Recently in my Fundamentals of Global Health class, we discussed Case#9 which was a successful program that was used to improve the health of the poor in Mexico. Nearly half of Mexico's population was living in poverty at the time, and as is the norm, social determinants of health, such as income level, have a significant impact on one's ability to access health care, which is exactly what this case looks at (Levine, 2007). And in 1997, a program called PROGRESA was implemented.
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| PROGRESA incentivized parents to invest in their children's health |
The program was successful (at that time) for a number of reasons. One of the reasons was the fact that this program was created to enhance the supply side was the first component of its success (Levine, 2007). In other words, it was designed to erase the barriers that limited people from using available public services. This was not like the traditional programs that were designed with a focus on providing more public service (Levine, 2007).
Another success element was that the program adopted a 3-stage targeting strategy to enroll people into the program (Levine, 2007). This was important as it ensured that there was the availability of resources to the poor people that needed them the most (Levine, 2007).
Furthermore, the program's monitoring and evaluation were excellent. This was crucial because it guaranteed the program's sustainability under various political regimes in Mexico. Also, the evaluation made the program gain recognition from the international community (Levine, 2007).
Generally, I think the fact that they worked towards a precise, clear, and specific goal was a major success element. For instance, they worked towards eradicating poverty by treating its root causes and the repercussions related to poverty. In the end, "breaking the cycle" allowed for improvements in residents' quality of life as well as the capacity to counteract adverse effects on future generations (both social and economic repercussions) (Meyer & Floyd, 2020).
Also, for the implementation of the program, cash grants were awarded to the mothers and this was a major bone of contention. A lot of people argued that that was the right call while others said it was not. According to Levine, 2007, cash grants were awarded to the mothers because the program relied on top social sciences research for success. I think this was a good idea as mothers are known to be closer to their children when compared to fathers. In most African homes, fathers are referred to as the breadwinners or major providers and as such, would always be outside trying to fend for the family while a lot of mothers are full housewives taking care of the home and children. On average, mothers would probably be the first to know if their children are ill or in need. Therefore, I agree that mothers be given the money for the benefit of the entire family.
Meyer and Floyd, 2020 argued that giving the money to the mothers instilled a sense of responsibility. It gave the mothers the freedom to feel like they could use that money however they saw fit and gave them the respect and independence they so deserve (Sherman et al., 2013).
While studies have shown that mothers are always working towards having means for the family and household necessities, it has also shown that men tend to use such money to purchase alcohol or cigarettes and not for the children’s welfare or health needs (Sherman et al., 2013). This is another reason why I agree with the cash being given to the mothers and not the fathers.
A positive side to this is that the money would be better managed and benefit the entire household. A flip side to this is that it can incite domestic violence as fathers who are seen as the end of the home could feel undermined. Failure to hand over the money to the fathers after the government issues the money to the mothers, could make the fathers violent and lead to domestic violence within the home.
My reason for bringing case#9 to this platform is because of its approach in relation to this Gender and Development class. It was a top-down approach, I could even argue that it had elements of the WID, welfare, and anti- poverty approach as one of its goals was to help women to be better mothers, and poverty was the problem. However, the program was a success. My conclusion is that it does not really matter if the world is using WID or GAD approaches, what matters is utilizing an approach that works for the particular people. There is the need to identify the grassroots, and what they have been doing or are used to. No one shoe size fits all; while WID approaches might work in some places, GAD might work in another and a combination of all approaches might work in other places.
Reference
International Labour Organization (2017, September 19). Global estimates of Child labor: Results and trends, 2012-2016. Report: Global Estimates of Child Labour: Results and trends, 2012-2016. Retrieved September 7, 2022, from https://www.ilo.org/global/publications/books/WCMS_575499/lang--en/index.htm
Levine, R. (2007). Case Studies in Global Health: Millions Saved. Jones and Bartlett Learning.
