It was an intense two days at Fiocruz Brasilia (22 and 23 October). Debates, experiences and voices that showed why caring is recognising. Here you'll find a series of exclusive articles on the International Seminar Homeless people: comprehensive care and rights now.
The morning of the second day (23 October) of the “International Seminar on the Homeless: Comprehensive Care and Rights Now” was dedicated to the presentation of care experiences across the country. On the occasion, experts debated integrated health, care and housing policies for homeless people, emphasising the urgency of respecting dignity and tackling social inequalities.
From respectful coexistence in São Paulo to the strengthening of primary care in Rio and the national articulation of public policies, the event highlights experiences that point towards a comprehensive, intersectoral and anti-racist approach.
Alderão Costa: Coexistence and dignity as the basis of care
Alderão Costa, from Street Network from São Paulo, emphasised that living on the streets is not a choice, but the result of structural inequalities. He emphasised the importance of prolonged coexistence and active listening in order to build bonds that promote subtle, significant changes. He recalled the historical experience of Fraternal Aid Organisation (OAF) and the work of Dom Paulo Evaristo Arns, who invested in community centres for the poor during the military dictatorship.
He criticised punitive measures, such as evictions and fences in public spaces, which criminalise the homeless population. Costa brought up important data, such as the 3% percentage of indigenous people in São Paulo's street population, and emphasised the importance of publications such as the newspaper The Climber to preserve the group's memory and visibility. “The street is not a choice, it's not” was her central phrase, correlated to the need for public policies focused on welcoming, listening and respecting autonomy.
Rio's Mental Health Superintendence: Integrating health and housing
The mental health superintendent of Rio de Janeiro's Municipal Health Department, Hugo Fagundes, highlighted the model implemented after the psychiatric reform, which included closing hospitals and creating therapeutic residences. According to him, the homeless population faces extreme suffering and significant barriers to accessing services. He presented the Rapid Assistance Programme (PAR), which provides a 24-hour structure with hygiene and clothing, and mentioned the experimental Housing First project, which is expected to expand to 100 hostels by 2026. He also revealed that there are 7,869 people being cared for and 892 currently in the system, according to electronic records. She emphasised the principles of psychiatric reform such as care in freedom, low demands and harm reduction, stressing, “We work for suffering.” She also emphasised the political and social challenges of continuing and sustaining these initiatives.
Daniel de Souza: Street clinics and the fight against racial stigma
Daniel de Souza, from the National Network of Street Clinics, revealed the daily challenges faced by 300 teams across Brazil who work to care for the street population, facing stigma and prejudice, including within the Unified Health System (SUS). By problematising the media stereotype that associates the street population mainly with problematic drug use, he defended the complexity and diversity of the population assisted.
He emphasised the crucial issue of race: 87% of homeless people are black or brown, a much higher percentage than the general population (56%), reflecting historical inequalities. Daniel also warned of the “hostile architecture” in public spaces that prevents this population from living in dignity. He highlighted initiatives that promote the right to the city, affection and social belonging as fundamental forms of inclusion. “The street has colour,” he concluded, pointing to the need for policies that combine combating institutional racism and expanding the intersectoral support network.
Maria Caetano: Vila Reencontro, transitional housing and social inclusion
Maria Caetano, coordinator of the Vila Reencontro programme in São Paulo, presented the project launched in 2023, which offers transitional housing based on comprehensive care, intersectoral coordination and community strengthening. The initiative works through residential modules equipped for families of different sizes, including adaptation for people with disabilities, with a high occupancy rate (96%).
The programme is structured around three axes: care (individual and family assistance), connection (strengthening community ties) and opportunity (socio-economic inclusion and professional qualifications). It emphasised the importance of residents“ active participation in internal collectives and entrepreneurship fairs, fostering autonomy and citizenship. Transitional housing is presented as the anchor for rebuilding lives, inspired by the Housing First model. ”Building paths of dignity and autonomy for the homeless" summarises its proposal, the impact of which depends on the continuity and expansion of the model.
Lília Gonçalves, Ministry of Health: Participatory management and strengthening primary care
Lilian Gonçalves, from the Access and Equity Coordination of the Ministry of Health's Primary Health Care Secretariat, highlighted the reactivation of the National Technical Health Committee for the homeless population, promoting systematic dialogue with social movements and expanding participatory management.
She emphasised that care must go beyond the street clinic teams, integrating all primary care and the health network for longitudinal and comprehensive care. She highlighted the challenges of aporophobia (fear of the poor) and other prejudices that persist in the practice of services, despite current regulations.
He reported the growth of street clinic teams from 222 in 2023 to a forecast of 320 teams in 2025, albeit under budgetary uncertainties.
He also discussed the innovation of mobile clinics, physical units designed to improve specialised care, which are expected to start in 2025. The launch of popular education courses for care professionals seeks to qualify and humanise care. “It's a consultative space for articulating and producing consensus, for actively listening to management,” summarising the importance of these processes for strengthening national policy.
This section of the international seminar brought together key voices to think of the homeless population as an integral and legitimate part of the city, emphasising that “the street is not a choice”.
From respectful coexistence practices and the strengthening of emotional bonds to intersectoral models that integrate health, social assistance, housing and productive inclusion, the interventions have shown both progress and challenges.
They also emphasised the historical dimensions of racial and social exclusion, which require structural confrontation.
Dialogue between social movements and public management has proved indispensable in building policies that go beyond welfare, seeking autonomy and the right to the city.
However, there are still gaps when it comes to assessing long-term impacts and overcoming institutional and social barriers, indicating priority paths for formulating and implementing more effective and humanising public policies.
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