CASE 9: Improving the health of the poor in Mexico

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Map showing Mexica

How do we know

Impact data was provided by a well-designed impact evaluation conducted by the International Food Policy Research Institute. The evaluation employed a quasi-experimental design in which a sample of Progesa communities were randomly assigned to "treatment" groups that received the benefits immediately and "control" groups that were delayed services for two years. Four surveys at six month intervals were conducted that allowed researchers to compare the differences in health and nutritional status.

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Health Condition: Among the rural poor in Mexico, the incidence of preventable childhood and adult illnesses, poor reproductive outcomes (including low birth weight), and infant mortality are high - the result of unhygienic living conditions, poor nutrition, and social deprivation.

Intervention or Program: The Programa de Educacion, Salud y Alimentacion (Progresa) - now known as Oportunidades - was designed to provide incentives in the form of cash transfers to poor families, to improve the use of preventive and other basic health services, nutrition counseling, and supplementary foods and to increase school enrollment and attendance. The program was designed to affect household-level decisions by providing incentives for behaviors that would result in improved social outcomes. The program was based on a compact of "co-responsibility" between the government and the recipients: The government would provide significant levels of financial support directly to poor households, but only if the beneficiaries did their part by taking their children to clinics for immunizations and other services, and sending them to school.

Impact: A well-designed evaluation revealed that Progesa significantly improved both child and adult health, which accompanied increased use of health services.

  • Children under 5 in Progresa, who were required to seek well-child care and received nutritional support, had a 12 percent lower incidence of illness than children not included in the program.
  • Adult beneficiaries of Progresa between 18 and 50 years had 19 percent fewer days of difficulty with daily activities due to illness than their non-Progresa counterparts.
  • For beneficiaries over 50 years, those in Progresa had 19 percent fewer days of difficulty with daily activities, 17 fewer days incapacitated, and 22 percent fewer days in bed, compared with similar individuals who did not receive program benefits.

Cost and Cost-Effectiveness: Expenditures on Progesa totaled about $770 million per year by 1999 and $1 billion in 2000, translating into fully 0.2 percent of the country's GDP and about 20 percent of the federal budget. Of that, administrative costs are estimated to absorb about 9 percent of total program costs.