Mental Health for All

The specificity of the problem we are addressing is centered around the lack of adequate mental health care within Brazilian Public Health System (SUS), particularly for individuals facing mild to moderate depression. In the Brazilian context, depression represents a significant public health concern, affecting approximately 9 million people, which corresponds to a considerable proportion of the approximately 150 million SUS’ users. This challenge is exacerbated by the shortage of mental health professionals, with only 0.18 psychologists and psychiatrists per thousand inhabitants throughout the country. In comparison, the United Kingdom's National Health Service, which inspired SUS, has a rate of 0.52, according to 2023 data.

The magnitude of this problem is not exclusive to Brazil; globally, about 279.6 million people are affected by depression, equivalent to 3,000 cases per 100,000 inhabitants. In Brazil, this number reaches  4,100 cases per 100,000 inhabitants. It is worth noting that depressive disorders rank second among the mental health conditions contributing to Brazil's overall disease burden, and ~USD90bi are loss every year to depression and anxiety in Brazil. These numbers underscore the urgency of actions to improve access to mental health care worldwide.

Furthermore, the demand for mental health services has increased, especially since the onset of the COVID-19 pandemic, which has had a profound impact on mental health worldwide. For example, in Latin American countries, there has been a notable deterioration in mental health during the first year of the pandemic, with 45% of adults in 30 countries reporting a decline in emotional and mental well-being, according to a study by the World Economic Forum (TAUSCH et al., 2022). Specifically in Brazil, there has been a significant increase in depression cases, with a 41% jump recorded by a joint survey conducted by Vital Strategies and the Federal University of Pelotas.

Several factors contribute to this situation. SUS currently focuses the care system on severe cases but neglects mild to moderate cases. Besides, primary care and community health professionals have insufficient resources and are not trained to provide adequate assistance in these cases. Consequently, Brazil boasts more than 500,000 health professionals working in Primary Health Care who, despite serving citizens in multiple health conditions (e.g., diabetes, hypertension, prenatal care), are ill-equipped and inadequately trained to provide comprehensive mental health care, exacerbating the situation with long waiting lists ranging from 1 to 3 years for treatment.

Our solution aims to address these challenges by implementing a scalable model within Brazil's public health system, leveraging this unprecedented army of healthcare professionals we have in the country. By empowering over 500,000 health professionals to implement this model, we aim to ensure that timely and comprehensive mental health care is provided to millions of people nationwide. This approach strengthens mental health care in primary care in such a way that tackling this problem has the potential to generate a $12 billion economy for Brazil, as indicated by a study conducted by ImpulsoGov

Our solution is a scalable model aimed at upskilling primary healthcare professionals to support individuals experiencing mild to moderate depression. Firstly, we offer a 25-hour training program for Primary Health Care professionals, including nurses, psychologists, and Community Health Workers (CHWs), employing a interactive methodology to equip them with the Interpersonal Counseling (IPC) approach, which is recommended by the WHO, mainly due to its simplicity and ability to empower professionals with no psychology/psychiatric background to provide mental health counseling and its evidence of impact.

International organizations have utilized similar methods and shown significant results, such as the case of Strong Minds, an organization offering group therapy led by non-psychologist and non-psychiatrist professionals for women and adolescents with depression in low-income settings in Uganda and Zambia, which was able to treat ~150K individuals with depression.

Once trained, Brazilian public primary care professionals will employ validated screening tools to identify individuals exhibiting symptoms of mild to moderate depression within their communities. This step is crucial for identifying the individuals who will be served by the professionals trained by the ImpulsoGov team, and for this purpose, we use the PHQ-9, a clinically recognized mood scale which pinpoints the intensity of depression symptoms.

Subsequently, cycles of appointments are conducted, where professionals trained by the ImpulsoGov team carry out a structured care model involving 4 care sessions for individuals identified with symptoms of depression. The appointment cycles are supervised by professionals specialized in the methodology, hired by ImpulsoGov. These sessions aim to provide active listening and support, facilitating the identification and relief of depressive symptoms by citizens with support of the healthcare professionals.

