Barriers and Solutions Pertaining to Pradhan Mantri Matru Vandana Yojana (PMMVY) Implementation in a Block of West Bengal: A Mixed-Methods Approach

Introduction: Improvement of maternal health care services will not only put a positive impact on maternal health, but also on the health of the new born. Objectives: This study was conducted to estimate the proportion of eligible beneficiaries who received the benefits provided by the scheme, to identify the barriers faced by the beneficiaries and health providers related to the scheme and to find possible solutions to overcome the barriers found as suggested by them in a block of West Bengal. Method: A cross-sectional study with sequential explanatory mixed-method approach was conducted in a block of West Bengal from January-December 2021. Quantitative data was collected from the digital portal of PMMVY. All beneficiaries who had their Last Menstrual Period (LMP) on and after 1st March 2020 up to 31st December 2020 were included. To identify the barriers faced and suggest possible solutions, Focused Group Discussions (FGDs) were held with the beneficiaries, ANMs and ASHAs and Key-Informant Interviews (KIIs) with the Block Medical Officer and Data Entry Operator. Data were analyzed using SPSS version 25.0. Descriptive statistics were used to summarize quantitative data while qualitative data were analyzed in the form of themes, codes and verbatim. Results: Total eligible beneficiaries for the three installments were 1066, 917 and 708 respectively. About 95.5% beneficiaries received the first installment, 93.0% received the second and 98.3% had received the third installment. The broad themes [codes] generated from the FGDs were challenges during antenatal care [ANC refused, home visit preferred, home ANC difficult, lockdown], challenges related to the PMMVY scheme [documents unavailable, incomplete forms, payment issues], possible solutions [prepare pre-requisites beforehand, provide cash]. Widely two main themes emerged from the KIIs: Form related issues and Payment issues. Conclusion: Coverage of PMMVY scheme in the block was satisfactory. However, speeding the payment process and stricter monitoring of the scheme is required

Contemporaneidade dos Programas de Transferência Monetária no Brasil: proteger ou mitigar a pobreza? / Contemporaneity of the Cash Transfer Programs in Brazil: to protect or to mitigate the poverty?

Resumo: O artigo aborda Programas de Transferência Monetária no Brasil; o contexto socioeconômico e político; modalidades e orientação político-ideológica dos programas; o Auxílio Emergencial e a substituição do "Bolsa Família" pelo "Auxílio Brasil". A metodologia contempla resultados de pesquisas; revisão bibliográfica e documental; dados secundários e acesso a websites. Os resultados destacam: funções; mitigação da pobreza e proliferação desses programas, deslocados do Sistema de Proteção Social.

Abstract: This article approaches Cash Transfer Programs in Brazil; socioeconomic and political context; modalities and politic-ideological orientation; the Auxílio Emergencial" and the substitution of the "Bolsa Família" by "Auxílio Brasil". The applied methodology was results of researches; bibliographic and documental studies; secondary data and access to websites. The outcomes pointed out the functions; poverty alleviation and proliferation of those programs displaced of the Social Protection System.

Mulheres e avaliação das desigualdades na distribuição de fatores de risco de doenças crônicas, Vigitel 2016-2017 / Women and evaluation of inequalities in the distribution of risk factors for Chronic non-communicable diseases (NCD), Vigitel 2016-2017

RESUMO: Objetivo: Comparar a distribuição de indicadores de doenças crônicas não transmissíveis (DCNT) entre mulheres adultas beneficiárias e não beneficiárias do Programa Bolsa Família (PBF) nas capitais brasileiras. Métodos: Análise de dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) em 2016 e 2017. Foram estimados as razões de prevalência (RP) brutas e ajustadas e seus respectivos intervalos de confiança usando o modelo de regressão de Poisson. Resultados: Mulheres do PBF tem menor escolaridade, são mais jovens e vivem com maior frequência nas regiões Nordeste e Norte do país. Prevalências mais elevadas de fatores de risco foram encontradas nas mulheres beneficiárias do PBF. A RP ajustada por idade das mulheres com BF foram: fumantes (RP = 1,98), excesso de peso (RP = 1,21), obesidade (RP = 1,63), frutas e hortaliças (RP = 0,63), consumo de refrigerantes (RP = 1,68), consumo de feijão (RP = 1,25), prática de atividade física no lazer (RP = 0,65), atividade física no domicílio (RP = 1,35), tempo assistindo à TV (RP = 1,37), autoavaliação do estado de saúde ruim (RP = 2,04), mamografia (RP = 0,86), Papanicolau (RP = 0,91), hipertensão (RP = 1,46) e diabetes (RP = 1,66). Quando comparadas as mulheres entre estratos de mesma escolaridade, as diferenças entre os fatores de risco foram reduzidas. Conclusão: Piores indicadores entre mulheres que recebem BF refletem desigualdades sociais inerentes a esse grupo mais vulnerável. O estudo evidencia também que o PBF está sendo destinado às mulheres mais vulneráveis.

