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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
components of the program
Components of the Program
  • Educational component
  • Health component
  • Nutrition component
  • Patrimonial component “Youth with Opportunities”
  • Component for older adults
slide7
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
slide12
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

slide13
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

slide14
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
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

slide27
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

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
slide37
The evaluation documents, instruments and databases are available at:

http://evaloportunidades.insp.mx

MANY THANKS

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