Annual Results and Impact Evaluation Workshop for RBF - Day Five - Opportunities CCT

Claudia Macias Health, Nutrition & Population

Latin America and the Caribbean

Human Development Program

Mexico: Background (1997)

% hogares en pobreza

2002. Programa Institucional Oportunidades 2002-2006

High prevalence of chronic malnutrition (34%) and anemia (27%) in children under 5

Federal budget focused on providing generalized subsidies

Extensive experience in food programs targeting poor people with limited impacts

47% of the population was considered poor

Low school attendance among children aged 14 and 15 years: 53% male and 47% female

Public policy

Facts

Poverty

Investment in human capital to help break the intergenerational transmission of poverty

Educational grants Preventive health care with an emphasis on nutrition

Conditional Cash Transfer Program

Objective

How Does Program Oportunidades Work

Oportunidades is an inter-institutional program, which involves the following sectors:

  Social Development  Health

 Education   Finance

Oportunidades, Supply Interventions and Expected Impacts

• Comprehensive Strategy for Nutrition Care (ESIAN) • Early Childhood Development • Preventive interventions, focused on maternal and child care

financed by the Popular Helath Insurance. • For children under 5 years - universal coverage of services

Health and Nutrition

•  Redesigning scholarships •  Financial support for non-formal education •  Financial support for job trainings

Education

•  Coordination with the existing institutional supply •  Access to credit •  Entrepreneurial skills training and development

Productive links and

job placement

Increase in human capital and productivity at an early age Improve health and nutritional status of beneficiaries

 Expand opportunities for development of productive capacities  Generate family income

Increase in human capital, greater employability and acquisition of job skills.

Expected Impact

Component Supply Intervention

Target Population

Target population

Households whose income and socioeconomic conditions hamper its members’ capacity building in terms of education, nutrition and health, in accordance with the established eligibility criteria and targeting methodology.

Selection criteria

1. Geographical (poverty by location) 2. Poverty level (household survey)

Coverage

5.8 million families in rural and urban locations = 23% of the population of Mexico 100 % of states 100% of municipalities

Coverage of Oportunidades

Year Rural Semi-urban Urban Total

2002 68,006 1,939 579 70,524

2006 80,352 2,130 491 82,973

2009 94,789 2,596 537 97,922

2012 142,518 3,532 549 148,229

Op. 94,291 2.605 541 97,437

PAL 48,267 1,982 543 50,792

Locations covered

Family corresponsibilities and support

Education

Regular school attendance

Attendance to health workshops for high school youth

Corresponsibility

Utilization of preventive health services (Popular Health Insurance Scheme) (2 yearly visits per beneficiary)

Attendance at workshops for self-care (monthly)

Transfers for food (about US$ 30)

Youth / Oportunidades

Complete High School before the age of 22 and formalize their own Bank account

Nutritional component (in-kind)

“Live Better” Nutrition (about US$ 13)

Live Better for Children (< 10 years of age) (about US$ 10 per child 0-9 years)

Monetary and in-kind Transfers

Educational scholarships (US$17-130 depending on school grade)

Health

Deposit to savings account for scholarship holders (US$450-550)

School supplies(in kind and monetary)

Seniors (>70 years of age)

Frequency

Bi-montlhy

Bi-monthly

Monthly

Bi-montlhy

Bi-monthly

Monthly

Yearly

Every six months

Community

Structure of health services

1)  65 health actions guaranteed, with preventive emphasis

2)  Community workshops for self-care with an emphasis on nutrition, pregnancy and breastfeeding

3)  Distribution of nutritional supplements

1)  Funding per person (family protection/family policies)

2)  Nutritional supplements for children under 5 and pregnant and lactating women

State Health Services

Financing Service provider Agent

Federal National Commission for Social

Protection in Health

Federal and local Government

Workshops

Health actions

Nutritional supplements

Local population Popular Insurance

Scheme

Synergy between Oportunidades and Popular Insurance Scheme

* CAUSES: Catálogo Universal de Servicios de Salud- SEGURO POPULAR

Oportunidades

Nutritional supplements for children under 5 and pregnant and

lactating women

Guaranteed Basic Healthcare Package (65 actions)

Community workshops for self-care

2003 1,407 medical conditions *

Fund for Protection against Catastrophic Expenditures

(308 highly specialized medical services)

Health Insurance for a New Generation (108 illnesses)

2006

Popular Insurance Scheme

1997

Prevención

Tratamiento

Start as a program

Legal establishment of the National System of Social Protection in Health

2000

Individual financing

2011: Universal Health Coverage

Source: CIDE, unpublished

Infant mortality rate of the population without social security decreased by 32%

Perinatal mortality of the population without social security decreased by 34%

2003

2010

2004-2009

Family financing In addition to a reduction in disparities, there was an increase in the population

and services covered

Popular Insurance Scheme

Main impacts

Sources: * INSP, External evaluation, 2001-2006 ** INSP, ENSANUT, 2006

Facts

7.6 medical visits per family/ year

12 educational workshops per family / year

360 doses of nutritional supplement for children under five and pregnant

and lactating women/ year

Impacts

1 cm increase in height of children under 2 years*

12.8% reduction in prevalence of anemia in children under 2 years**

15 % increase in preventive medical visits*

Evaluations Detection of conditions and

interventions that were not covered

Resistence of health personnel to serve healthy population over sick

Expected

Unexpected

43% of the families in urban areas withdrew from the program in the

first year

Evolution of poverty in Mexico 1992-2006

Between 2002 y 2009, the prevalence of low height for age and anemia decreased by 18.3% and 27.5%, respectively, in beneficiary children of Oportunidades in urban areas who were 2 years old in 2002.

Oportunidades had a positive impact on the use of tests for detecting diabetes in people 19-49 years of age: between 2002 and 2009, usage rates were 12.8% higher among urban households that were beneficiaries compared to urban non-beneficiaries.

In 2009, Oportunidades beneficiary children under 6 in urban areas had, on average, less sick days than non-beneficiary children in the same age group: 1.57 versus 2.72 days.

Between 2003 and 2009, beneficiary households in urban areas substantially increased their expenditure on food compared to non-beneficiary households, even though the total household expenditure was higher in non-beneficiary households.

In urban areas, the percentage of beneficiary children aged 5-13 that were employed decreased from 2.6% in 2002 to 1.1% in 2009.

In 2009, in urban areas, the participation of beneficiary women in decision-making that affected their household members was 12% higher when compared to non-beneficiary women.

Health sector challenges for providing care to the Oportunidades beneficiaries

- 18.1% of population reported not being affiliated to social security, nor to the Popular Insurance Scheme; - 10.5% use pharmacies and private doctors as their first choice; - 3.5% of their total expenditure is allocated to expenditures for health care; - 56.4% of sexually active adolescents reported having been pregnant; and, 58.9% of these adolescents were not offered any birth control after their last pregnancy.