Our pilot program in the municipality of São Caetano do Sul (SP) has shown promising results, with trained professionals demonstrating improvements in their ability to identify and provide support to individuals with depressive symptoms. So far, in the municipality, we observed:

• 16 health professionals were trained by the ImpulsoGov team and 10 are conducting care sessions and undergoing the supervision process;

• 25 citizens with mild to moderate symptoms were assisted by the end of March 2024;

• 16 citizens who went through the 4 care sessions showed an average reduction of 50% in the intensity of depressive symptoms. 

This was a low-tech, successful pilot. Looking ahead, we will expand our program to more municipalities, with the ambitious goal of training approximately 30K professionals and serving 1.5 million individuals by 2027.

To achieve this scale, we'll leverage technology with support from Empower at Scale (ExS), an organization dedicated to expanding evidence-based psychosocial interventions digitally. Through our partnership, ImpulsoGov will use technology to extend evidence-based primary care to more Brazilian municipalities. This includes enabling remote access to training content for healthcare professionals, providing guidance messages for user monitoring, and tracking session progress for individuals with mild to moderate depression symptoms.

In essence, our solution empowers Brazil's public PHC professionals to identify and support individuals with mild to moderate depression using evidence-based techniques and strategic partnerships, aiming to scale our impact and enhance mental health care nationwide

Our solution aims to directly and significantly impact the Brazilian population affected by mild to moderate depressive disorders. Based on available information, in Brazil, there are approximately 9 million people affected by depressive disorders, which equates to about 4.1 thousand people per 100 thousand inhabitants. Depressive symptoms represent the second highest global burden of disease in Brazil among mental disorders. 

The profile of people with depression shows that 66.7% are female, representing the majority of cases in the country. Additionally, there is a predominance of white individuals among those clinically diagnosed with depression, followed by mixed-race and black individuals, with rates of 12.5%, 8.6%, and 8.6%, respectively. However, when it comes to depressive symptoms (not-clinically diagnosed), the numbers are closer among different ethnic groups, with rates of 10.6% for white individuals, 11.7% for black individuals, and 10.7% for mixed-race individuals (Source: IBGE. National Health Survey, 2020).

In terms of age group, the 30 to 44-year-old group has the highest number of individuals affected by depressive disorders in Brazil.

Regarding income distribution, there is an interesting trend: while the highest percentage of depression diagnoses is among those earning more than 5 minimum wages (13.8%), the highest proportion of reported depressive symptoms is among those earning up to USD100 (12.8%) (Source: Institute for Health Metrics and Evaluation). These data highlight the complexity of the relationship between depression and socioeconomic factors in Brazil.

Our solution aims to bridge this gap in mental health care provision by empowering primary healthcare professionals to identify and provide appropriate care for mild to moderate depressive symptoms within the public health system, used predominantly by the lower-income population, exactly those who suffer the most from depressive symptoms but who do not have the means to afford private mental health care. Our project consists of three main stages: training healthcare professionals, identifying symptoms, and implementing population-level care.

By empowering primary healthcare professionals, including nurses, psychologists, and community health workers, many of whom may have limited background in mental health care but are focused on other areas, we provide the necessary skills to identify depressive symptoms and offer initial care for the population they already know and serve in other health conditions. Our methodology based on individualized care set by approaches recommended by the World Health Organization, aims to improve symptoms and mental well-being of those served.

With this approach, we hope to not only reach those currently untreated but also promote a significant reduction in depressive symptoms and improve the quality of life of the Brazilian population as a whole

Experience in Mental Health: Between 2021 and 2022, we developed a control panel for public health managers and implemented it in Aracaju (SE), Recife (PE), and Aparecida de Goiânia (GO). Through this initiative, we identified a lack of access to information and data concerning mental health services among public health managers. Subsequently, we designed and implemented a control panel to enhance the management of mental health services, utilizing existing data. Working with a combined population of ~ 2.7 million people across the three cities, which host over 30 mental health units, not only provided us with expertise in managing public mental health policies but also granted us an intimate understanding of the realities faced by members of these communities.

