Integrated action for social equity:

Chile Barrio Chile Solidario

Chile EmprendeChile Crece Contigo

Thematic Session: Intersectoral Action and Health – Global Learnings

CPHA Conference Halifax, Nova Scotia

June 2, 2008

Dr. Patricia Frenz

Poverty and Indigence Indicators: A policy driver

45,1

17,4

38,6

12,9

32,6

8,8

27,5

7,6

23,3

5,6

21,7

5,6

20,6

5,5

18,8

4,7

13,7

3,2

1987 1990 1992 1994 1996 1998 2000 2003 2006

Poverty Indigence

Source: MIDEPLAN, CASEN Surveys

Stagnationin extreme

poverty reduction

Chile Barrio

Chile Solidario

Chile Emprende

Chile CreceContigo

Infant Development Gap % of children with deficits,

comparing I and V SE quintiles

Source: Infant Module, National Health and Quality of Life Survey 2006

Policy Timeline

President Patricio Alywin

Eduardo Frei RicardoLagos

MichelleBachelet

SocialEmphasis

Social debt Eradicate poverty

Equality and rights

Social protection

Reform EducationJustice

Health Pension

Program Chile Barrio Chile Solidario+ Chile Emprende

Chile Crece Contigo

Objective Eradicate precarious settlements

Social capital and inclusión: families and territories

Achieve maximum develop-ment potential

Health sector role

Occasional , community demands

Key in CSMarginal in CE

Leading strategic role

Exreme Poverty Reduction

-5,3% -2,1% -2,4%

IncomeGini Index

0,57 0,58 0,54

1990 2000 2006 20101994

World Health Organization

Ref : Policy integration: what does it mean and how can it be achieved? A multi-disciplinary review Evert Meijers, Dominic Stead Delft University of Technology OTB Research Institute for Housing, Urban and Mobility Studies PO Box 5030 2600 GA Delft The

Netherlands

Integrated policy-making

Coordination

Cooperation

Joint new policy

Adjusted + more efficient sectoral

policies

More efficient sectoral policies

Interaction

Interdependence

Formality

Resources needed

Loss of autonomy

Comprehensiveness

Accessibility

Compatibility

( between sectors)

Integrated policy- making, policy co-ordination and co-operation.

Moving towards an Integrated Policy System for Social Welfare

SOCIAL PROTECTION SYSTEM 2006 -2010SOCIAL PROTECCION CARD

INTEGRATED SOCIAL INFO. SYSTEMCASEN: NATIONAL S.E. SURVEY

Work and Income Protection

Job

Intermediation

Basic Solidarity

Pension

Chile SolidarioChile Crece

Contigo

Monetary Benefits

Programatic

Benefits

Families Homeless

People

SeniorsChildren from

the poorest

homes

Children from

gestation to

pre-kinder

(0-4)

All citizens

Source: MIDEPLAN, adapted by the author based on conversation with the Executive Secretary of Chile Solidario.

Biopsicosocial Support

From dispersion to integration

Sectoral Efforts =

Fragmented Services

Sectoral Efforts =

Fragmented Services

Integrated Intersectoral

Action

Integrated Intersectoral

Action

Strategy: organize benefits and accompany families

Longitudinal Accompaniment Scheme during the child’s development

Universal Benefits (Biopsychosocial Support Program)

Differenciated benefits, according to the needs of the child

To the health institution

To the basic municipal network

To the extended network

What is ChCC

Health control

Risk Checklist

Gestation Guide

Primary Care Center

Registry

Examples

1° PrenatalControl

Enters

ChCC 2° Prenatal

Control

Vulnerabilityscore

1. Late start to prenatal controls

Local ChCC Network

Home visits

Entry into Chile Solidario (Bridge

Program)Apply social protection scorecard

Receives Family subsidy

Employment program

Health institution

Basic municipal network

Extended network

2. Low income family with unemployed adult and no

social protection scorecard

Vulnerability

Score

Enters

ChCC

4 yearsLeavesChCC

4 yearsLeavesChCC

MINISTERS COMMITTEE ON INFANCY

Intersectoral Technical Committee(Social Protection Executive Secretary– MINISTRIES – HEALTH – EDUCATION

PRESCHOOL – LABOR – YOUTH – HOUSING – WOMEN – BUDGET OFFICE -PRESIDENCY– REGIONES (INTERIOR)

MIDEPLANMINSAL MINEDUC

PlanningSecretary

Health Authority

EducationSecretary

Health Services

ChCC Managers

Governors Preschool Institutions

Social Protection Coordinator

Local Network ChCCLoMunicipality

Health Educatiob

EncRegional

ChCC

Municipal levelMunicipal level

Provincial level Provincial level

Regional level Regional level

National level National level

Decentralized implementación

articulated especially by three central Ministries:

Operational Network

Intendentes

Model of Integrated IA

MINISTRY

MINISTRY 1

MINISTRY 2

MINISTRY

GOVERNOR

SERVICE 2

SERVICE 1

BUDGET OFFICE

MINISTRY

MINISTRY 1

MINISTRY 2

MINISTRY

GOVERNOR

SERVICE 2

SERVICE 1

BUDGET OFFICE

PRIMARY CARE

FAMILY UNIT

PRIVATE SECTOR

EDUCATION MAYOR

LABOR

SERVICE 1

NGO

FAMILY UNIT

PRIMARY CARE

PRIVATE SECTOR

EDUCATION

MAYOR

LABOR

SERVICE 1

NGO

1

2 Municipal Network Community Network

National Coordination National Network

NGO

NGO

Multidimensional Management Model

Shared Outcome Targets

Network management

Systemic management

Knowledge management

Information management

Budget management

Values management

Electronic Platform

Monitoring and evaluating outcomes

Independent evaluation mechanisms

Insights on IA from the Chilean experiences

Monitoring and evidence as a driver

Political will is crucial but not enough

Common outcome targets, not just shared objectives (strategic policy framework)

The management model and tools determine the results

Santiago’s great expectations depend on local capacity and needs

Expertise for IA: social policy managers

A new culture of respect and dialogue

Institutional social capital

Strengthening the community: participation and social cohesion

Monitoring and measuring success

Persist, working together is not easy

Effective IA

Effective IA