ABSTRACT: Objective: To compare the distribution of chronic non-communicable diseases (CNCD) indicators among adult female beneficiaries and non-beneficiaries of the Bolsa Família Program (BFP) in Brazilian capitals. Methods: Analysis of Vigitel telephone survey data in 2016 and 2017. Gross and adjusted prevalence ratios (PR) and their respective confidence intervals were estimated using Poisson Regression model. Results: Women with BF have lower schooling, are young people, live more frequently in the Northeast and North of the country. Higher prevalence of risk factors were found in woman receiving BF. The adjusted PR of the BF women were: smokers (PR = 1.98), overweight (PR = 1.21), obesity (PR = 1.63), fruits and vegetables (PR = 0.63), consumption of soft drinks (PR = 1.68), bean consumption (PR = 1.25), physical activity at leisure (PR = 0.65), physical activity at home (PR = 1.35), time watching TV (PR = 1.37), self-assessment of poor health status (PR =2.04), mammography (PR = 0.86), Pap smears (PR = 0.91), hypertension (PR = 1.46) and diabetes (PR = 1,66). When women were compared among strata of the same schooling, these differences were reduced. Conclusion: Worst indicators among women receiving BF reflect social inequalities inherent in this most vulnerable group. The study also shows that BF is being targeted at the most vulnerable women.

Programa Bolsa Família e a redução da mortalidade infantil nos municípios do Semiárido brasileiro / Bolsa Família Programme and the reduction of child mortality in the municipalities of the Brazilian semiarid region

Resumo Em 2003, o governo federal lançou o Programa Bolsa Família (PBF), uma transferência condicional de renda destinada às famílias pobres que cumprissem com certas condições relacionadas à saúde e educação. Foi realizado um estudo ecológico longitudinal com dados em painel, a partir dos microdados dos 1.133 municípios do Semiárido. O objetivo consistiu em avaliar o efeito do PBF sobre a mortalidade infantil na região Semiárida do Brasil, no período 2004-2010. O estudo de associação foi feito por meio de regressão linear multivariada por dados em painel com efeitos fixos. A Taxa de Mortalidade Infantil foi considerada como variável dependente, ajustada por covariáveis sociais e demográficas, e pelo efeito do maior esquema de cuidados de saúde primária no País - Estratégia Saúde da Família (ESF). O PBF e a ESF tiveram um papel significativo na redução da mortalidade infantil, bem como no aumento das consultas de pré-natal, redução das taxas de analfabetismo, baixos níveis de fecundidade e diminuição de indivíduos que viviam em agregados familiares com acesso ao abastecimento de água e saneamento inadequados. Concluiu-se que o PBF teve um impacto positivo na redução dos níveis da mortalidade infantil, o qual foi potencializado pela intervenção de fatores sociais e demográficos.

Abstract In 2003, the Brazilian federal government launched the Bolsa Família Programme (Programa Bolsa Família - PBF), a widespread conditional cash transfer to poor households when they comply with conditions related to health and education. A longitudinal ecological study using panel data from 1,133 municipalities of the Brazilian semiarid region was performed. The main goal was to assess the effect of the PBF on child mortality (CM) in the semiarid region of Brazil during the period of 2004-2010. Associations were estimated using a multivariate linear regression for the panel data with fixed effects. The child mortality rate (CMR) was considered the dependent variable, adjusted for relevant social and demographic covariates, and for the effect of the largest primary healthcare scheme in the country through the Family Health Strategy (FHS). The PBF and the FHS played significant roles in reducing CM, increasing prenatal consultations, reducing illiteracy rates, lowering fertility levels, and decreasing the number of individuals living in households with inadequate access to water supplies and sanitation. In conclusion, the PBF had a positive impact on reducing CM levels; its impact was boosted by the intervention of other social and demographic factors.

The relation of cash transfer programs and food insecurity among families with preschool children living in semiarid climates in Brazil / A relação dos programas de transferência de renda e a insegurança alimentar entre famílias com pré-escolares da região semiárida do Brasil

Abstract Background Food insecurity has important effects on human health, particularly in children's. It continues to increase, with an estimated prevalence of 14.9% in the USA and 35% in Brazil. There have been few studies on the effect of cash transfer programs (CTPs) on the prevalence of food security in Brazil. Objective Evaluate the association between cash transfer programs and reductions in inequity and food insecurity. Method Population-based cross-sectional study in the state of Ceará, Northeast Brazil, with a sample of 8.000 households. Ceará is one of the poorest states. The state population of 8.5 million inhabitants, social security benefits and government grants, " Bolsa Família", have become the most stable source of income. The main outcomes measures were food insecurity and CTP participation. Multivariate logistic models were constructed to assess the association between participation in CTPs and food security. Results Participation in CTPs was found to be independently related to the prevalence of food security (APR 2.29 95% CI 1.57-3.33), as are education level, residential setting, and children's nutritional status. Conclusions CTPs and investment in education are initiatives that might be used to reduce food insecurity.

