass graves are being used to bury COVID-19 victims, some of the president’s supporters still view the disease as a “little cold”, said Ivan Brito, who runs a community radio programme and has been threatened by Bolsonaro backers for promoting social distancing.

How public and private relief have been targeted

Of the $3.5 billion in emergency federal health funding approved for pandemic response, Eli Iola Gurgel, an economist at the Federal University of Minas Gerais, said it’s likely that as little as 20 percent will be spent on primary care, and at least double that amount on medium- to highly complex services.

Primary care includes preventive work by community-based doctors, which Lago at IEPS said “should be a cornerstone” of Brazil’s response.

One frequently heard concern of community-based response groups is that donations will dry up, forcing more people to leave their homes and potentially spread the virus, said Pereira, of Rio’s Collective Union for the West Zone. Many of the group’s aid recipients have been unable to access federal income support due to lack of internet and smartphone access.  

Concerns have also been raised about the geographic equity of private aid.

Most donations have been directed to Brazil’s wealthier southeast, home to Rio de Janeiro and São Paulo, according to GIFE. One of the relatively few private aid organisations active in the country’s north is Médecins Sans Frontières. Its COVID-19 plan focuses on hygiene support for the homeless, drug users, Venezuelan migrants, indigenous Brazilians, and those in nursing homes.

Read more → As COVID-19 takes off in Latin America, Amazon indigenous groups fear the worst

“We know the difficulties of adopting social isolation for the part of the population that lives in very small spaces, and they are even greater for people who don’t have a home,” said Ana de Lemos, MSF-Brazil’s executive director.

Gurgel, the Federal University of Minas Gerais economist, advocates putting Brazil’s public healthcare system in charge of allocating private donations. But she said it is “extremely worrying” that in recent weeks the Bolsonaro administration has swapped former military officials with little healthcare experience into the upper ranks of the Ministry of Health.

Two health ministers have departed during the pandemic and the position is currently unfilled. 

Still, Debora Pio of the advocacy NGO Nossas, who works with favela-based virus response forces across Rio de Janeiro, said only public authorities can ensure that water reaches all communities in need and that deadly police operations stop. Last week, police opened fire in two Rio favelas while volunteers distributed coronavirus food aid, killing two teenagers.

It was mass social mobilisation that spurred Brazil’s Congress to approve three months of emergency income support that could cost as much as $29 billion – 29 times the total value of private donations during the pandemic so far.

“As bad as the government is,” Pio said, “popular pressure is fundamental for political change to happen.” 

Local officials hold rank against Bolsonaro

Advocates for a stronger Brazilian COVID-19 response have increasingly focused on city and state officials, who have taken more aggressive stances than the federal government. A coalition of governors from Brazil’s northeast has commissioned its own team of scientific advisers and defied federal decrees that mandated re-opening some businesses.  

“Brazilian mayors and governors are looking hard at successful virus responses from abroad,” said Rodrigo Perpétuo, South America director of ICLEI, a global coalition of local governments. 

For example, Mayor Rodrigo Neves of Niterói in the state of Rio de Janeiro, has held regular video calls with the head of a coalition of favela residents’ associations during the pandemic. 

“Effective measures that are not expensive are possible if you are well-coordinated,” he told TNH.  

Brazilian mayors have also attended webinars with mayors from South Korea, Argentina, Portugal, and Italy, and taken steps like suspending utility bills for poor residents, providing city-level income assistance, and housing the homeless in hotels. Such actions are among those recommended in UN-Habitat’s COVID-19 response guidelines

Where local governments lag on adopting internationally recommended practices, public pressure has grown. Last week, Paraisópolis residents kept social distance as they marched to the front of São Paulo’s statehouse to demand water, food aid, service by public ambulances, virus testing, and hygiene assistance. 

“We organise, or we starve,” Rodrigues said.


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