Progresa used marginality index, poverty, population, infrastructure to identify eligible communities for intervention
LAHORE: Progresa was introduced by the government of Mexico in 1998 with the aim to incentivise the health utilisation and enrollments in school. The underlying purpose was to improve human development by improving the overall health of the target population. The programme used conditional cash transfers in order to increase the take-up rates of health facilities and enrollments in school. The rationale behind the initiative was to develop human capital so that it could translate into increasing the country’s overall economic welfare.
Progresa’s primary aim was to stop or reduce inter-generational poverty transmission. The secondary aims included improving health and nutrition and immunisation and participation in educational programmes pertaining to health and nutrition. The hypotheses of Progresa included whether the CCTs improved utilisation of healthcare facilities and overall health of children and adults (self-reported by mothers, but verified). The impact of the intervention on the children’s attendance and performance in school was also evaluated.
The sample size of the Progresa communities was 10 per cent (506) of the total population of 50,000 communities. Of these, 320 were included in the treatment group and 185 were in the control group. The experimental design is termed Randomised Control Design. However, there is some debate as to whether it was a randomised control experiment or quasi-experimental.
Progresa used marginality index (poverty, population density and infrastructure) to identify eligible communities for intervention. After determining the eligible communities, the programme used a proxy means test (PMT) to determine eligible households within these communities. It used observable characteristics that proxy for poverty such as housing material, education and family structure. Progresa uses direct cash transfers that are given only to the women (female head of household). These are expected to be spent on food and health. The families receive credit cash transfer if and only if they accept preventive health services, children and mothers attend nutrition monitoring clinics (and get nutritional supplements) and pregnant women obtain prenatal care, nutritional supplements and health education. The size of the transfer is about one-third of the average household income. Progresa’s conditional cash transfer programme has improved household consumption patterns. The cash transfer is predominantly used to increase food quality and quantity in the household. The impact of any programme relies on how it has changed the behaviour of the target population. Progresa has shown to inculcate a more responsible attitude by positively changing the target population’s consumption behaviour.
It can be argued that Progresa has been a success story for Mexico and a model worth replicating in Pakistan. A comprehensive impact evaluation would substantiate the fact that the programme is an excellent human development initiative. Furthermore, the cost effectiveness of the initiative is laudable. Policymakers can use Progresa’s example in devising human development policies that are best suited to the needs of Pakistan.
A way forward is to consider the budget constraints and allocation of the state of Pakistan. A major proportion of budget allocation is used up in debt servicing. The remaining share is directed predominantly towards defence spending. Health and education sectors get nominal shares from the economic pie. For human development initiatives to be sustainable, Pakistan needs major budgetary reforms in allocations. For this reform, a reorientation of socio-economic policies is required.
Furthermore, Pakistan must consider cooperation with the stakeholders in Mexico to implement a Progresa-like initiative in Pakistan. Factors such as individual and collective budget constraints, larger target population, socio-political aspects and institutional framework in Pakistan must be considered before devising a comprehensive policy.
Obaid Arshad Khan
Lahore University of Management Sciences
Published in The Express Tribune, June 22nd, 2014.
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