Resumo Introdução A insegurança alimentar tem efeitos importantes na saúde humana, em particular na das crianças. Continua aumentando, com uma prevalência estimada de 14,9% nos EUA e de 35% no Brasil. Existem poucos estudos sobre o efeito de programas de transferência de renda (PTR) sobre a prevalência de segurança alimentar no Brasil. Objetivo Avaliar a associação de programas de transferência de renda e da redução da inequidade com a insegurança alimentar. Método Estudo transversal de base populacional no Estado do Ceará, no Nordeste do Brasil, em uma amostra de 8 mil domicílios. O Ceará é um dos estados mais pobres do país. A população estadual é de 8,5 milhões de habitantes e os benefícios da segurança social e subsídios governamentais, como o Bolsa Família, tornaram-se a fonte de renda mais estável. As principais variáveis foram insegurança alimentar e a participação em PTR. Foram construídos modelos logísticos multivariados para avaliar a associação entre participação em PTR e segurança alimentar. Resultados A participação em PTR foi relacionada de forma independente com a prevalência de segurança alimentar (APR 2,29 IC 95% 1,57-3,33), assim como nível educacional, ambiente residencial e estado nutricional das crianças. Conclusões PTR e investimentos em educação são iniciativas que podem ser utilizadas para reduzir a insegurança alimentar.

Household characteristics, housing profile and diet diversity of Pantawid Pamilyang Pilipino Program (4Ps) beneficiaries and non-beneficiaries in Lucena City, Quezon, Philippines

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> The Philippines adopted the Conditional Cash Transfer (CCT) program as the Pantawid Pamilyang Pilipino Program (4Ps) that serves as the government's flagship social assistance program for the poor. This provides short-term income support to poor families while investing on health and education to overcome future poverty.</p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> This study aimed to characterize the beneficiary and non-beneficiary households and evaluate the impact of 4Ps program on housing facilities and diet diversity.</p><p style="text-align: justify;"><strong>METHODS:</strong> Quasi-experimental design was used to evaluate survey outcomes between 91 randomly sampled beneficiaries and 91 completely enumerated non-beneficiaries (incoming grantees). FANTA Household Dietary Diversity Score (HDDS) was used as an indicator for dietary diversity while structured questionnaire on housing profile was based on BIDANI and CEM-UPLB tools.</p><p style="text-align: justify;"><strong>RESULTS:</strong> The 4Ps beneficiaries had significantly higher maternal education, household size (?=0.038), and improved water source (?=0.004) than non-beneficiaries. Cash transfer among 4Ps households provided 11% increase in the average monthly income of P7,324 pre-transfer. Diet diversity using FANTA scoring (0-12) showed that nonbeneficiaries were significantly lower by 0.4 than 4Ps score of 7.9 (?=0.003). Maternal education was found to have significant positive correlation with diet diversity. Both groups had high cereals and fats intake (>90%) while low in complex carbohydrates and legumes (<31%).</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> The 4Ps had positive correlation on housing profile and diet diversity among beneficiaries. Family Development Session should integrate practical methods on improving variety of foods, specifically, the low consumption food groups. Additionally, a review on the selection criteria based on the provincial poverty threshold vis a vis income of grantees must be implemented to accurately target intended beneficiaries.</p>

Los efectos de los programas sociales en la salud de la población en condición de pobreza: evidencias a partir de las evaluaciones de impacto del presupuesto por resultados a programas sociales en Perú / Effects of social programs on indigent population health: evidence from results-based budgeting’s impact evaluations to social programs in Peru

Este artículo describe la experiencia en la gestión de evaluaciones de impacto del Ministerio de Economía y Finanzas (MEF) como uno de los instrumentos del presupuesto por resultados, y documenta el diseño de las evaluaciones de impacto a tres programas sociales emblemáticos y los resultados obtenidos, haciendo énfasis en aquellos vinculados a la salud de su población objetivo. Estos son el Servicio de Acompañamiento a Familias (SAF) del Programa Nacional Cuna Más, el Programa Nacional de Apoyo Directo a los Más Pobres JUNTOS y el Programa Nacional de Asistencia Solidaria Pensión 65. Los resultados muestran que el SAF generó mejoras en el desarrollo cognitivo y de lenguaje en los niños mas no en las prácticas de cuidado infantil de las madres, ni en el estado nutricional de los niños. JUNTOS logró incrementos en el gasto per cápita, gasto en alimentos, disminución de la severidad de pobreza y mejoras en el logro educativo. Sin embargo, no se encontraron resultados significativos en la mayoría de indicadores de salud prenatal ni estado nutricional infantil. Pensión 65 mejoró la salud emocional del adulto mayor (depresión, autovaloración), pero no se evidenció aumentos en el uso de servicios de salud por parte de los adultos mayores ni mejoras en su salud física. Se recomienda que dichos programas fortalezcan sus diseños y acciones de articulación con el Ministerio de Salud y entre diferentes niveles de Gobierno, cuando corresponda, a fin de mejorar la oferta y contenidos de las prácticas saludables y optimizar la prestación de los servicios de salud.

