Alexandre Silva

Favela Compassiva is transforming the capacity of vulnerable communities to care for people eligible for palliative care by empowering residents to provide this type of support alongside healthcare professionals and local public services.

Favela Compassiva, founded by Alexandre Silva, transforms volunteers into compassionate leaders and engaged citizens trained to offer palliative care within their own communities. The model is part of the global compassionate communities movement, created to address the challenges posed by population growth and aging. It is the first initiative of its kind in Brazil and stands out for being adapted to the geographical, social, and security conditions of favelas. Alexandre’s model has become a national reference in palliative care in peripheral territories, successfully implemented in twenty-four communities across the country.

Alexandre began building a volunteer network in Vidigal and Rocinha, communities in Rio de Janeiro, involving residents, multidisciplinary healthcare professionals, and an administrative team to offer holistic, high-quality care to patients eligible for palliative care. The project, rooted in compassion, is guided by a continuous commitment to taking all necessary steps to alleviate human suffering. Volunteers address the physical, spiritual, psychological, and social well-being of each patient.

The strategy supporting this model - and generating systemic change - is grounded in three pillars: integration with local public health units, enabling better planning and responses for end-of-life care; community training, which promotes a mindset shift and empowers residents to become active and meaningful participants in care; and in-person visits conducted by residents from other favelas, who learn how to apply the model in their own territories. This process encourages replication throughout the country and promotes equal rights and access to the healthcare system for all, regardless of physical condition or socioeconomic background.

Alexandre played a key role in the implementation of the National Palliative Care Policy (PNCP) within Brazil’s Unified Health System (SUS), through his 2024 consultancy to the Ministry of Health focused on the community component. Since 2024, the number of compassionate community initiatives in Brazil has grown across various regions, driven by the direct technical support of the Favela Compassiva team. This support includes methodology sharing, mentoring, workshops, and coordination with healthcare professionals, public managers, and universities. The project originated from a university extension program, enabling Alexandre to bring his knowledge as a researcher and professor directly into the communities. The organization also collaborated with the Ministry of Health to create guidelines, materials, and support for those interested in implementing such initiatives.

One of the main factors contributing to Brazil’s aging population is the increase in life expectancy and the reduction of mortality rates from non-communicable chronic diseases. In 2019, 54.7% of recorded deaths in the country were caused by non-communicable chronic diseases (NCDs), such as cancer, diabetes, and cardiovascular diseases. This scenario highlights the need for prevention and management of these illnesses through effective public policies. Risk factors associated with NCDs - including living conditions, access to public goods and services, income, employment, rights, and information - vary significantly between regions and population groups due to socioeconomic, cultural, racial, accessibility, and urbanization inequalities. These disparities make some territories substantially more vulnerable than others.

Basic Health Units (UBS) within the Unified Health System (SUS) are distributed based on demographic census data. However, in areas like Rocinha, where an estimated 180,000 people live, the gap between official data and the territorial reality compromises the planning and service capacity of UBS units. This discrepancy especially affects care for patients requiring palliative care. In this context, the presence of community care agents, properly trained and legitimized by the community itself, becomes an urgent need to strengthen care provision within Brazil’s public health system.

Favelas often lack effective regulation by public authorities, resulting in irregular land division, narrow passageways, and poor paving conditions. These structural characteristics restrict mobility within the community and limit access to both residents and state-provided services, particularly those related to health assistance.

The study “Care in the Training of Healthcare Professionals,” published in the Revista Brasileira de Educação Médica, demonstrates that many medical students feel unprepared and uncomfortable with practices involved in palliative care. Their emotional responses to death often manifest as helplessness, fear, or even aversion. Without adequate training and emotional support, meaningful improvement in palliative care is unrealistic. The journal highlights that Brazil ranks as the third-worst country in the world to die, reinforcing the urgent need to improve both training and mindset among healthcare professionals.

Rocinha, recognized as one of the largest informal urban settlements in the world, has high humidity and limited natural light, creating an environment conducive to worsening illnesses. According to the Pan American Health Organization (PAHO), the tuberculosis rate in Rocinha is ten times the national average - a sign of its sanitary vulnerability. These challenges become even more severe given the aging population, as older individuals are more susceptible to illness.

International projections indicate that by 2060, approximately 48 million people will die annually from intense suffering associated with debilitating health conditions, with 83% of these deaths occurring in low and middle-income regions where palliative care services are insufficient or nonexistent. In Brazil, this scarcity is especially acute in vulnerable communities, where the absence of effective public policies and limited research contribute to structural neglect. This context increases the occurrence of misthanasia - premature deaths caused by structural inequalities and systematic exclusion from basic conditions of dignity and assistance. This phenomenon directly violates constitutional principles of human dignity and the fundamental right to health.

The Favela Compassiva model offers comfort to people at the end of life in favelas through a collaborative approach centered on healthcare needs, relieving pressure on local health centers. The successful implementation of this model depends on seven practical steps and five groups of actors: local volunteers, healthcare professionals, health units, administrative teams, and financial supporters. Their interaction is essential for ensuring effective functioning and long-term implementation, creating a resilient, community-oriented support network that guarantees dignified care while strengthening the broader healthcare ecosystem in favelas.

The first step involves administrative volunteers serving as coordinators, recruited through community engagement - often relatives of individuals already assisted by Favela Compassiva. These coordinators identify local leaders and other volunteers willing to serve as community caregivers. No prerequisites are required, as all volunteers receive training. During this process, potential patients needing assistance are also identified. Building trust is essential, as end-of-life care is a sensitive experience, and as such, residents are engaged in conversations to ensure their concerns are heard. In Rocinha and Vidigal, initial entry points were the Residents’ Association and the local Catholic Church, both of which had individuals already involved in health-related activities.

