Context: This post is an introduction to the organization ImpulsoGov. The goal is to present our work. We will soon make more posts detailing our operations with a greater emphasis on cost-effective analyses of our interventions.

About ImpulsoGov

ImpulsoGov is a non-profit and non-partisan organization founded in 2019 that collaborates with Brazilian municipalities to improve public policies focused on health promotion and prevention by working directly with the primary care of the Brazilian public health system.

Our organization consists of a diverse team of 53 professionals and has already supported 150 cities across Brazil, from various regions and of varying sizes. All our projects and partnerships with the government are provided free of charge, allowing us to focus entirely on maximizing impact. ImpulsoGov is supported by foundations, institutes, and companies that share our commitment to advancing public health. In 2023 our revenue was R$7.8 million (approximately U$1.6 million).

We were recently selected by the 100x Impact Accelerator, a leading social impact accelerator based at LSE’s Marshall Institute, as a high-impact social venture and João Abreu, one of the co-founders, was elected an MIT innovator under 35 in 2022.

The Problems We Aim to Address

Brazil has a universal public health system that serves 75% of the population—approximately 150 million people. Primary Health Care (PHC) plays a crucial role in any health system, being the first point of contact for patients and the foundation for health promotion, disease prevention, and early diagnosis. Brazil's PHC system has contributed to reducing infant mortality and increasing life expectancy in recent decades. However, significant challenges remain^[1].

According to our back-of-the-envelop calculations (in Portuguese), we estimate that around 34,000 healthy Brazilian lives are lost annually due to preventable causes due to priority health conditions related to PHC (e.g., women's health, child vaccinations, chronic diseases, and prenatal care). In Mental Health, data from the Institute for Health Metrics and Evaluation (IHME) shows that approximately 8.9 million Brazilians suffer from depression, with 71.2% of these individuals not receiving necessary treatment.

We have two areas of focus to address these issues:

• Impulso Previne (IP): a software in which we organize electronic medical record data so that healthcare professionals can identify patients with overdue appointments and exams (e.g., glycated hemoglobin test, Pap smear) and conduct active outreach, increasing these patients' adherence to the healthcare system.
• Mental health in primay care (MHPC): We train non-specialist health professionals, such as nurses and community health workers, in evidence-based care methodologies, such as interpersonal counseling, and implement a care model within the public health system to reduce depressive symptoms.

Why working in Brazil, a middle income country

One important disclaimer regarding our choice to work in Brazil instead of in poorer countries is our personal commitment to making a difference in our home country. Both João and I have always been motivated by our desire to positively impact Brazilian communities, and this personal connection drives our work.

We also recognize that the resources we operate with are tied to the Brazilian context. All our current donors, apart from the LSE grant, are Brazilian and specifically fund initiatives within Brazil. Notably, over the past two years, approximately 30% of our financial resources have come from philanthropic contributions from the Brazilian Development Bank (BNDES), which are inherently linked to projects within the country. Thus, we primarily use funding from national sources, which would be highly unlikely to be counterfactually allocated to more effective international opportunities.

That said, I will outline below reasons why we believe we can achieve cost-effective interventions.

Why We Believe We Can Be Cost-Effective: Evidence-Based Solutions and Existing Infrastructure

1. We work with evidence-based protocols:

   In IP, we utilize WhatsApp to send targeted messages to specific population groups, improving adherence to preventive exams and the monitoring of chronic conditions. This approach is backed by a robust body of evidence^[2] showing that mobile health interventions (mHealth) can increase service utilization and patient engagement.

   In MHPC, we train public health professionals to provide evidence-based treatments like Interpersonal Counseling (IPC) for depression. This protocol is designed to help individuals manage and improve their mental health, and has shown strong evidence of effectiveness^[3].

2. We leverage existing public health resources:
   • Workforce: Our target audience includes more than 500,000 public health professionals, including community health agents and nurses, who are essential to the delivery of healthcare. Because our interventions are implemented through these existing professionals, we don’t need to pay additional staff, keeping costs low.

   • Data Infrastructure: Over 90% of Brazil’s 57,000 primary care clinics use electronic medical records, and data is standardized and sent to the federal government. This allows us to develop highly scalable solutions using data already collected by the public system. For example, the photo below illustrates one of our reports from IP. We are able to access the nominal data of patients and accurately identify those who need closer monitoring. We do this without any effort to collect primary data, as this information is already collected by the professionals.

     

^[4]

1. We design scalable solutions using technology

   We have a technology team and invest heavily in this area. For example, in the PHC area, we have software that organizes patient`s information and generates reports to health teams indicating who are the patients who need to schedule appointments. We do this free of charge for local governments. We believe that our focus on software and technology makes our interventions cost-effective to replicate, given the associated economies of scale.

Our Ambitions and Uncertainties

Our vision is to implement cost-effective solutions validated by ImpulsoGov throughout Brazil as we are optimistic about the initial results of our solutions.

Our main challenge now is to scale these solutions to more municipalities while maintaining low costs and high quality. We are exploring possibilities for internalizing our solutions through the government, for instance through public sales or a partnership with the Ministry of Health.

Engaging with the Effective Altruism Community

When I was pursuing my master's degree in public policy and international development at the Harvard Kennedy School of Government, I got involved with the university’s EA group. I worked on a study in partnership with the Founder’s Pledge to define priority areas for a family foundation in Brazil using the ITN methodology. Since then, I have been involved with the EA Brazil group and participated in EAGx Latam. Our monitoring and evaluation leader, Bernardo Baron, has participated in the Charity Entrepreneurship fellowship for research and the EAGx Latam events.

The decision to co-found ImpulsoGov with João Abreu was heavily influenced by Effective Altruism principles. For instance, choosing to work in public health was not obvious since most philanthropic resources in Brazil are directed towards education. However, we believed we could have a greater impact in a more neglected area.

We're posting here to engage more actively with the EA community and share our learnings. We will soon provide more detailed posts with cost-effectiveness analyses of our interventions in PHC and mental health.

We are excited to contribute to discussions on how to effectively implement solutions in partnership with governments. We believe there’s great potential for collaboration and knowledge exchange in this space.

1. ^{^}

   https://www.gatesnotes.com/Lessons-from-Brazil

2. ^{^}

   chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://9475dbf4-555e-4808-9886-5f8ee815cc82.usrfiles.com/ugd/9475db_d9e68d40d8e340b2beced586d8619e48.pdf

3. ^{^}

   Weissman, M. M., Hankerson, S. H., Scorza, P., Olfson, M., Verdeli, H., Shea, S., Lantigua, R., & Wainberg, M. (2014). Interpersonal Counseling (IPC) for Depression in Primary Care. American Journal of Psychotherapy, 68(4), 359-376.

4. ^{^}

   This is a picture of our IP software that provides information about healthcare system patients, their consultation status, and the healthcare professional responsible for active search. The data in the picture are fictional.