This article describes the experience of the MEF’s impact evaluation management as one of the RBB instruments and documents the design and results obtained from three impact evaluations of the most emblematic government social programs. The Service of Visiting Families (SAF) of the National Program "Cuna Mas", conditional cash transfer Program "JUNTOS" and National Program "Pension 65" focusing on objective population’s health the outcomes. Among the main results, it was found the SAF generated improvements in cognitive and communication development in children, but had no impact on mothers’ child care practices or children’s nutritional status. In the case of JUNTOS, there were increases in per capita spending, food expenditure, decreases in severity and poverty gap, increases in school attendance and reductions of school dropout. However, no significant results were found in most indicators of prenatal health, child health, or chronic malnutrition. In the case of Pension 65, there were increases in household consumption and improvements in elderly’s emotional health (depression, self valoration); but there was no evidence of increases in the use of health services by the elderly or improvements in their physical health. Therefore, it is recommended that such programs boost their designs and inter-sectoral coordination with MINSA and subnational institutions, in order to improve contents of healthy practices and child care, and optimize the provision of health and education services, in order to meet the demands of their users.

Dietary diversity of Pantawid Pamilyang Pilipino Program beneficiary and non-beneficiary households in selected barangays in San Pablo City, Laguna, Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> The study aimed to analyze the household dietary diversity of beneficiary and non-beneficiary households of Pantawid Pamilyang Pilipino Program (4Ps) in selected barangays in San Pablo City, Laguna, Philippines and determine the nutritional status of children (6-60 months old) within these households.<br /><strong>METHODS:</strong> Household dietary diversity score (HDDS) was used as an indicator for the households' dietary diversity. The nutritional status of children was determined using anthropometric data from the Barangay Health Centers. A total of 270 households was randomly selected through stratified random sampling with equal allocation.<br /><strong>RESULTS:</strong> Findings showed that beneficiary households had higher HDDS compared to the non-beneficiary households. The results also suggest that beneficiary households with larger household size, higher income, who were living in rural areas and who have female as well as more educated financial managers, tend to have a more diverse diet. On the other hand, a higher prevalence of malnutrition was observed among children in beneficiary households.<br /><strong>CONCLUSION:</strong> Beneficiary households of 4Ps had better diet quality in terms of diversity than non-beneficiary households. However, the advantage of having a more diverse diet has not fully addressed the malnutrition problem among children as it was still widely prevalent in beneficiary households.</p>

Programa Bolsa Família e o acompanhamento das condicionalidades na área de saúde / Family Allowance Program and the follow-up of the conditions related to the health field

Resumo: Este artigo consolida resultados de uma pesquisa realizada em dez municípios brasileiros, que buscou analisar a dinâmica de acompanhamento das condicionalidades de saúde do Programa Bolsa Família. A ideia central consistiu em abordar variáveis que poderiam afetar o desempenho municipal na gestão do programa, tais como: porte populacional e magnitude da população a ser coberta; estrutura e capacidade técnico-gerencial dos municípios; oferta e organização da Atenção Básica em Saúde e arranjos intersetoriais.

Abstract: This article consolidates results from a research carried out in ten Brazilian cities. The research analyzed the dynamic of the follow-up of the conditions related to the health field of the Family Allowance Program. The central idea was to approach the variables that could affect the City Hall performance in managing the program, such as: population size, magnitude of the population to be attended, the structure and both the technical and managing capacity of the each one of the City Halls analyzed, the offer and organization of the Primary Health Care and sector arrangements.

A study on utilization of Janani Suraksha Yojana and its association with institutional delivery in the state of West Bengal, India.

Background: India launched the Janani Suraksha Yojana (JSY) on the principles of conditional cash transfer providing monetary incentive to needy women to improve access to institutional childbirth. Objectives: This study was conducted among JSY-eligible women who delivered between April 2012 and June 2012 to assess the utilization of cash incentives toward institutional delivery, along with other associated factors influencing institutional delivery. Methods: It was a cross-sectional, descriptive study conducted between July 2012 and May 2013 on 946 women selected through stratified random sampling of subcentres from better and worse performing districts of West Bengal. Results: 74.7% of the study population was JSY-eligible. 90.2% of those who took three antenatal check-ups (ANCs) and 36.8% JSY-noneligible women received cash. Government institutions were preferred for childbirth among all groups irrespective of JSY eligibility, receipt of cash, and number of antenatal visits. Overall, 78.8% opted for institutional delivery if they had received cash, which was significantly more than those who did not (64.5%). JSY-eligible women were 1.5 times more likely to deliver in government institutions compared to JSY-noneligible women. With no incentive, the likelihood of institutional delivery was halved. The distance of a 24 Χ 7 delivery hub beyond 5 km (74.8% vs. 81.8%), the religion of Islam (62.7% vs. 83.2%), and multiparity (63.9% vs. 83.6%) were significant deterring factors. Conclusion: Despite some inclusion and exclusion errors, cash incentive under JSY was associated with increased institutional delivery, especially in government institutions though there were other factors influencing the decision as well.

