Social protection systems in vulnerable families: their importance for the public health.

OBJECTIVE To analyze the effectiveness of the Chilean System of Childhood Welfare in transferring benefits to socially vulnerable families. METHODS A cross-sectional study with a sample of 132 families from the Metropolitan Region, Chile, stratified according to degree of social vulnerability, between September 2011 and January 2012. Semi-structured interviews were conducted with mothers of the studied families in public health facilities or their households. The variables studied were family structure, psychosocial risk in the family context and integrated benefits from the welfare system in families that fulfill the necessary requirements for transfer of benefits. Descriptive statistics to measure location and dispersion were calculated. A binary logistic regression, which accounts for the sample size of the study, was carried out. RESULTS The groups were homogenous regarding family size, the presence of biological father in the household, the number of relatives living in the same dwelling, income generation capacity and the rate of dependency and psychosocial risk (p ≥ 0.05). The transfer of benefits was low in all three groups of the sample (≤ 23.0%). The benefit with the best coverage in the system was the Single Family Subsidy, whose transfer was associated with the size of the family, the presence of relatives in the dwelling, the absence of the father in the household, a high rate of dependency and a high income generation capacity (p ≤ 0.10). CONCLUSIONS The effectiveness of benefit transfer was poor, especially in families that were extremely socially vulnerable. Further explanatory studies of benefit transfers to the vulnerable population, of differing intensity and duration, are required in order to reduce health disparities and inequalities.

Social protection systems in vulnerable families: their importance for the public health / Sistemas de protección social en familias vulnerables: su importancia en la salud pública

OBJECTIVE To analyze the effectiveness of the Chilean System of Childhood Welfare in transferring benefits to socially vulnerable families. METHODS A cross-sectional study with a sample of 132 families from the Metropolitan Region, Chile, stratified according to degree of social vulnerability, between September 2011 and January 2012. Semi-structured interviews were conducted with mothers of the studied families in public health facilities or their households. The variables studied were family structure, psychosocial risk in the family context and integrated benefits from the welfare system in families that fulfill the necessary requirements for transfer of benefits. Descriptive statistics to measure location and dispersion were calculated. A binary logistic regression, which accounts for the sample size of the study, was carried out. RESULTS The groups were homogenous regarding family size, the presence of biological father in the household, the number of relatives living in the same dwelling, income generation capacity and the rate of dependency and psychosocial risk (p ≥ 0.05). The transfer of benefits was low in all three groups of the sample (≤ 23.0%). The benefit with the best coverage in the system was the Single Family Subsidy, whose transfer was associated with the size of the family, the presence of relatives in the dwelling, the absence of the father in the household, a high rate of dependency and a high income generation capacity (p ≤ 0.10). CONCLUSIONS The effectiveness of benefit transfer was poor, especially in families that were extremely socially vulnerable. Further explanatory studies of benefit transfers to the vulnerable population, of differing intensity and duration, are required in order to reduce health disparities and inequalities. .

OBJETIVO Analizar la efectividad de las transferencias de beneficios del Sistema de Protección Integral de la Infancia a familias de Chile socialmente vulnerables. MÉTODOS Estudio transversal analítico con 132 familias, estratificadas según vulnerabilidad social en la Región Metropolitana, Chile, entre septiembre de 2011 y enero de 2012. Se aplicó entrevista semiestructurada a madres de familias en centros de salud públicos o en sus domicilios. Las variables fueron: estructura familiar, riesgo psicosocial del entorno familiar y beneficios integrados del sistema de protección social requeridos en las familias que cumplían con el requisito de aplicabilidad para la transferencia del beneficio. Se calcularon estadígrafos descriptivos, de posición y dispersión. Fue realizada regresión logística binaria, pertinente por el tamaño de la muestra. RESULTADOS Los grupos fueron homogéneos en cuanto a tamaño de la familia, presencia del progenitor y número de allegados, capacidad generadora de ingresos, tasa de dependencia y riesgo psicosocial (p ≥ 0,05). La transferencia de los beneficios fue baja en los tres grupos (≤ 23,0%). La mejor cobertura estuvo representada por el Subsidio Único Familiar, cuya entrega se relacionó con el tamaño de la familia, la presencia de allegados, progenitor ausente, la alta tasa de dependencia y alta capacidad generadora de ingresos (p ≤ 0,10). CONCLUSIONES La efectividad de entrega de los beneficios fue baja, especialmente en familias de extrema vulnerabilidad social. Nuevos estudios explicativos de formas de transferencia de beneficios deben ser realizados con diferentes niveles de intensidad y tiempos de exposición en poblaciones vulnerables, para disminuir las disparidades y desigualdades en salud. .

Effectiveness of the Comprehensive Childhood Protection System for vulnerable mothers and children.