Multidisciplinary Team with Extensive Experience for Project Implementation: Our team is composed of professionals from diverse backgrounds, ensuring our capacity for project management and operationalization. This includes individuals with extensive experience working within the SUS and government sectors, enabling a deep understanding of Brazilian governance dynamics and effective communication with stakeholders at all levels. Additionally, we have psychologists and mental health specialists who bring expertise in conducting consultations, supervision, and training, ensuring the technical quality of our work. Moreover, our team includes individuals with experience in strategic management, data, and technology, allowing us to focus on intelligent data usage and ensuring a dedicated focus on monitoring, impact assessment, and scalability.

Collaboration: Through collaborations with organizations such as Empower Incubator (Harvard Medical School - letter of endorsement here) and Empower at Scale (ExS), we have identified challenges in managing cases that are more severe than the project can handle. Drawing on these exchanges, we have designed a model to ensure qualified referrals for individuals with more severe symptoms than initially anticipated by the project, ensuring they receive appropriate care within the public health system. Additionally, our exchanges with partners have informed our decision to initially work with the Interpersonal counseling (IPC) approach, which is highly implementable within the Brazilian public healthcare system. These exchanges have enabled us to work on improving instruments and strategies for training, supervision, and monitoring, adapting them to the Brazilian context. For example, we have refined instruments for screening, supervision formats, and monitoring and quality control formats.

Adaptive Implementation: We work closely with governments to ensure that our initiatives are implementable within the public sector and adopt an adaptive approach, identifying errors and challenges rapidly and making adjustments to ensure greater impact. For instance, we engage various government stakeholders, create engagement activities for different groups, and establish mechanisms for their feedback and follow-ups. We also collaborate with municipalities to select professionals and test professional categories/profiles that are most engaged in mental health care, tailoring training sessions accordingly. Additionally, we develop strategies with management/professionals to ensure the reorganization of professionals' schedules and the implementation of mental health services without compromising other primary care activities.

ImpulsoGov has made significant strides in addressing mental health challenges by developing and implementing a dashboard for public health managers. Between 2021 and 2022, we successfully created this user-friendly online tool and deployed it in Aracaju (SE), Recife (PE), and Aparecida de Goiânia (GO). Currently, 19 Brazilian cities have access to this dashboard, enabling data-driven decision-making in mental health services and filling the information gap for public health managers. This initiative has garnered active engagement from managers in 73% of the municipalities, with over 30 minutes of usage per session, and we have 37 engaged users across 14 municipalities

Building upon our previous experience working with mental health and our proximity to primary care professionals across 19 (out of 26) Brazilian states, in 2022 we conceptualized the Mental Health for All initiative, which was validated through a pilot  in 2023 in São Caetano do Sul (SP). 16 professionals were trained, and 10 are currently conducting care sessions. By the end of March 2024, these professionals had served 25 individuals with mild to moderate symptoms. During the pilot, we observed a noteworthy 50% reduction (-6.38 points) in the intensity of depressive symptoms, registered through the PHQ-9 scale,  among 16 participants in São Caetano do Sul (SP), indicating the effectiveness of our model. Moreover, five new users have been registered since the last monitoring, demonstrating ongoing demand and engagement.

These accomplishments underscore the success and viability of our approach to delivering mental health care. Moving forward, we remain dedicated to refining our solution based on the data and feedback gathered during the implementation process, ensuring that we continue to provide effective and impactful services to our beneficiaries. In this phase our plan and objectives are to ensure the validated and refined model is scaled to as many municipalities and to as many healthcare professionals as possible, starting with the +160 interested municipalities we have on our waitlist who are eager to receive the project.