Avaliação das condicionalidades em saúde do Programa Bolsa Família / Conditionalities health evaluation of the Bolsa Família Program

Os programas de transferência condicionada de renda estão disseminados em países em desenvolvimento na América Latina com ênfase no Brasil como um novo paradigma nas políticas sociais para erradicação da pobreza. Consistem no repasse de recusros monetários de renda do governo diretamente para familias pobres mediante cumprimento das condicionalidades em educação e saúde. Na saúde, memos com variçãoes entre os países as condicionalidades tem como público alvo gestantes e crianças com vistas à redução de indicadores de saúde da criança, como cescimento e desenvolvimento, mortalidade infantil e incemento do pré-natal. Os objetivos deste trabalho são comparar o programa de transferencia condicionada de renda brasileiro, o Bolsa Familia e os programas semelhantes na América Latina em relação aos seus efeitos no crescimento e desenvolvimento de crianças até 7 anos de idade e avaliar a prevalencia das condicionalidades em saúde da mulher e da criança entre usuárias dos serviços de saúde brasileiros cujas equipes aderiram ao Programa de Acesso e Qualidade da Aenção Básica (PMAQ). Para o primeiro objetivo foi realizada uma revisão sistemática onde selecionaram-se dez artigos entre mais de mil encontrados nas bases de dados Embase, Pubmed, Scopus, Scielo e Lilacs. Os artigos são estudos epidemiológicos observacionais dos tipos descritivos transversais e analíticos de coorte e casos-controle. Para o estudo de prevalencia, análise estatística utilizou a regressão de Poisson com variância robusta para investigar como a prevalência do cumprimento das condicionalidades na área de saúde foi influenciada pelas diversas variáveis explicativas.

Foram estimadas razões de prevalências brutas e ajustadas, com seus respectivos intervalos de confiança de 95%. O cadastro no programa bolsa família foi considerado como principal variável de exposição. As variáveis de confundimento foram: idade da mãe, escolaridade, raça/cor, saber ler, viver sozinha e região de moradia. Na análise dos dados foi utilizado o software R 3.0.1 (RDevelopment Core Team, 2013). Em relação a comparação do Bolsa Familia com demais programas da América Latina, a revisão mostrou resultados semelhantes quanto ao efeito positivo dos programas de transferência de renda no estado nutricional de crianças beneficiárias, sendo que estes efeitos são mais evidenciados em crianças menores de dois anos de idade, bem como pertencentes às famílias de mais baixo nível socioeconômico. Para a prevalencia das condicionalidades entres os diferentes grupos de usuárias do Bolsa Família e não usuárias Os resultados apontaram que não houve diferença estatística significativa entre respondentes (com filhos menores de dois anos) cadastrados e não cadastrados no PBF quanto às questões referentes aos seguintes aspectos: cumprimento do calendário vacinal da criança, realização de pelo menos sete consultas de pré natal, realização do acompanhamento do crescimento e desenvolvimento da criança e receber orientação da equipe de saúde quanto a alimentação da criança. Conlui-se de um lado que aumento de renda mínima para familias de exterma pobreza mostrou impacto possitivo na saúde das cranças no Brasil e América Latina. Do outro não confirmou, no Brasil, uma incremento das condicionalidades expressas numa utlização dos serviços de atenção básica por parte das usuárias do Bolsa Familia. (AU)

The programs of conditional cash transfer are widespread in developing countries in Latin America with emphasis on Brazil as a new paradigm in social policies for poverty eradication. Consist of transferring monetary funds from the government directly to poor families by fulfilling the conditionalities on education and health. In health, even with variations between countries, conditionality targeting public pregnant women and children with a view to improving health indicators maternoinfantil as growth, infant mortality and prenatal care. The objectives of this study are to compare the transfer program conditional Brazilian income, the Family and similar programs in Latin America in relation to its effects on growth in children, and to evaluate the effect of Bolsa Família in the prevalence of use of services (conditionalities) of prenatal care in Brazilian health services whose teams joined the Programa de Acesso e Melhoria da Qualidade da Atenção Básica (PMAQ-AB). For the first objective a systematic review , we selected ten articles between 1007 (one thousand and seven) found in the databases Embase, PubMed, Scopus, Scielo and Lilacs databases was performed. Articles are observational epidemiological studies of transverse descriptive and analytical types of cohort and case - control. For the second objective, for it is a prevalence study, a statistical analysis using Poisson regression with robust variance was performed to investigate how the prevalence of compliance with conditionalities on health was influenced by various explanatory variables. Ratios, crude and adjusted prevalence, with their respective confidence intervals of 95 % were estimated. The family joined the scholarship program was considered as the main exposure variable. Confounding variables were: maternal age, race / color, paid employment , marital status and region of residence. In data analysis software R 3.0.1 (RDevelopment Core Team 2013) was used . Regarding the comparison of the Bolsa Família with other programs in Latin America, the review found similar results regarding the positive effect of income transfer in the nutritional status of beneficiary children programs, and these effects are more evident in children under two years old and belonging to families of lower socioeconomic status. For the prevalence of conditionalities entres different groups of users of the Bolsa Família and nonusers results showed no statistically significant difference between respondents (with children under two years) registered and not registered in PBF on issues relating to: meet at least six prenatal visits, meet and participate in health education activities. It follows from side to increase minimum income for families in extreme poverty showed positive impact on children's health in Brazil and Latin America. The other is not confirmed in Brazil, an increase in conditionality expressed in use of primary care by the users of the Bolsa Família services. (AU)