OBJECTIVES: To establish the effectiveness of the public benefits and services of the "Chile Grows with You" and "Protect Network" programs for socially vulnerable women and children in an urban community in the Metropolitan Region of Chile. METHOD: Descriptive study employing a questionnaire. The sample consisted of 132 mothers and their 133 infants, all grouped according to social vulnerability. Primary data were collected via a structured interview of the mothers and were complemented with institutional (secondary) data. Descriptive and associative analyses were performed. RESULTS: The perception of social vulnerability by the professionals was low at the time of admission into the program. The effectiveness of the universal and specific benefits was low, with better results for the children than for the mothers. However, no significant differences were observed according to vulnerability. Another finding was the low access to specific benefits for children with psychosocial risk and psychomotor delay, especially in the most vulnerable group. CONCLUSION: The results revealed a gap in the access to the benefits guaranteed by law. To overcome this situation, nurses must strengthen their skills in contextualized health practices and the comprehensive administration of interdisciplinary and intersectoral networks.

Effectiveness of the Comprehensive Childhood Protection System for vulnerable mothers and children / Efetividade do Sistema de Protecao Integral da Infancia em maes e criancas vulneraveis / Efectividad del Sistema de Proteccion Integral de la Infancia en madres y ninos vulnerables

OBJECTIVES: to establish the effectiveness of the public benefits and services of the "Chile Grows with You" and "Protect Network" programs for socially vulnerable women and children in an urban community in the Metropolitan Region of Chile. METHOD: Descriptive study employing a questionnaire. The sample consisted of 132 mothers and their 133 infants, all grouped according to social vulnerability. Primary data were collected via a structured interview of the mothers and were complemented with institutional (secondary) data. Descriptive and associative analyses were performed. RESULTS: the perception of social vulnerability by the professionals was low at the time of admission into the program. The effectiveness of the universal and specific benefits was low, with better results for the children than for the mothers. However, no significant differences were observed according to vulnerability. Another finding was the low access to specific benefits for children with psychosocial risk and psychomotor delay, especially in the most vulnerable group. CONCLUSION: the results revealed a gap in the access to the benefits guaranteed by law. To overcome this situation, nurses must strengthen their skills in contextualized health practices and the comprehensive administration of interdisciplinary and intersectoral networks. .

OBJETIVO: estabelecer a efetividade da oferta pública de benefícios e/ou de prestações do Programa Chile Cresce Contigo e a Rede Protege, em crianças e mulheres socialmente vulneráveis de um bairro da Região Metropolitana do Chile. MÉTODO: estudo descritivo, com a utilização de um questionário. A amostra foi constituída por 132 mães de 133 crianças e estratificada segundo grupos de vulnerabilidade social. A informação primária foi coletada através de uma entrevista estruturada às mães e complementada com dados das fontes secundárias institucionais. Realizaram-se análises descritiva e de associação. RESULTADOS: houve baixa percepção de vulnerabilidade social pelos profissionais quando do ingresso do controle. A efetividade dos benefícios universais e específicos foi baixa, com melhores resultados nas crianças e nas mães, contudo, não foram observadas diferenças significativas, segundo a vulnerabilidade. Outro resultado foi o baixo acesso aos benefícios específicos nas crianças com risco psicossocial e atraso psicomotor, especialmente no grupo mais vulnerável. CONCLUSÃO: os resultados mostram uma lacuna no acesso aos benefícios garantidos por lei. Para superar essa situação, as enfermeiras/os necessitam fortalecer competências nas práticas sanitárias contextualizadas e de gestão integrada nas redes interdisciplinares e intersetoriais. .

OBJETIVO: establecer la efectividad de la oferta pública de beneficios y/o prestaciones del Programa Chile Crece Contigo y la Red Protege, en niños y mujeres socialmente vulnerables en una comuna urbana de la Región Metropolitana de Chile. MÉTODO: estudio descriptivo con uso de la técnica de la encuesta, la muestra constituida por 132 madres de 133 niños fue estratificada según grupos de vulnerabilidad social; la información primaria fue obtenida con una entrevista estructurada a las madres y complementada con datos de fuentes secundarias institucionales. Se calcularon estadísticas descriptivas y de asociación. RESULTADOS: hubo baja percepción de vulnerabilidad social de las diadas, por las profesionales al ingreso del control; la efectividad de beneficios universales y específicos fue baja, con mejores resultados en hijos que en madres, no obstante, no se observaron diferencias significativas según vulnerabilidad; un hallazgo fue la baja accesibilidad a beneficios específicos en niños con riesgo psicosocial y retraso del desarrollo psicomotor, especialmente en el grupo más vulnerable. CONCLUSIÓN: los resultados muestran una brecha en el acceso a beneficios garantizados por ley; para superar esta situación, las enfermeras/os requieren fortalecer competencias para prácticas sanitarias contextualizadas y de gestión integrada, en redes interdisciplinarias e intersectoriales. .