Investing on Human Development: More than Conditioning Cash Transfers. Woodrow Wilson Center September 25, 2008

Transcription

1 Investing on Human Development: More than Conditioning Cash Transfers Woodrow Wilson Center September 25, 2008

2 Contents Appreciation for CCTs is growing in the world Basic design for CCTs Specific features of Mexican CCT: Oportunidades How may CCTs improve Health & Nutrition? Final remarks

3 Appreciation for CCTs is growing in the world

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5 CCTs are supposed to have better performance and to achieve impacts Targeting poor families Delivering cash transfers timely and safely Improving health services use Improving school attendance and advancement Improving food intake Reducing malnutrition (stunting) Alleviating poverty, specially decreasing severity and depth of poverty Evaluating impacts and monitoring outputs and outcomes

6 Basic design and important differences

7 CCTs Basic Design (not a recipe, but...) Targeting mechanism to reach poor households (Short) List of conditionalities use of health services and attendance to school Procedure to verify compliance Paying mechanism M&E system

8 CCTs in LAC are different: In scale and reach Bono de Desarrollo Humano - Ecuador: 1.2 million families, 100% municipalities, more than 100% of target population Bolsa Familia - Brazil: 11.2 million HH, 99% municipalities, 100% of target population Oportunidades - Mexico: 5 million HH, 100% of municipalities, 100% of target population Red Solidaria El Salvador: 48,000 families, 18% municipalities, 20% target population PATH - Jamaica: 230,000 beneficiaries (persons), 100% of parishes, 50-60% target population Juntos - Peru: 336,000 families, 34% municipalities, 25% target population

9 CCTs in LAC are different: In benefit size Bolsa Familia Brazil Amount of cash transfers Familias en Acción Colombia Solidaridad - Dominican Republic Red Solidaria - El Salvador PATH - Jamaica Oportunidades - Mexico Juntos - Peru US dollars / Source: Author estimates, to be reviewed

10 CCTs in LAC are different: In design Targeting methodology: PMT or declared income Eligibility: Families with children or Families below PL Cash transfer composition: One component - Several components Variability in components Targeted education beneficiaries: Primary, Secondary, Upper secondary Cash transfer update: Discretionary Ruled - Indexed

11 CCTs in LAC are different: In operations Fully centralized or partially decentralized Registry of Beneficiaries and the Program are in charge of the same or two different agencies Program agency is part of a Social Ministry or part of Presidential office Compliance of conditionalities are verified as part of the process of cash transfer calculations (like a pay-roll) or not Strong or weak monitoring systems and fraud prevention mechanisms are in place

12 Specific relevant features of the Mexican Program: Oportunidades

13 Some relevant features of Oportunidades Targets poor HH regardless demographic composition: with and without children Coordinates intersectorial and interinstitutional participation Delivers a variable cash transfer depending on demographic composition and compliance Independent experimental impact evaluation Transparency and accountability

14 Oportunidades targets poor HH with and without children Padrón de Familias Oportunidades % 60% Familias con becarios Familias sin becarios On the 40% without cash transfers for education, almost 40% have children 0-8 yrs

15 Inter-institutional coordination at the highest level of Government Board of Ministers Social Development Technical Committee Education Health Deputy ministers of: of: Human and and Social Development Health Promotion and and Prevention Planning and and Coordination Budget Mexican Institute of of Social Security Finance Specialized Agency National Coordination with technical and administrative autonomy

16 Inter-institutional coordination in the day-to to-day State coordination Health and Education Schools 110,000 School and Health Units Printing of Forms E2 and S2 Health Units 15,000 Validation of attendance National coordination (DGPL) Capture of E2 and S2 Payment lists 7,500 MAP s (bimonthly) Cash transfer point of payment Cash transfer point of payment 32 States State State Resources dispersion and electronic transfers liquidations Paying agencies Telecomm Bansefi

17 Oportunidades delivers variable cash transfers (depending on grade and gender) transfers Cash transfer variations US Dlls. $80.00 $70.00 $60.00 $50.00 $40.00 $30.00 $20.00 Top of transfers Without upper secondary $ 112 With upper secondary $ 186 Education cash transfer (boys) Education cash transfers (girls) $10.00 $0.00 3rd grade 5th grade 1st secondary Grade 3rd secondary + Basic Cash Transfer $ 22 2nd upper secondary

18 To align incentives for Human Development School Attendance (%) Cash transfer for women Women Attendance Cash transfers for men 700 Men Attendance Primaria Secundaria Media superior Education cash transfers (Us dlls)

19 CCTs may achieve impacts in Health & Nutrition

20 Experimental evaluation of Oportunidades shows positive impacts on nutrition Height gain in children <6 mo of age at start of follow-up Prevalence of anemia after one year of program implementation Child growth baseline to follow-up (cm) cen tím etro s % Increase in Height 2nd year only 1.1 cm P< years % % P< % Control Oportunidades Rivera y col. JAMA, 2004

21 National statistics also show a significant difference before and after Oportunidades Prevalence (%) National Prevalence of Stunting (INSP: ENN 88, ENN 99, ENSANUT 06) pp/ year pp/ year National Nutrition Survey Year

22 Largest decrease noted in poorest population National Prevalence (%) pp/year 3.23 pp/year 1.56 pp/year 1.34 pp/year 0.8 pp/year 16 points in the 1st decile 23 points in the 2nd decile 11 points in the 3rd decile 16 points in Rural South Mexico (where Oportunidades has its greater coverage) Socioeconomic Status (by deciles of Mexican population)

23 Days per year Impact on utilization of health services and on self-reported health status 35% increase in use of public-sector health services in rural areas and US$9 reduction in household monthly health care expenditures due to Oportunidades Reduction in number of days sick and incapacitated in urban and rural areas Urban (short-term term) 6 a 15 años 16 a 49 años Days per year Rural (medium( medium-term) 0 a 5 años 6 a 15 años 16 a 49 años Sick Incapacitated Sick Incapacitated

24 How may CCTs achieve Health & Nutrition impacts? CCTs should be a tool (an intervention) to articulate supply side services with demand driven interventions Supply side services are a sine qua non precondition of the Program Health & Nutrition actions for beneficiaries are established in the Operational Rules as a part of the Program Although Health & Nutrition services are not provided by the Program

25 Some operational features to coordinate Health with the Program A package of effective interventions according to poor population morbidity Focused on prevention and health promotion (extra-unit intervention) Aligned to Life-Line and prioritizing pregnancy, birth and early childhood development interventions Oportunidades also promotes attendance to health care education ( ( platicas and workshops)

26 Final remarks Magic bullet does not exist CCTs may or may not be a best practice depending on: The problem to address: Is there a gap related to income in school attendance and in health services use? The supply side capacity: Is there a demand side barrier or is it a problem of services reach and coverage? Fiscal and policy decisions: Is this one more program or is it a general support for eligible families/persons (universal for poor)? Is there a policy decision to substitute ineffective programs for a best program?

27 Final remarks (2) In Oportunidades the concept is not conditionality but corresponsabilidad (shared responsibility): There are responsibilities for the families... and for Government Government must guarantee the provision of health services and education. The question is the quality of Health Services and Education! Both are outside the control of the Program and are KEY to achieve its goal Politicians like the cash transfer side, but not often commit to the transparency, accountability and the shared responsibility

28 Thank you! Rogelio Gomez Hermosillo M gomezh.rogelio@gmail.com