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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.