Mexico


                          MEXICO – Expanding an Icon’s Mandate
    Moving beyond access to health and nutrition to focus on cognitive development in the
                       PROSPERA conditional cash transfer program

PROSPERA shows how a longstanding nation-wide safety net program can evolve into a cross-ministerial
effort that impacts the nutritional status and start to focus on cognitive development of children.

The Situation in Mexico:
Significant segments of the population in Mexico face food insecurity and nutrition challenges, despite
having reduced poverty ($1.90/day) to just over 3 percent in 2014.
The poorest states in Mexico, such as Chiapas, Guerrero, and Oaxaca, have stunting rates over 20 percent,
and the prevalence ranges up to 44 percent among rural areas and indigenous populations.1 Across the
country, many Mexicans are now overweight or obese, a condition affecting 33 percent of children
between 5 and 11 years old.2

The Program:
Mexico’s Conditional Cash Transfer Program (CCT), PROSPERA, was launched in 1997.3 It began as a cash
transfer to poor families with young children, supporting their access to health and nutrition services and
schooling. The PROSPERA program currently covers 6.1 million families under the conditional cash transfer
modality.
PROSPERA’s evolution in the last 20 years has been informed by impact and process evaluations
conducted regularly by external and national evaluators. Today, the program supports investments in the
early years by providing cash incentives for regular health check-ups of pregnant women, growth
monitoring and promotion sessions for children, as well as nutritional supplements and counseling. The
Ministry of Health is gathering information on beneficiary visits to health centers, which is expected to
help fine-tune these interventions.
More recently, the Ministry of Education started working with PROSPERA on interventions that stimulate
cognitive development of children under 5, looking for ways to confront supply-side constraints in (e.g.)
preschool for children between 3 and 5 years old. Early stimulation is now promoted in counseling
sessions provided by the Health Ministry, which include guidance on good parenting, identification of
symptoms of child underdevelopment, and practices that stimulate motor, cognitive, and socio-emotional
development of children.

Implementation Lessons:
PROSPERA’s impacts and processes have been evaluated carefully throughout its implementation. Main
lessons include:
     1. CCT programs can have significant impacts on stunting and anemia. Between 1998 and 2007,
     the program contributed to a reduction in stunting by 11 percentage points in children under 5 and
     reduced the probability of children 1-4 years old becoming anemic by 25.5 percent (Gertler, 2004).

1
  National Health and Nutrition Survey - ENSANUT 2012
2
  ENSANUT 2016
3
  Launched under the name PROGRESA, and later named Oportunidades, before finally becoming PROSPERA.
Mexico


      Between 2012 and 2016, preschool children of PROSPERA families showed an 8.1 percentage point
      reduction in low height-for-age, and an even larger reduction in rural areas (11.4 percentage points).4
      2. Evidence-based policy making supports continuous program improvement. For example, an
      evaluation of PROSPERA supplements led to a change from “papillas� (e.g. pureed food) to “sprinkles�
      (nutritional supplements), switching from a high-caloric food vehicle to a non-caloric micronutrient
      supplement. The findings also led to rebranding the nutritional supplements and more attractive
      packaging to encourage use.
      3. Counseling sessions must be adapted to the needs of the targeted population. In 2016,
      PROSPERA adjusted these sessions to strengthen messages on healthy lifestyles and on the
      importance of compliance with co-responsibilities. In rural areas, the number of sessions was reduced
      from 12 to 6 and they were organized by groups of mothers with similar needs and to include more
      participatory methodologies.
      4. Programs need to integrate the delivery of services they promote. PROSPERA is implemented
      under two strategies and coordinates between the Ministries of Health and Education. In 2013, the
      Strategy for Child Development was introduced to integrate activities related to timely detection of
      risks and delays in development, assessment of infant development, promotion of child
      development at health centers, counseling for stimulation and good parenting and reference to
      pediatrics and child psychology. In parallel, the Integrated Strategy to Promote Nutrition was
      introduced to coordinate nutrition interventions such as: delivery of new supplements, provision of
      equipment to agencies in the field and preparation of communications and capacity building plans.

References & Resources:
• Gertler, Paul (2004) Do Conditional Cash Transfers Improve Child Health? Evidence from PROGRESA's
  Control Randomized Experiment. American Economic Review, 94(2): 336-341.
• Secretaria de Desarrollo Social (2008) External Evaluation of Oportunidades in rural areas (1997-2007)
• Lia C. H. Fernald, Paul J. Gertler, and Lynnette M. Neufeld (2008) The Importance of Cash in Conditional
  Cash Transfer Programs for Child Health, Growth and Development: An Analysis of Mexico’s
  Oportunidades.
• Fernald LC1, Gertler PJ, Neufeld LM. (2009) 10-year effect of Oportunidades, Mexico's conditional cash
  transfer programme, on child growth, cognition, language, and behaviour: a longitudinal follow-up
  study.
• CONEVAL (2016) PROSPERA’s Progress Evaluation 2014-15.
• List of evaluations on PROSPERA & Program’s website




4
    ESANUT 2016.