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

1. Claudia Macias
Health, Nutrition & Population
Latin America and the Caribbean
Human Development Program

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. 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. How Does Program Oportunidades Work
Oportunidades is an inter-institutional program, which involves the following
sectors:
 Social Development
 Health
 Education
 Finance

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. 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. 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. Coverage of Oportunidades

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. 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. 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. 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
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v
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n
c
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ón
T
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t
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o

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. 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. Evolution of poverty in Mexico 1992-2006

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. 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.