ImpulsoGov is applying to Solve with the aim of expanding its scalable model to treat mild to moderate depressive symptoms within the Brazilian public health system. Although we have achieved promising results in our pilot program, we face significant challenges in implementing the project on a larger scale,  considering that we have +160 municipalities interested in participating in the project. We hope that the Solve program can help us overcome these barriers, especially in the following areas:

• Technical Barriers: Following the pilot phase, we recognized the need to adapt our operational model to incorporate technology and increase our scale. We intend to leverage technology to streamline and strengthen the project, such as redesigning the training of healthcare professionals so that part of it can occur offline through a learning platform, in a hybrid format. We are seeking partners through Solve who can provide the necessary expertise in platform development and help us build internal technical capacity to overcome this barrier.

• Networking and Mentoring: Additionally, we hope that Solve will connect us with experienced Solver teams and industry leaders, providing valuable guidance to our team and expanding our connections for potential partnerships. This assistance is crucial as it will help us develop a scalable model and strategies for expansion, leveraging the expertise of seasoned professionals in the field. Such support will enable us to broaden our reach and impact in the realm of mental health solutions.

• Financial Barriers: To expand the project, it is crucial to secure adequate funding to include a technological interface, expand services to more municipalities, and train more healthcare professionals. Therefore, receiving the initial grant from Solve and gaining access to additional funding opportunities will be essential to subsidize implementation costs and ensure the project's long-term sustainability.

Some of the key features that highlight the innovation and effectiveness of our model include:

• Training of Primary Health Care (PHC) professionals through Brazilian Public Health System (SUS) unique network of professionals: The focus on training PHC professionals to deal with mild to moderate depressive symptoms is essential to expand access to mental health care. Our project aims to train nurses, psychologists, and Community Health Agents (CHAs) to identify and provide primary mental health care, thus leveraging a structure with over 500K professionals (the largest army of public healthcare professionals in the world), training, upskilling and equipping them with an evidence-based care model. Consequently, the project has a clear and tangible scaling potential, as ImpulsoGov already has experience in mental health care and maintains a close relationship with municipal health departments, and as the project already has a waiting list of +160 municipalities interested in participating.

• Use of Interpersonal Counseling (IPC): Our approach is based on IPC, a methodology recommended by the World Health Organization (WHO) due to its proven effectiveness and its ability to be implemented by non-specialized mental health professionals. This model allows for simple yet effective counseling to support individuals with depressive symptoms.

• Evidence of impact: Our pilot initiative in São Caetano do Sul has already shown promising results, with an average reduction of 50% in the intensity of depressive symptoms among individuals served by professionals trained by ImpulsoGov. Additionally, by the end of March 2024, 25 individuals had already been served by the professionals trained by ImpulsoGov, demonstrating that our approach has potential to reach and benefit a wide range of individuals.

• Strategic partnerships: We are collaborating with institutions such as Empower at Scale (ExS'), who developed clinically proven mental health interventions in collaboration with Harvard Medical School’s Empower Incubator, which offer proven digital solutions for evidence-based psychosocial interventions. This partnership allows us to further expand the reach of our initiative by incorporating technology into the professional training process to ensure a sustainable, long-term approach to mental health care.

Our initiative aims to empower over 500,000 primary health care professionals within the largest public health system globally, serving more than 150 million individuals dependent on the Brazilian Public Health System (SUS). By focusing on addressing mild to moderate depressive symptoms, our theory of change hinges on the following components:

• Activities: We engage municipalities to introduce and explain our project, collaborating with primary care coordinations to select primary health care professionals. These professionals undergo initial training provided by ImpulsoGov and receive ongoing supervision and support.

• Immediate Outputs (Deliverables): Through our activities, professionals become proficient in the Interpersonal Counseling (IPC), an approach recommended by the WHO. They identify individuals with depressive symptoms, stratify their risk levels, and provide support and treatment. As part of our pilot program, 16 health professionals were trained, with 10 conducting support sessions. By March 2024, we had served 25 individuals with mild to moderate symptoms, with an expected average 50% reduction in depression symptom intensity among those completing support sessions (based on preliminary analyses with 16 citizens).

