Social enterprise for health, Brazilian style

With the leaders of Saúde Criança at their headquarters in Rio de Janeiro.

This was originally published on Global Health TV on April 27, 2014.

RIO DE JANEIRO, Brazil — One is poised to become the condom market leader in Brazil, with 40 variants in its Prudence condom line. Its newest offering features the flavor and scent of caipirinha, the iconic Brazilian cocktail made from cachaça, lime and sugar. DKT believes it prevented over 9,000 HIV infections in 2013.

Another rescues the poorest and unhealthiest children from the urban slums of Rio de Janeiro, Sâo Paulo and other cities, and nurses them – and their families – back to health.  Since its creation, an estimated 50,000 people have benefitted from its work.

They are very different global health organizations, with very different operating models, but both call themselves social enterprises, Brazilian style, and both were created in 1991.

Brazil has become a kind of hub of the social enterprise world. In 2012, the Social Enterprise World Forum was held there. And I’m reading more articles, like this one, which claims that social enterprise is becoming the norm, “a really valid option proposed for anyone wanting to start or grow a business in Brazil.”

So in March, on a trip to Brazil, I visited both organizations to find out what brand of social enterprise they are.

Saúde Criança

Last year, I wrote about this organization (Saúde Criança means “child health”) founded by Dr. Vera Cordeiro in Rio de Janeiro.  It has developed a unique methodology that attempts to break the devastating cycle of disease-hospitalization-discharge-misery-disease experienced by many young children in the favelas (slums) of Brazil.  

Saúde Criança identifies children and their families living below the poverty line. They are interviewed and assessed by Saúde Criança. Based on this information, a "family action plan" is developed for each family with objectives and indicators in the areas of health, citizenship, housing, education and income generation. To tackle these five areas, the program offers direct assistance, technical support, professional training, support programs and citizenship.

It is obvious that Saúde Criança produces short-term benefits for the family including improved health, an increase in income and better housing. But it was not known whether these effects were ephemeral or sustainable until last year when Georgetown University conducted the first rigorous evaluation of Saúde Criança. The evaluation found large and sustained gains across the five themes of Saúde Criança’s approach including a 90 percent decrease in hospitalization and a near-doubling of household income.

Saúde Criança now has 10 organizations in its social franchise network and another 11 using its methodology. Belo Horizonte, one of the largest cities in Brazil, has adopted its methodology and made it public policy. Dr. Cordeiro believes its methodology can be adapted to other countries in South America and elsewhere.

“Saúde Criança has now reached the point where the spread of its approach is gaining momentum,” said Bill Drayton, president of Ashoka. “This is the arc of the world’s truly excellent social entrepreneurs.”

Saúde Criança is dependent on its diversified funding coming from Brazilian and international companies, social entrepreneur organizations and individual donations but has a plan to sell its consultancy services to generate revenues and become more financially self-sufficient.

DKT Brazil

In its 23 years of existence, DKT Brazil has transformed itself from a charity entirely dependent on international donors to a social enterprise dependent only on its own marketing savvy.

When DKT Brazil was launched in 1991 as a condom social marketing organization, it received major funding from the U.S. Agency for International Development and other donors. But it was forced to become financially sustainable in 2003 when it lost its USAID funding.

Today, it is 100% financially sustainable. All of its products make money, and yet all of them are also within the contraceptive affordability index, which dictates that the cost of contraception should be less than 1% of a family’s annual income. In fact, its cheapest condom is only 0.22%. Even its most expensive brand does not reach 0.5%.

I first reported on DKT Brazil in an article on their ground-breaking efforts to use sexy advertising to sell condoms. They know this works as their share of the Brazilian condom market has increased to 21% in 2012. The new caipirinha condom is only the latest in a long line of flavored, scented and specialty condoms.

In 2013, DKT Brazil apparently became the first company to sponsor Carnaval for a social purpose.

Daniel Marun, country manager of DKT Brazil, based in Sâo Paulo, has a simple definition of social enterprise: “ Having a sustainable social impact without depending on anyone else.”

Clearly, DKT Brazil has achieved that goal, and even generated funds to start a new social marketing program in Mozambique. Furthermore, the approach has been shown to be replicable elsewhere, as DKT programs — including Indonesia, Philippines and Turkey — have already achieved financial sustainability.

Saúde Criança and DKT Brazil are very different types of social enterprises. Although neither gets funding from traditional donors, DKT Brazil has already achieved financial sustainability; Saúde Criança has a ways to go before it achieves that goal. But both can serve as useful models of social enterprise for other organizations in Brazil and other countries around the world.