The oportunidades human development program lessons learned
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The Oportunidades Human Development Program: lessons learned. José E. Urquieta. Tegucigalpa, Honduras October 09, 2006. Presentation Structure. The Oportunidades program today Primary health-related results Conclusions Challenges for the future. The Oportunidades Program.

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The oportunidades human development program lessons learned

The Oportunidades Human Development Program: lessons learned

José E. Urquieta

Tegucigalpa, Honduras

October 09, 2006


Presentation structure

Presentation Structure

  • The Oportunidades program today

  • Primary health-related results

  • Conclusions

  • Challenges for the future


The oportunidades program

The Oportunidades Program

  • (Originally called Progresa). It is a program:

    • that targets the poorest families and communities in Mexico,

    • based on conditional cash transfers,

    • that is multi-sectoral, and one of the federal government’s largest social development programs


The oportunidades program1

The Oportunidades Program

  • Its mission is to promote the development of human capital among families living in extreme poverty, by improving educational, health and nutrition conditions, with the goal of interrupting the intergenerational transmission of poverty

  • The Program began in 1997 in rural areas and expanded to semi-urban areas in 2001 and urban areas in 2002

    • evaluation as an asset of the Program


Growth of the program

Growth of the Program


Components of the program

Components of the Program

  • Educational component

  • Health component

  • Nutrition component

  • Patrimonial component “Youth with Opportunities”

  • Component for older adults


The oportunidades human development program lessons learned

  • National Health Program

  • Basic health and nutrition package

  • Synergies with other programs (SPSS and APV)*

Operational scheme for

Oportunidades

Inter-sectoral Collaboration

Health Sector

Secretary of Education

  • National Education Program

  • Support for schools and educational quality

Secretary of Social Development

General Coordinator for Oportunidades

  • National Social Development Program

  • Synergies with other programs

  • Analysis of targeting, administration of transfers, evaluation and accountability

SPSS: Social Protection in Health System; APV: Equal Chance in Life program


Conditional transfer scheme

Conditional Transfer Scheme

Co-responsibilities of the beneficiary families

Benefits

  • Educational scholarships

  • Other monetary transfers (youth, older adults, nutrition)

  • Provides a Basic Package of Health Services

  • Fortified nutritional complements

  • Facilitates access to a broader social protection in health system (Popular insurance)

  • Regular school attendance by children

  • Attendance at preventive health services by family members

  • Attendance at health promotion, nutrition and hygiene workshops


Basic package of health services

Basic Package of Health Services

  • Basic sanitation at the family level

  • Family planning

  • Prenatal, delivery, puerperal and newborn care

  • Monitoring of nutrition and child growth

  • Immunizations

  • Management of diarrhea cases in the home

  • Anti-parasite treatment in families

  • Management of acute respiratory infections

  • Prevention and control of pulmonary tuberculosis

  • Prevention and control of arterial hypertension and diabetes mellitus

  • Prevention of accidents and initial treatment of injuries

  • Community training for self-care in health

  • Prevention and detection of cervical cancer


Oportunidades has great potential for improving women s and children s health

Oportunidades has great potential for improving women’s and children’s health

  • Targets its activities on highly marginalized families and localities

  • Priority groups for the health component:

    • Pregnant and breastfeeding women

    • Children under 5 years old


The oportunidades human development program lessons learned

Results in child health and nutrition


The oportunidades human development program lessons learned

54.9

**

50

44.3

40

Control group

%

30

Intervention group

20

10

0

* Children older than 12 months. Adjusted for age, using a GEE model

** p < 0.05

Impact of Oportunidades on the prevalence of anemia in rural areas after 1 year of implementation

Oportunidades has attained a decrease in the prevalence of anemia in rural areas. Nevertheless it remains high.

60

Source: Rivera et al., JAMA 2004


The oportunidades human development program lessons learned

30.0

29.8

28.0

26.4

25.3

26.0

24.0

22.0

Increase in height (cm)

20.0

18.0

16.0

Poorest

Growth without the program

Growth with the

program

Potential

growth

Impact of Oportunidades on the height

of children ≤ 6 in rural areas

The Program achieved an increase in height in centimeters among children who were participants, in comparison with non-participants

* Adjusted for age and height in 1988, using a linear random intercept model

Source: Rivera et al., JAMA 2004


The oportunidades human development program lessons learned

Impact of Oportunidades on the increase in height after 2 years of intervention in urban areas

Difference in height,

Oportunidades-control in 2004 (cm)

n = 206

p<0.05

n = 96

p=0.05

n = 437

p<0.05

Age of child in 2002 (months)

Paired on: propensity score, age, height in 2002, sex and maternal height

Source: Neufeld et al, In preparation


Oportunidades does not have an effect on weight for height in urban areas

Oportunidades does not have an effect on weight for height in urban areas

p<0.10

Difference in weight for height,

Oportunidades-control in 2004

NS

NS

Age of child in 2002 (months)

Paired on: propensity score, age, weight for height in 2002, sex

Source: Neufeld et al, In preparation


Impact of the program on the prevalence of anemia in urban areas

Without Oportunidades

Mean ± SD (n=414)

With

Oportunidades

Mean ± SD (n=524)