• Longer-Term Outcomes (Results): Our vision involves expanding primary health care capacity to address depressive symptoms, aiming to reach 300 professionals and impact 20,000 individuals by the end of 2025. By 2027, our goal is to scale up to 30,000 professionals, positively influencing 1.5 million people. With trained professionals, individuals with severe symptoms receive qualified referrals to specialized services, while continuous professional development enhances care delivery within communities.

• Impact: Ultimately, our initiative seeks to increase overall life satisfaction among the target population. By improving access to mental health care, delivering effective treatment within primary health care settings, and fostering continuous professional development, we aim to enhance well-being and quality of life. Our evidence-based approach, supported by WHO recommendations and successful pilot results, along with strategic partnerships like Empower at Scale (ExS’), will enable scalability and sustainability.

In summary, our theory of change revolves around enabling access to basic, effective mental health care and promoting community well-being through strategic collaborations and evidence-based interventions. 

Impact Goals:

• Capacity Building: Our aim is to empower primary healthcare professionals within the Brazilian Public Health System (SUS) to effectively address mild to moderate symptoms of depression. By the end of 2025, we plan to upskill 300 professionals, increasing to 30,000 by 2027, which represents approximately 5% of all primary care professionals in Brazil. We'll achieve this by offering them training in Interpersonal Counseling (IPC), an evidence-based methodology recommended by the WHO, enhancing their ability to provide counseling and support in mental health at the community level.

• Improving Access to Mental Health Care: Our objective is to enhance access to mental health care for individuals experiencing mild to moderate symptoms of depression. By the end of 2025, we aim to assist 15,000 people, scaling up to 1.5 million by 2027 through healthcare professionals. Our model seeks to identify and support these individuals, reducing barriers to mental health care and preventing symptom exacerbation.

• Symptom Reduction: Our ultimate goal is to alleviate depressive symptoms in individuals enrolled in our program. We aim to achieve an average reduction of 50% in Patient Health Questionnaire-9 (PHQ-9) scores, mirroring the average observed in the pilot study, thereby significantly improving mental well-being for our participants.

Measurement of Progress:

• Training Progress: We monitor the progress of our training program by tracking the number of professionals at each stage of the project (training, screening, and treatment cycles). By monitoring progress, we gain visibility into the number of professionals trained relative to our targets.

• People Identified: Through the process of identifying individuals with mild and moderate symptoms of depression by professionals trained by the ImpulsoGov team, we can determine how many and which individuals will be served by the project.

• Symptom Improvement: We assess the effectiveness of our model by regularly evaluating changes in PHQ-9 scores among participants. By comparing baseline scores to post-intervention scores, we assess the extent to which our care model contributes to reducing symptom intensity and improving mental well-being.

Main Technology:

Our project, Mental Health for All  utilizes a combination of traditional knowledge systems, proven in their effectiveness, and technology to address mild to moderate depressive symptoms within the Brazilian Public Health System (SUS). The main technology driving our solution will include:

• Interpersonal Counseling: Our approach is based on Interpersonal Counseling (IPC), recognized by the World Health Organization (WHO) as an effective practice. Although this approach is not strictly technology-based, it is evidence-backed and provides a simple yet effective framework for providing support to depression cases, enabling primary healthcare professionals to conduct counseling sessions in a warm and efficient manner.

• Digital Tools: We are in the process of developing and implementing digital tools to enhance the scalability and effectiveness of our solution. These tools will include:

  • Online training modules: Professionals will be trained through in-person sessions and online modules accessible asynchronously for continuous learning.

  • Screening and identification processes: We will implement digital forms and validated screening tools to efficiently identify individuals with mild to moderate depressive symptoms.

  • Remote supervision: Professionals will receive supervision and guidance from specialized mentors remotely, leveraging digital communication channels such as video conferencing and messaging platforms.

  • Data Analysis and Monitoring: We will develop and utilize data analysis and monitoring techniques to track the progress and engagement of professionals during and after the implementation of the care model. This will include:

• Monitoring of professional training progress: We will track the number of professionals trained and their progression through the planned care cycles in the project to ensure alignment with our scalability objectives.

