João Cláudio Lara Fernandes

Ashoka Fellow
Fellow Since 1988
AMABB - Posto de Saúde


This profile was prepared when João Cláudio Lara Fernandes was elected to the Ashoka Fellowship in 1988.
The New Idea
Joao is gradually developing ways to integrate health care for the poor, both vertically and horizontally. The vertical integration links everyone -- from local community workers to community and municipal neighborhood health posts to sophisticated major hospitals -- into an economic and unified service. Horizontal integration ensures each patient doctor-guided access to the full array of health sciences: preventative and curative, homeopathic and allopathic, and psychological, as well as medical and dental.
His plan is succeeding for the people he is serving through the community health post he created in the Rio de Janeiro favela (slum) of Rocinah. Whereas most public patients served by public doctors get only a consultation of only a minute or two, the average consultation at his post is 20 minutes. He has attracted six psychologists to volunteer several hours weekly, and he has opened dental services. He organizes community education programs, including extensive use of street theatre. He has started to work with Ashoka Fellow Emilio Eigenheer to launch a community program to manage the area's wastes. He is able to get hospital lab tests back in 24 hours, although it commonly takes several weeks for the hospital's own patients. He is developing a host of service innovations, e.g., a portable medical record book that patients could carry with them.
Joao Claudio has been succeeding for a number of reasons: he is recognized as first-class doctor by his profession; he understands his clients and their community and is fully accepted by them; he has an instinctive feel for human institutions and organizational change; and he combines personal balance with commitment, creativity and vision. For example, how has he been able to get the major hospitals to give his poor patients prompt service? He has carefully controlled referrals (only 7 percent of his post's cases are referred) and has convinced the hospital that he is only sending carefully screened patients that need the test or help indicated. His referrals are therefore likely to be an economic use of the hospital staff's time and resources. His careful statistical tracking system helps carry this argument with the specific institutions where he seeks help. It will also help more broadly as he tries to spread his model, which is not only more economical, but provides better care.
Joao Claudio's objective is far broader than serving one community. Rocinah is his laboratory and demonstration project, but it is not where his work ends.
He is increasingly attracting medical students to do part of their training with him, and already several of his "graduates" are launching new centers in other poor areas. This tie gives his ideas increased credibility and visibility in the medical community. He is drawing other favela health groups together to use his statistical and management tools. He is speaking at and writing for the major medical institutions.
Joao Claudio's goal is to bring about institutional change. He is working to bring the very separate parts of Brazil's health care effort together to build a better overall system -- and he is gradually refining and demonstrating concrete steps in this direction that make sense for each of the actors.
The Problem
The Strategy
The Person

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