Conexão Saúde project reduces COVID-19 mortality in favela complex in Rio de Janeiro

During the pandemic, few actions to control the transmission and manage cases of COVID-19 in low-income urban communities were implemented worldwide. Inequalities in the access to health have contributed to an increase in cases and deaths in vulnerable communities. However, an article recently published by the online journal BMJ Global Health documents the effectiveness and impact in the reduction of the COVID-19 mortality rate after a multicomponent intervention carried out in the set of favelas of Maré, in Rio de Janeiro, through the project Conexão Saúde: de olho na Covid, (Health Connection: Keeping an Eye on COVID-19) of which Fiocruz is an integral part. The results point to a 46% reduction in the mortality rate and a 23% increase in reported cases of COVID-19 during the period. The success of the action is due to a combination of different factors, such as community involvement, communication, mobile surveillance, massive tests and telehealth, the research points out.

The intervention carried out integrates a new model of surveillance and health care to face epidemics in urban communities. The results presented may support future actions and establish equitable epidemic responses, especially in terms of access to health for the socially vulnerable population, as pointed out by Fiocruz researcher and study coordinator, Fernando Bozza.

“The study opens a perspective from the perspective of public policies, in acting in situations of crisis in historically neglected territories. Health actions that combine science, engagement and work with civil society organizations may become government programs in the future. The Conexão Saúde project, carried out in the favelas of Maré, points to an effective model of governance and horizontal management, where you work in partnership and which can possibly be replicated”, he states.

Between March 2020 and April 2021, 31,3474 cases of COVID-19 were confirmed and 6,613 deaths were reported in the municipality of Rio de Janeiro, with 4,967 cases and 279 deaths recorded in Complexo da Maré. The research method used in the study, called “differences in differences” (DID), analyzed the mortality and the impact of the action, from March to August 2020, and after the intervention (September 2020 to April 2021) in the community, in an estimated population of 140 thousand people, distributed in 16 favelas. The applied model compared the results obtained with three other favelas, which, together, are equivalent in population (Rocinha, Cidade de Deus and Mangueira), and sought to understand the behavior over time by cases and deaths by COVID-19, before and after the intervention.

At the time, an analysis was performed to estimate the effect of all joint strategies on the progression of cases and deaths per 100 thousand inhabitants. The intervention combined three main activities: Mass Testing promoted and managed by mobile technology, Telehealth and Home Isolation with social networks as a source of support and information. In the context, the progression of the pandemic and the results before and after the start of the intervention were analyzed, aimed at provision of information, surveillance and health services to reduce the impact of the COVID-19 pandemic. The communication strategy with appropriate language, newsletters on social networks and guidance for community residents made all the difference in the process, reducing the spread of fake news. Visits to homes, through basic health units, distribution of alcohol gel, masks, pamphlets and placement of banners and posters supported the action.

“Among the main aspects of the research, it is important to highlight that it is possible to carry out combined actions in a pandemic involving different sectors of society, even in historically neglected areas. The study also demonstrates that science is essential in generating information, in epidemiological monitoring, in qualified information that generates data for society and as a way of informing and guiding the population. The type of modeling used helps in the conclusions and suggests that the intervention carried out in Maré cannot be measured by isolated actions, but by a set of them, which had a positive impact on the reduction of deaths by COVID-19”, complements Bozza.

The study indicates that the integrated health surveillance and care model to support the favelas of Rio de Janeiro during the pandemic was able to prevent deaths, ensuring protection for a socially vulnerable population by reducing the impact of inequities in the access to health care through the promotion of effective local care actions.

Conexão Saúde

The study is an integral part of and one of the stages of the initiative Conexão Saúde: de olho na Covid, a coordinated action among six initiatives: Fiocruz, Redes da Maré, Dados do Bem (DdB), SAS Brasil, União Rio and Conselho Comunitário de Manguinhos, whose organizational arrangement includes the public and private sectors, academia and non-governmental organizations, which operate in the favelas of Maré and Manguinhos, in Rio de Janeiro. The project was designed with the proposal of an integrative approach and participatory model of surveillance and health care, with the contracting of new technologies to expand the access to health and enable quick and effective responses to the demands of the population, which ranges from guidance and support for the local population, to telehealth, molecular testing, tracing of people in direct contact with patients and the production of risk maps within communities.