• Assessment of symptom improvement: We will regularly assess changes in PHQ-9 scores among individuals receiving counseling to measure the effectiveness of our intervention in reducing the intensity of depressive symptoms.

By integrating these approaches, our solution aims to empower primary healthcare professionals to provide effective mental health support, aiming to prevent the worsening of depression cases. Additionally, we have a strategic partnership with Empower at Scale (ExS'), which has developed proven effective mental health interventions in collaboration with Harvard Medical School's Empower Incubator. ExS' community interventions reduced PHQ-9 scores by over 50% in long-term clinical trials (same average as we observed in our pilot in São Caetano do Sul). After 5 years, 50% of patients were still in remission. Therefore, through the partnership, we will leverage their digital tools and evidence-based interventions to further expand psychosocial support for mental health issues

The project team is composed of individuals from different areas of expertise to support healthcare professionals. The team comprises two psychologists, one designer, one coordinator, and one manager, all with experience in executing projects for the government. One of the psychologists is Mairla Protazio, who serves as a Project Analyst and has experience as a coordinator of mental health services at the municipal level, bringing a technical health perspective to the project. Meanwhile, Daniela Krausz, the project manager, has experience in public administration in large cities like São Paulo, as well as in smaller and more vulnerable cities like Una (state of Bahia).

Since 2021, we have been working to enhance mental health in Brazil, by developing and implementing an indicator dashboard to assist public health managers in managing mental health services across 14 municipalities. In 2022, we conceptualized Mental Health for All, for which we did a pilot in 2023, testing and validating a model to address mild and moderate depression cases within the municipality of São Caetano do Sul. We have been refining our model ever since, concluding by the need of a technological component to expand our project to more municipalities, the reason why we established a technical partnership with Empower at Scale (ExS').

At ImpulsoGov, our approach to ensuring diversity, equity, and inclusion is multifaceted and rooted in our core values. We recognize that diversity of thought, experience, and background is essential to driving innovation and creating effective solutions to the challenges we face. Below, we share our diversity plan, outlining our actions to promote an inclusive and representative work environment.

1. Team Composition:

Currently, our team consists of 53 individuals, reflecting significant diversity in terms of gender, race, sexual orientation, and regional diversity. Our team comprises 81% women (1 transgender woman) and 19% men, while in terms of race, we have a diversified representation, with 54% white, 21% brown, 21% black, and 4% yellow. Regarding sexual orientation, we have a mix of 26% bisexual, 64% heterosexual, 8% homosexual, and 2% pansexual. Additionally, we operate in 15 Brazilian states and 2 countries abroad, covering various regions of Brazil.

2. Representativity Goals:

We have set clear goals to increase the representation of black or brown individuals in our team, especially in leadership positions. By September 2023, we aim to have 20% of leadership positions held by black or brown individuals and 45% of new hires in all positions coming from these groups. These goals will progressively increase in the following years, with the aim of reaching 40% of leadership positions held by black or brown individuals by September 2025.

3. Development of Black Individuals:

We've launched a mentoring program tailored to black interns and analysts, designed to cultivate their leadership, communication skills, and broaden their professional networks. Facilitated through ImpulsoGov, this program pairs participants with industry professionals, providing invaluable guidance and support. Our goal is to prepare these individuals for future leadership roles, fostering their career advancement within the organization while also contributing to the diversification of our leadership pipeline. To date, [insert number] analysts have benefited from this program, leveraging the insights and expertise of their mentors to navigate their career paths effectively.

4. Training and Discussion Spaces:

We are committed to creating regular spaces for discussion on diversity and inclusion throughout the organization, fostering open and constructive dialogue on issues related to diversity, equity, and inclusion. Additionally, we are planning specific training sessions for our leaders, focusing on developing their sensitivity and ability to effectively lead diverse teams.

