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Improving the Health of the Poor in Mexico

Global Health Case Study

Sabina Shakya

on 27 January 2013

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Transcript of Improving the Health of the Poor in Mexico

WHAT ARE THE CAUSES OF POOR HEALTH OUTCOMES? Even though resources are available, many of the poor people do not utilize them even when there is no direct cost through the public sector. This is because:

Services in low income areas are in poor repair –are not adequately maintained

There are inadequate supplies of medicine with health workers who have high rates of absenteeism from their posts

Low level of education

Social marginalization

Lack of money to pay for transportation and other costs related to seeking medical assistance So, WHATS THE PROBLEM? Poor literacy rates and poor health indicators

90% of rural children attend primary school at some time, however, about half drop out after the sixth grade

Among those that continue, 42% drop out after 9th grade

High infant mortality and preventable childhood diseases, reproductive health problems, malnutrition and violence

Use of health services – less than 1 visit per year per person

Protein energy malnutrition – resulting in stunting THE INTERVENTION PROGRESA
(Programa de Educacion, Salud y Alimientacion)

Education, Health and Food Program Improving the Health of the Poor in Mexico By:
Sabina Shakya MEXICO Poverty in Mexico

40-50% of Mexicans live below poverty line

Majority of poor people are found in regions away from the US-Mexico Border and the 3 main cities

More than half of the families in the 13 states of the south western region falls below the poverty line

In rural areas, 3/4 fall under the poverty line

Poorest citizens live in small villages with no paved roads, running water and modern sanitation

The only work for them is agricultral labor

Largely depend on remittance for economic survival Health Education Nutrition THE PROGRESA APPROACH A quasi experimental design

Designed to affect the demand side

Provide monetary incentive directly to families to help overcome the financial barriers to health services and schooling

Focus on co responsibility between government and recipients

A reciprocal relationship based on mutual reinforcement

Increased purchasing power - fuel local economy Cash transfers were given ONLY IF
every member of the family accepted preventative health services provided by the ministry of health Improvements made on the quality of medical services basic sanitation
family planning, prenatal, childbirth and postpartum care
vaccinations, anti- parasite treatment
prevention of respiratory diseases, tuberculosis
high blood pressure, diabetes
first aid for injuries etc train doctors and nurses
steadier flow of medicine to the public Monetary education grants given to children under 18 who were at the highest risk of dropping out
Money compensates for the lost wages while in school

Increases as they moved from grade to grade

girls got higher payment too Cash transfers were given ONLY IF:

children aged 5 and under and breast feeding mothers attended nutrition monitoring clinics

pregnant women visited clinics for prenatal care, nutritional supplements, and health education INTERVENTION OUTCOMES SUCCESS AND LIMITATIONS SUCCESS: Lessons Learned Supplying materials alone is not enough

Responsibility should not be one sided, both players need to come to a mutual understanding

Importance of training mothers, empowering women in society

Money incentive works well because everyone needs it

Programs must be tracked and evaluated on a consistent basis WHAT DO YOU THINK? Is this program sustainable in the long run?

Should all developing countries in invest in programs similar to this?

What role do the 'rich' people play? POSITIVE IMPACT Health Impact Educational Impact Nutritional Impact Health series utilization increased more rapidly

Prenatal care started earlier in pregnancy

Children under the age of 5 years who received nutritional support had a 12% lower incidence of illness

Adult beneficiaries between 18 and 50 years had 19% fewer days of difficulty with daily activities due to illness

Beneficiaries above 50 years had 19% fewer days of difficulty with daily activities, 17% fewer days incapacitated, and 22% fewer days in bed Education results were even better:

11% to 14 % increase in secondary school enrollment for girls

5% to 8% for boys and child labor declined Reduced no of stunting among children 12 to 36 months of age

Higher calorie consumption

A more diverse diet including more fruits, vegetables and meat

Iron deficiency anemia decreased by 18% LIMITATIONS: The program started in 1997 and by 1999, it was operating in 50,000 localities in 32 states and reaching 40% of the rural Mexican Population

The Mexican government decided to extend the program to urban areas, and education grants were extended to the high school level

Has inspired similar efforts in Argentina, Honduras, Nicaragua, Colombia, Bangladesh and other countries

Has the potential to make a difference in a massive scale Design left out people living in very remote areas with no access to public services

Expenditure on Progresa totaled about 1 billion dollars in 2000, 0.2% of the country's GDP DEMOGRAPHIC INFORMATION Population :114,975,406 (July 2011 est.)

Ethnic groups: mestizo (Amerindian-Spanish) 60%, Amerindian or predominantly Amerindian 30%, white 9%, other 1%
Religions: Roman Catholic, Protestant, Jehovah's Witnesses, other unspecified (2000 census)

Languages: Spanish only 92.7%, Spanish and indigenous languages 5.7%, indigenous only 0.8%, unspecified 0.8%
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