Anemia, %

Children age 2-4 in 2004

17.4

16.8

Impact of the Program on the prevalence of anemia in urban areas


Other child health findings

Other child health findings

  • Significant increase in the average number of daily nutritional follow-up visits. Rural and urban

  • Reduction in the number of days of illness for children 0 to 5 years old

  • The Program does not appear to have an effect on the cognitive development of children in rural areas


Other child health findings1

Other child health findings

  • It was determined that children with Oportunidades in rural areas significantly improved their motor abilities, by 15%

  • There was no demonstrated effect of the Program on the duration of maternal breastfeeding

  • The nutritional complement is well-accepted, but the quantities consumed are smaller than the desirable


In rural and urban areas the educational component is weak

In rural and urban areas, the educational component is weak

  • Irregular sessions

  • Insufficient information about nutritional complements

  • Language barriers in rural areas

  • Poor learning and teaching conditions


The oportunidades human development program lessons learned

Results in women’s health and nutrition


Trend toward an increase in obesity among women 18 years old in urban areas

Trend toward an increase in obesity among women >18 years old in urban areas

Source: Neufeld et al, In preparation


Change in the bmi women 18 years old in urban areas

Change in the BMI. Women >18 years old in urban areas

Change in BMI between 2002 and 2004 (kg/m2)

With overweight or obesity

Overweight

Obesity

Status at baseline (2002)

Source: Neufeld et al, In preparation

Without Oportunidades

With Oportunidades


Impact of oportunidades on maternal and child mortality

Impact of Oportunidades on maternal and child mortality

  • Using data from the routine information systems (1995-2002), it was estimated that Oportunidades reduced the maternal mortality ratio by 11% and the child mortality rate by 2%

    • It is estimated that an average of 147 maternal deaths and 777 child deaths have been avoided annually

  • The effects on maternal and child mortality were greater in highly marginalized areas


Evolution of maternal mortality

Evolution of maternal mortality

The analysis of historical data on maternal mortality shows a reduction of:

  • 6.5% between 1990 and 1995

  • 12.7% between 1995 and 2000,

  • 12.8% between 2000 and 2005.

Maternal mortality ratio, Mexico 1990-2005

Deaths x 100,000 live births

Millennium goal for Mexico


Women that know about and use contraceptive methods in rural areas 2003

Women that know about and use contraceptive methods in rural areas, 2003

Incorporated in 1998

Incorporated in 2000


Prenatal care in rural areas 2003

Prenatal care in rural areas 2003

Incorporated in 1998

Incorporated in 2000


The oportunidades human development program lessons learned

Average number of procedures carried out in relation to the NOM* for prenatal and newborn care in rural areas in 2003

NOM: Official Mexican Norm


Other women s health findings

Other women’s health findings

  • Positive effect on the number of women that get a Pap smear test

  • The Program has had effects on the timely detection of diabetes; however it has not been sufficient for improving control of this disease

  • Increase in knowledge about modern family planning methods, although this knowledge has not translated into effective use of contraceptive methods

  • There was no effect found on the concentration of hemoglobin and anemia among non-pregnant women

  • The Program had no effect on skilled delivery care in urban or rural areas


Percentage of women receiving care from a doctor at the time of delivery

Percentage of women receiving care from a doctor at the time of delivery

From 61.9 to 86.7%

From 89.2 to 93.9%

From 94.1 to 97.5%

2

From 98.1 to 100%

Source: National Health and Nutrition Survey - ENSANut 2006


The oportunidades human development program lessons learned

Access to a broader Social Protection in Health System (Popular Insurance)


Percentage of oportunidades covered by the popular insurance

From 50 to 75%

From 25 to 50%

From 0 to 25%

Percentage of Oportunidades covered by the Popular Insurance

Source: ENSANut 2006


The oportunidades human development program lessons learned

Conclusions and challenges for the Program


Conclusions

Conclusions

  • Oportunidades has had an important effect on child health in rural areas (growth and anemia)

  • Oportunidades has had a smaller effect on the health of the population in rural areas

  • Oportunidades has had modest effects on women’s health

  • Oportunidades has had positive effects on the health indicators related to co-responsibilities

    • Few or no impacts on “hard”health indicators


Conclusions1

Conclusions

  • Oportunidades has no effect on obesity and overweight in women

    • There is evidence of an important increase in the overall population

  • Evidence that the health component needs overall improvement:

    • Undesirable quality of health services

    • Weak educational sessions

    • Limited access to Popular Insurance in the most vulnerable areas


  • Challenges for the future

    Challenges for the future

    • Improve the quality of care of health services

      • “Empower” the population regarding its rights to better care

  • Improve the inter-sectoral coordination of the Program

    • Establish a Governing Board with clear responsibilities for each sector and institution

    • Define the co-responsibilities of the participating health institutions

    • Make explicit the synergies or integration with programs in the health sector


  • Challenges for the future1

    Challenges for the future

    • Promote greater access to the Social Protection in Health System

      • Efforts to improve quality are not aligned with Program coverage: risk of greater inequity

  • Strengthen the health education component

    • Promotion of the consumption of healthy foods

    • Promotion of physical activity

  • Evaluate the intermediate- and long-term effects of the Program


  • The oportunidades human development program lessons learned

    The evaluation documents, instruments and databases are available at:

    http://evaloportunidades.insp.mx

    MANY THANKS


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