Meyer, L., & Floyd, I. (2020, November 30). Cash assistance should reach millions more families to lessen hardship. Center on Budget and Policy Priorities. https://www.cbpp.org/research/family-income-support/cash-assistance-should-reach-millions-more-families-to-lessen
Sherman, A., Trisi, D., & Parrott, S. (2013, July 30). Various supports for low-income families reduce poverty and have long-term positive effects on families and children. Center on Budget and Policy Priorities. https://www.cbpp.org/research/various-supports-for-low-income-families-reduce-poverty-and-have-long-term-positive
External Links
BBC on Mexico's Welfare Revolution
Impact of PROGRESA on Women's Status
also took fundamentals of global health and really enjoyed the course! In terms of the program PROGRESA (or specially with conditional cash transfer programs) do you think it would be able to be successful elsewhere? For example, would it be successful in other "third world" classified nations such as Haiti or Chad or "second world" classified nations such as Albania or Vietnam? Or were there specific conditions in Mexico that made it successful? Personally, when also learning about this program in the course, I thought their unique approach to giving the mother's of households the funds earned from attending/participating in a specific health programs instead of the father's was wonderful as like you mentioned mothers are more knowledgeable about what is occurring with their children and household and thus know what essential services/goods the funds need to be spent on but also I remember reading that the men were more likely to spend it on alcohol, tobacco, entertainment, and other non-essential consumer goods compared to the women. As well as (as you also pointed out) it gives the women a sense of financial independence and initiative that they otherwise might not have had. I also think getting this money directly instead of how other aid programs would give families specific goods (such as school supplies, clothing, water, etc.) that they may not need as much as specific goods/services that money could help them purchase. It also incentivizes/motivates them to continue with these positive health programs (and semi unconsciously improve their family's health) as a means to earn a supplemental income independently from their husbands
ReplyDeleteI recently visited Mexico for the first time, so your post caught my attention. First, I remembered my research presented last semester about non-conditional cash-transfer programs in Latin America. I analyzed from a neoliberal perspective if these types of programs promoted democracy and helped to end poverty. And in fact, these types of top-down programs were created and applied in Latin America based on the successful experience of PROGRESA (1996) in Mexico. However, considering countries in the region with similar characteristics like fast industrialization, economically dependent, and non-democratically stable. It was one of my conclusions that these types of top-down designed programs were not helping people to fight against poverty.
ReplyDeleteOn the contrary, they are only a "band-aid" for deeper problems such as lack of access to education, health, and employment. Only as an example, in the post-COVID era, Latin America's economy is 60% based on informal workers. 50% are poor, meaning they still receive a bonus from the State (Vox Lacea, 2020.) Interviews amongst the latter group declared that they prefer to keep receiving the money from the State, so they do not register their business or start-up if they have one.
On the other hand, I would like to encourage you to read about the case of the maquila textile sector in Ciudad Juarez – Mexico. This city has one of the highest rates of femicide due to the high demand for women's employment that has left men out of the labor market. In conclusion, I must say that PROGRESA had good results at the beginning but proved not to be sustainable in the long run because it is not helping people to end the cycle of poverty. Additionally, I find your thought about gender violence very important because that is precisely what happened after PROGRESA and NAFTA occurred in Mexico, giving us a significant reflection about WID.
References:
https://www.lacea.org/vox/?q=blog/informality_latam_postcovid19
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ReplyDeleteYour piece was so interesting, and I understand the conclusion of stating the need for a contextualized approach for specific needs not only geographically but also in terms of time. As you mentioned, at that time the program with the combination of strategies both WID and some light GAD did work. I think what would be important know is to start thinking about the future. Why did this program cease to work? There are some methodologies in project implementation that recommend poverty alleviation strategies only for a certain amount of time until the barriers for strategic needs are eliminated. But eliminating these barriers might lead to more structural reforms that gendered institutions might not be able or ready to meet. As mentioned in McIlwaine and Datta’s piece “From Feminizing to Engendering Development” the transformation needs to go from a ‘needs-based’ to a ‘rights-based’ perspective. The understanding that adequate, equitable and safe access to basic rights such as clean water, education and health services is a human right and not just the barriers perceived by minority groups especially women, will allow gendered systems and institutions to reform and review current policy and structures.
ReplyDeleteThat's precisely what the missing piece of GAD is but I think looking at previously positive experiences like the one you mentioned could help us pave the way!