A gestão das condicionalidades de saúde do Programa Bolsa Família: relações intergovernamentais e intersetoriais / \" The health conditionalities of the management of the Bolsa Família Program: intergovernmental and intersectoral relations \"

O Programa Bolsa Família (PBF) é um programa nacional de transferência de renda com condicionalidades, destinado às famílias em situação de pobreza ou extrema pobreza. O recebimento do benefício monetário está vinculado ao cumprimento pelas famílias de condicionalidades nas áreas de educação, saúde e assistência social. As condicionalidades do programa têm suscitado um amplo debate, com posicionamentos contrários e favoráveis à sua existência. As condicionalidades de saúde se referem a ações básicas (imunização, pré-natal, acompanhamento do crescimento e desenvolvimento infantil) que já deveriam ser garantidas no âmbito do Sistema Único de Saúde (SUS). A pesquisa desenvolvida teve como objetivo analisar a gestão das condicionalidades de saúde do PBF no contexto do município do Rio de Janeiro,considerando os propósitos e diretrizes da política nacional e as relações intergovernamentais e intersetoriais na gestão local do programa. A metodologia utilizada foi um estudo de caso, que envolveu revisão bibliográfica, análise documental, análise de bases de dados secundários e realização de vinte entrevistas semi estruturadas com dirigentes e profissionais envolvidos na gestão do PBF. A pesquisa demonstrou que o desenho dos programas próprios de transferência de renda implantados na esfera estadual (Renda Melhor) e municipal (Cartão Família Carioca) incorporou inovações relevantes. Além disso, constataram-se diferenças na lógica subjacente às condicionalidades entre esses dois programas. As relações intersetoriais na gestão local das condicionalidades da saúde do PBF demonstraram-se frágeis no que concerne à interação entre a saúde e a assistência social...

The Program Bolsa Família (PBF) is a Brazilian national conditional cashtransfer program aimed at families in poverty or extreme poverty. Receiving thefinancial benefit is dependent on meeting conditionalities in the areas of education,health and social assistance, which constitutes a controversial aspect of the program.The health conditionalities refer to basic actions (immunization, prenatal care,nutritional monitoring of children) that should already be ensured under the UnifiedHealth System (SUS). This study aimed to review the management of the PBF healthconditionalities in the context of the municipality of Rio de Janeiro, considering theobjectives and guidelines established by national policy and the relations betweendifferent levels of government and different sectors in the local management of the program. The methodology employed was a case study, involving bibliographic review,documental analysis, analysis of secondary data and twenty semi-structured interviewswith managers and other staff involved in PBF management. The study showed that cash transfer programs implemented at a state level (Renda Melhor) and municipal level(Cartão Família Carioca) have incorporated important innovations. Furthermore, differences were found in the underlying logic of the conditionalities between these two programs. The cross-sectorial relations in the local management of the PBF health conditionalities were found to be fragile in terms of the interaction between health and social assistance...

Dimensões qualificadoras dos Programas de Transferência de Renda na América Latina e Caribe / Qualifying Dimensions of Income Transfer Programs in Latin America and the Caribbean

O presente artigo resulta de trabalho investigativo desenvolvido no contexto do Grupo de Avaliação e Estudo da Pobreza e das Políticas Direcionadas à Pobreza (GAEPP) da Universidade Federal do Maranhão. O texto situa os programas de transferência de renda condicionada em contexto histórico da proteção social nessa parte do continente americano, contemplando reflexões sobre as principais dimensões que os qualificam: a família pobre como unidade básica de atenção; as condicionalidades como caminhos para favorecer a autonomia e a ruptura com a pobreza intergeracional; o território como espaço de focalização do atendimento; a racionalidade gerencial como paradigma do processo de gestão. Conclui-se que esses programas são uma face das recentes mudanças ocorridas no modo de regulação do capitalismo e que, embora sejam um lenitivo para os nomeados pobres, não representam mudanças importantes na configuração da pobreza e da desigualdade nos países que os adotam.

