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 chr...
Investment in human capital to help break the intergenerational
transmission of poverty
Educational grants Preventive heal...
How Does Program Oportunidades Work
Oportunidades is an inter-institutional program, which involves the following
sectors:...
Oportunidades, Supply Interventions and Expected
Impacts
• Comprehensive Strategy for Nutrition Care (ESIAN)
• Early Child...
Target Population
Target population
Households whose income and
socioeconomic conditions hamper its
members’ capacity buil...
Selection criteria
1. Geographical (poverty by location)
2. Poverty level (household survey)
Coverage
5.8 million families...
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
2...
Family corresponsibilities and support
Education
Regular school attendance
Attendance to health workshops
for high school ...
Community
Structure of health services
1)  65 health actions guaranteed,
with preventive emphasis
2)  Community workshops ...
Synergy between Oportunidades and
Popular Insurance Scheme
* CAUSES: Catálogo Universal de Servicios de Salud- SEGURO POPU...
Start as a program
Legal establishment of the National
System of Social Protection in Health
2000
Individual financing
201...
Main impacts
Sources: * INSP, External evaluation, 2001-2006
** INSP, ENSANUT, 2006
Facts
7.6 medical visits per family/ y...
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 benefi...
Health sector challenges for providing care
to the Oportunidades beneficiaries
- 18.1% of population reported not being af...
Annual Results and Impact Evaluation Workshop for RBF - Day Five - Opportunities CCT
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Annual Results and Impact Evaluation Workshop for RBF - Day Five - Opportunities CCT

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A presentation from the 2014 Annual Results and Impact Evaluation Workshop for RBF, held in Buenos Aires, Argentina.

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

  1. 1. Claudia Macias Health, Nutrition & Population Latin America and the Caribbean Human Development Program
  2. 2. 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
  3. 3. 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
  4. 4. How Does Program Oportunidades Work Oportunidades is an inter-institutional program, which involves the following sectors:   Social Development   Health   Education   Finance
  5. 5. 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
  6. 6. 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.
  7. 7. 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
  8. 8. Coverage of Oportunidades
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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 Pr e v e n c i ón T r a t a m ie n t o
  13. 13. 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
  14. 14. 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* E v a lu a t i o n sDetection 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
  15. 15. Evolution of poverty in Mexico 1992-2006
  16. 16. 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.
  17. 17. 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.

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