In summary, our diversity plan reflects our commitment to building a more diverse, equitable, and inclusive team, where all members feel valued, respected, and supported. We are confident that these measures will enable us to develop more effective and impactful solutions to the challenges we face, while promoting a truly inclusive and welcoming work environment.

Our business model revolves around addressing the pressing need for improved mental health care within Brazil's Public Health System (SUS), particularly for individuals grappling with mild to moderate depression. With approximately 9 million individuals affected by depression in Brazil alone, representing a significant portion of the 150 million SUS users, the demand for accessible and effective mental health services is evident. The current ratio of only 0.18 psychologists and psychiatrists per thousand inhabitants in Brazil exacerbates the challenge.

Our solution aims to tackle these challenges by implementing a scalable model within the public health system, focusing on empowering over 500,000 primary healthcare professionals to deliver effective mental health care. We provide these professionals with a 25-hour training program, equipping them with the Interpersonal Counseling (IPC) approach endorsed by the WHO to expand mental health care by leveraging professionals with no previous psychological/psychiatric background. This approach upskills and equips them to identify and support individuals experiencing mild to moderate depression within their communities, enabling them to expand the care beyond primary care health conditions (e.g., diabetes, hypertension) in order to include mental health care.

Throughout our pilot program conducted in the municipality of São Caetano do Sul (SP), we observed promising results. 16 health professionals have been trained, with 10 conducting counseling sessions and providing support to individuals with depressive symptoms. By the end of March 2024, we had served 25 individuals with mild to moderate symptoms, with an average reduction of ~50% in the intensity of depressive symptoms among those completing counseling sessions (measured via PHQ-9).

Looking ahead, we aim to scale our program to more municipalities, with the ambitious goal of training approximately 30,000 professionals and serving 1.5 million individuals by 2027. To achieve this scale, we will leverage technology with support from strategic partnerships like Empower at Scale (ExS), enabling remote access to training content and session progress tracking for individuals with depressive symptoms.

Our business model focuses on delivering value to both primary healthcare professionals and individuals seeking mental health support. By upskilling healthcare professionals (leveraging the army of primary care professionals in Brazil) and providing evidence-based mental health care techniques, we empower them to deliver timely and effective mental health care within their communities, bridging a gap they recognize they have. For individuals experiencing depression, our model offers accessible support within familiar primary care settings, addressing their mental health needs closer to home, especially for the lower-income population in Brazil who suffers the most and has less resources to sustain private mental health providers.

ImpulsoGov's plan for achieving financial sustainability involves a multifaceted approach, leveraging various revenue streams and strategic initiatives. Here's how the organization intends to become financially sustainable, along with evidence of its success so far:

Diversified Revenue Streams:

• Private Social Donations: ImpulsoGov secures a significant portion of its funding (60%) from private donations from companies, foundations, and individuals who share its commitment to social good and public health improvement. These sustained donations provide a stable source of income.

• Public Grants: Leveraging public funding opportunities, such as a match funding initiative held by the Brazilian National Development Bank, for which we were the first organization selected and which accounts for 26% of the org's revenue. 

• Service Provision: Generating revenue through service contracts with municipalities and private institutions constitutes 14% of ImpulsoGov's income. This diversifies revenue streams and enhances financial stability.

Monetization Strategies:

• Transitioning to Sustainability: While initially providing core services free to municipalities, ImpulsoGov is strategically exploring monetization strategies. These include offering subscription services to municipal governments and entering into contracts with state governments for large-scale implementation. This approach aims to ensure revenue streams cover expected expenses in the long term.

Financial Achievements and Successes:

• Successful Fundraising: Over four years of operation (2019-2023), ImpulsoGov has raised USD 3.5 million (USD 600K destined to the Mental Health initiative alone) in investment capital, indicating investor confidence in its mission and potential for success.

• Grant Funding: The organization has successfully secured public grants, including participation in match funding initiatives with institutions like BNDES. These grants contribute to sustaining operations and expanding services, showcasing successful utilization of governmental support