This article is the result of investigative work developed in the context of the Poverty Assessment and Study Group and Policies Aimed to Poverty (GAEPP) of the Federal University of Maranhão. The text places the conditional cash transfer programs in historical context of social protection, in this part of the american continent, covering reflections on the key dimensions that qualify them: the poor family as the basic unit of attention; conditionalities as ways to promote autonomy and the break with intergenerational poverty; the territory as an area of focus of care; managerial rationality as the management process paradigm. Concludes that these programs are a face of the recent changes in the capitalist mode of regulation and that, although they are a solace for the poor named, do not represent major changes in poverty and inequality configuration in countries that adopt them.

El resurgir de viejos fantasmas: política asistencial y mundo del trabajo / The resurgence of old ghosts: social assistance policy and labor world

Desde fines de los años 90 en América Latina la política asistencial se ha ampliado e institucionalizado, asumiendo principalmente la forma de Programas de Transferencia Condicionada. También en el Uruguay, desde el 2005 se ha consolidado esta línea de actuación pública. Uno de los principales aspectos desde los que han sido discutidos estos programas, refiere al vínculo con el trabajo. Las transferencias desalentarían a los beneficiarios a trabajar, aumentando la dependencia del Estado. A partir de la experiencia uruguaya este trabajo analiza la relación entre inserción en el mundo del trabajo y transferencias condicionadas, observando que no se verifican esas preocupaciones. Estas, son estructurantes del campo de la asistencia que resurgen en la actualidad como viejos fantasmas.

Since the end of the nineties, Latin America has widened and institutionalized its social assistance policies, mainly by the implementation of Conditional Cash Transfer Programs. In Uruguay, these programs have been implemented since 2005. One of the more debatable topics regarding these programs has been their impact on work and whether transfer programs would not incentive beneficiaries to work and promote their dependency with the State. This paper presents the Uruguayan case analyzing Conditional Cash Transfer Programs and the world of work stating there is no such impact of these programs on adult work. Rather, these concerns are old ghosts which have always been present in the social assistance arena.

Impact of Janani Shishu Suraksha Karyakram on Out-of-pocket Expenditure among Urban Slum Dwellers in Northern India.

Objective: To assess the impact of Janani Shishu Suraksha Karayakaram (JSSK) on outof- pocket expenditure during perinatal period in an urban slum area of Chandigarh, India. Methods: Data on out-of-pocket expenditure were collected retrospectively from 425 women who gave birth during June 2010 to June 2012. Results: Out-of-pocket expenditure for delivery decreased from Rs. 5342 to Rs. 3565 between pre and post-intervention period. There was no significant difference in catastrophic health expenditures between pre-JSSK (21.2%) and post-JSSK (15.6%) periods (P=0.15). Conclusion: Strengthening of implementation of JSSK is required to ensure universal access for natal care.

El desarrollo del capitalismo y la nueva configuración de la protección social: la Asignación Universal por Hijo en Argentina / The development of capitalism and the new configuration of social protection: the Universal allocation per child in Argentina

En este trabajo señalamos el contexto político, económico y social en que surge y se implementa la Asignación Universal por Hijo en Argentina como un programa de "Transferencias Monetarias Condicionadas" aprobado a fines del año 2009. Caracterizamos este programa a partir de un conjunto de dimensiones de análisis, desde una perspectiva amplia y compleja sobre la política social, e identificamos problemas en relación a la orientación y sentido ético político que persigue. En relación a estos interrogantes colocamos algunas tensiones centrales que hacen al desarrollo del capitalismo y a la implementación de políticas: la relación de las condiciones y formas de organización del trabajo y las desigualdades contemporáneas con las formas de protección social; el papel de las condicionalidades y las tensiones con perspectivas universalistas. De este modo damos cuenta de la configuración de un nuevo sistema de protección social acorde con las transformaciones del capitalismo contemporáneo.

In this paper we pointed out the economic, political and social context that arises and implements the Universal allocation per child in Argentina as a program of "Conditional Cash Transfers" adopted at the end of the year 2009. We characterize this program from a set of dimensions of analysis, from a broad perspective and complex on social policy, and identify problems in relation to the orientation and sense of ethics that aim. In relation to these questions we put some tensions that make central to the development of capitalism and to the implementation of policies: the relationship of the conditions and forms of work organization and inequalities with contemporary forms of social protection; the role of the conditionalities and tensions with universalist perspective. In this way do we account for the configuration of a new system of social protection in line with the contemporary transformations of capitalism.

Impact of Janani Suraksha Yojana on Institutional Delivery Rate and Maternal Morbidity and Mortality: An Observational Study in India.

The Government of India initiated a cash incentive scheme—Janani Suraksha Yojana (JSY)—to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India.