Steps two and three occur simultaneously. The second step consists of offering community training on palliative care and explaining who may require such care. Coordinators and healthcare professionals encourage residents to identify neighbors who meet this profile. The third step involves creating a network of healthcare professionals to conduct monthly visits and develop comprehensive care plans. Alexandre established this network through partnerships with universities, ensuring a continuous flow of professors and student volunteers.

The fourth step is verifying the eligibility of identified individuals. Small interdisciplinary teams conduct home visits alongside the volunteer who identified the patient. Criteria include: life-threatening or limiting illness; fluctuating clinical evolution with recurrent crises; significant emotional or social impact; reserved prognosis with indication for primarily palliative care; and need for therapeutic adequacy. If eligible, the patient begins receiving regular visits from the local volunteer and monthly visits from the project team, complementing public health services. If not eligible, the family receives guidance on available services within the public health system.

The fifth step involves integrated support for the patient. Each local volunteer follows two to three patients, guiding care plans, conducting periodic monitoring, and mediating communication with the public health team. Professional support may occur in person or remotely, particularly for psychological services. Since many volunteers do not have technical training in health, much of Favela Compassiva’s effort focuses on volunteer education, with training adapted to their knowledge level, availability, and goals.

Support also occurs through financial contributions obtained via donations, grants, and revenue from paid courses. These funds are used to provide direct support to families - such as purchasing diapers, medicines, and protein-rich foods when not supplied by the public system- or to cover transportation for patient visits and monthly care events. This constitutes the sixth step, in which the management team administers donations, organizes trainings, and integrates the project with university extension programs, ensuring a continuous flow of trained professionals. Collaboration with universities also generates research to support public policy development, refine the model, and facilitate replication.

The final and most important step is integration with the public health and social care network. Favela Compassiva’s work requires direct communication and co-coordination of care plans with local health units. This is a complementary service that does not replace SUS. The organization generates electronic medical records and shares them with units, receiving relevant information in return to support patient care management.

Favela Compassiva has become a solution for vulnerable territories by reducing pressure on crowded health units and empowering residents to care for one another within their capacity. In vulnerable populations, the organization helps people live with more comfort and dignity and fosters care-based communities grounded in compassion, preventing loneliness among the sick and elderly. Its simple structure and low equipment requirements have enabled successful replication in 24 communities nationwide. The model was integrated into the national strategy and recognized as a benchmark in the National Palliative Care Policy (Ordinance GM/MS No. 3,681/2024). Alexandre contributed to the policy’s implementation, focusing on community-based palliative care. The initiative socially contributes to developing guidelines that make palliative care accessible in areas facing major social challenges. The model’s scalability is organic and adaptable, based on consolidated experiences in Rocinha and Vidigal.

Alexandre’s goal is for Favela Compassiva to become a national reference for community-based palliative care implementation by public authorities. In the next five to ten years, he intends to continue supporting emerging initiatives inspired by the model.

From an early age, Alexandre demonstrated a profound interest in compassionate nursing. As a child, he cared for balloons he imagined to be patients, tending to them until they “died” (deflated), an early reflection of his sensitivity to suffering. He felt deeply disturbed by the pain experienced in the final stages of life - a concern that became personal when his aunt developed liver cancer. She was discharged from the hospital to die at home, without any medical support. For Alexandre, people should be discharged to live, not die, comfortably at home, even in the face of an incurable disease, preserving whatever quality of life they still have. Later, when his father suffered a stroke, Alexandre and his mother took over his care. During this period, he also began working to support his family financially, balancing caregiving responsibilities with employment.

As a child, during a science fair, Alexandre was responsible for the hospital division. It was at that moment that his passion for nursing flourished and solidified as his chosen career path in university. In 2008, Alexandre was simultaneously pursuing his master’s degree in Minas Gerais and his MBA in Rio de Janeiro. During this period, while visiting Casa Rosa and influenced by the local model of care led by Luana Muniz, he met councilwoman Marielle Franco, who took him to the Complexo da Maré to understand how people were cared for in favela conditions, especially during the final stages of life. He continued studying Maré until he was forced to interrupt his research due to conflicts between different groups of parallel power. Alexandre continued dividing his time between Rio de Janeiro and Minas Gerais, carrying on his research in Vidigal and later in Rocinha.

After completing his MBA in Rio de Janeiro, he continued visiting Vidigal and Rocinha to support local women who were already caring for their neighbors. During this period, Alexandre encountered an elderly woman who had been forced to eat seasoned cardboard for eight days due to a lack of food. This encounter was a turning point that led him to leave the research field and transform his passion into a practical solution. This solution would later become Favela Compassiva, combining his academic background with his empathy for palliative care. In 2018, he was invited to speak about palliative care in favelas at the 1st Rio de Janeiro Congress on Palliative Care. There, he met Maria Gefé da Rosa Mesquita and Liana Amorim Corrêa Trotte, nurses from the Federal University of Rio de Janeiro (UFRJ), and Lívia Pereira Coelho, a physician in the municipal health network. Together with them, the desire and opportunity emerged to formalize Alexandre’s activities as a university extension program at the Federal University of São João del-Rei.

As the project grew, it became clear that the extension program could no longer support its scale. In 2019, Favela Compassiva, idealized by Alexandre, also became a non-governmental organization (NGO). Its ties with the university remain essential for maintaining trust and credibility among community residents, as well as being fundamental to attracting specialized volunteer healthcare professionals, developing research, and forming people with the compassion and commitment indispensable to the project's functioning.