Fluxos decisórios na formulação das condicionalidades de saúde do programa bolsa família / Decision-making fluxes related to counterpart healthcare condition's concept in the programa bolsa família

Os programas de transferência condicionada de renda (TCR) entram na agenda pública por sua potencialidade em interferir no ciclo intergeracional de pobreza. Este artigo tem como objetivo analisar o processo de formulação das condicionalidades de saúde do Programa Bolsa Família e, secundariamente, avaliar sua interface com a trajetória das políticas de alimentação e nutrição no Brasil. Para isso, o estudo adotou como referencial analítico o modelo de análise de múltiplos fluxos, proposto por Kingdon, para quem a mudança na agenda pública acontece com a convergência entre o fluxo dos problemas, o fluxo das soluções e alternativas e o fluxo político. A trajetória desses fluxos foi recomposta por meio da análise de documentos governamentais e de relatos orais obtidos por meio de entrevistas. No momento da formulação das condicionalidades de saúde, no fluxo de problemas, havia a necessidade de mudar a estratégia de combate à desnutrição, devido às críticas ao Incentivo ao Combate às Carências Nutricionais (ICCN) e à extinção do Programa de Distribuição de Estoques de Alimentos (PRODEA). No que diz respeito ao fluxo das soluções, diversas propostas de TCR estavam em curso. No fluxo político, havia a decisão de criação de uma rede de proteção social. Nesse processo, a Coordenação Geral da Política de Alimentação e Nutrição assumiu o papel de empreendedora de políticas. A reflexão sobre esse processo ajuda a compreender o papel dos serviços de saúde em um programa de caráter intersetorial.

Pobreza e Política Social: a implementação de programas complementares do Programa Bolsa Família / Poverty and Social Policy: the implementation of complementary programs for the Bolsa Família Program

The Bolsa Família Program involves the transfer of income and the implementation of complementary programs to foster human capital development and empower the beneficiaries. To analyze the implementation of complementary programs in Manguinhos, Rio de Janeiro, a review of documents and secondary data was conducted, focus groups of beneficiaries studied and semi-structured interviews were staged with governmental, nongovernmental stakeholders and beneficiaries. The design, coverage and evaluation of the complementary programs have been weak, and beneficiaries were even unaware of vocational training courses. The program administrators acknowledged the failings and the fact that the courses offered by Próximo Passo are not adapted to local demand, even though they were conceived as a vocational training strategy aimed at creating construction jobs in the Growth Acceleration Program and the tourist industry in the city. Considering that the social inclusion perspective is linked to access to public policies, the supply and follow-up of these activities by government agencies and civil society organizations are essential for the effectiveness of the fight against poverty and hunger, aimed at contributing to the so-called "exit routes" from the Bolsa Família Program.

O Programa Bolsa Família articula a transferência de renda à implementação de programas complementares, a fim de promover o desenvolvimento de capital humano e a autonomização dos beneficiários. Para analisar a implementação dos programas complementares em Manguinhos, Rio de Janeiro, realizamos consultas documentais; grupos focais com beneficiários; entrevistas semiestruturadas com atores governamentais, não-governamentais e beneficiários, além da coleta de dados secundários. O desenho, a cobertura e a avaliação dos programas complementares mostraram-se frágeis. Os beneficiários desconheciam cursos de qualificação profissional. Os gestores reconheceram a debilidade das ações e destacaram que os cursos do Próximo Passo não se adéquam à demanda local, ainda que pensados como estratégia de capacitação voltada às obras do Programa de Aceleração do Crescimento e à vocação turística da cidade do Rio de Janeiro. Considerando que a perspectiva de inclusão social está atrelada ao acesso às políticas públicas, a oferta e o acompanhamento destas ações pelas esferas governamentais e organizações civis constituem um eixo crucial para o combate à pobreza e à fome, contribuindo para as chamadas "portas de saída" do Programa Bolsa Família.

Additional cash Incentive within a conditional cash transfer scheme: A 'controlled before and during' design evaluation study from India.

Background : Conditional Cash Transfer (CCT) schemes have shown largely favorable changes in the health seeking behavior. This evaluation study assesses the process and performance of an Additional Cash Incentive (ACI) scheme within an ongoing CCT scheme in India, and document lessons. Material and Methods: A controlled before and during design study was conducted in Madhya Pradesh state of India, from August 2007 to March 2008, with increased in institutional deliveries as a primary outcome. In depth interviews, focus group discussions and household surveys were done for data collection. Results: Lack of awareness about ACI scheme amongst general population and beneficiaries, cumbersome cash disbursement procedure, intricate eligibility criteria, extensive paper work, and insufficient focus on community involvement were the major implementation challenges. There were anecdotal reports of political interference and possible scope for corruption. At the end of implementation period, overall rate of institutional deliveries had increased in both target and control populations; however, the differences were not statistically significant. No cause and effect association could be proven by this study. Conclusions: Poor planning and coordination, and lack of public awareness about the scheme resulted in low utilization. Thus, proper IEC and training, detailed implementation plan, orientation training for implementer, sufficient budgetary allocation, and community participation should be an integral part for successful implementation of any such scheme. The lesson learned this evaluation study may be useful in any developing country setting and may be utilized for planning and implementation of any ACI scheme in future.