Transcript “ CHILE GROWS WITH YOU “ EQUITY FROM THE BEGINNING A RIGTH APPROACH PUBLIC POLICY Helia Molina MD.MPH Chief of Public Policies Division Director of.

“ CHILE GROWS WITH YOU “
EQUITY FROM THE BEGINNING
A RIGTH APPROACH PUBLIC POLICY
Helia Molina MD.MPH
Chief of Public Policies Division
Director of Chile Grows With You Program
Ministry of Health
Protección Integral a la Infancia
Chile
TOPICS
• CHILEAN CONTEX
• CONCEPTUAL AND POLITICAL
FRAMEWORK
• THE PUBLIC POLICY IN PLACE
• SOME REFLEXIONS
Protección Integral a la Infancia
n
Mortalidad
Infantil eninChile
Infantile Mortality
1960 - 2003
Evolución del Tratamiento de
Chile 1960-2003
140
EvolutionAguas
of Sewage
Treatment
Servidas
120
100
100
80
80
%
60
60
Cobertura
100
40
66
40
En 2003:
7,3 por mil
20
0
1960
1965
1970
1975
1980
1985
1990
1995
2000
42,3
20
0
80
10
Antes
2000
2002
2003
2006
2010 Año
A ñ o
MORTALIDAD MATERNA,
CHILE, 1960 - 2002.
Maternal Mortality Chile 1960-2002
Due to growth around 6% between 2003 and
2006, a 3 point decrease in total poverty
isprojected
35
Tasa por 10.000 nacidos vivos
Tasa por mil nacidos vivos
120
30
25
20
15
10
5
0
1960 1965 1970 1975 1980 1985 1990 1995 2000
A
ñ
o
Protección Integral a la Infancia
Fuente: Ministerio de Salud
Fuente: www.minsal.cl o www.mideplan.cl
Trends of Poverty
Casen, 2006. MIDEPLANProtección Integral a la Infancia
Socioeconomic Situation
40,0
36,6
30,1
30,0
22,2
20,0
18,7
24,2
13,6
10,0
-
I
II
III
IV
V
Total
Quintil
MIDEPLAN, Social Division, starting with the CASEN survey - 2003
Protección Integral a la Infancia
¿De dónde partimos?
DESIGUALDAD EN LA DISTRIBUCIÓN DEL INGRESO DE AMÉRICA LATINA EN
COMPARACIÓN CON EL RESTO DEL MUNDO
30
25
AM ÉRICA
LATINA
20
ÁFRICA
RESTO
DE ASIA
15
ASIA
SUDORIENTAL
PAÍSES
INDUSTRIALIZADOS
10
5
0
0
2000
4000
8000
Protección
Integral a6000
la Infancia
Ingreso que recibe el 5%más rico
10000
12000
14000
16000
Ingreso que recibe el 30% más pobre
Fuente: BID, Progreso Económico y Social en América Latina, Informe 1998-1999, América Latina Frente a la Desigualdad , pág. 13.
Protección Integral a la Infancia
We are progressing but the inequities in health
persist
Brechas
en mortalidad
infantilto
Gaps
in Infantile
Mortality according
por escolaridad
de 1998-2000;
la madre
mother’s
schooling Chile
Chile 1998 ﾐ 2000 y 2001 - 2003
2001-2002
En la población con menores ingresos
Indisminuye
the population
income
el % with
que less
declara
quethe
su %
salud
es
buena
o
muy
buena
of people who say that their health is
good
100% or very good decreases
3
80%
2,5
60%
2
40%
1,5
52,3
1998 - 2000
2001 - 2003
1
57,8
60,3
67,3
77,6
Mala
Regular
MB y Buena
20%
0%
0,5
I
II
III
IV
V
0
13+
Fuente: Mideplan, Encuesta Casen 2003
80
3
%
60
2,5
40
20
2
Hipertensión
Diabetes
1,5
1
0,5
0
Básica
Media
0
17-24 años
25-44 años
45-64 años
65 y + años
Hombres
33,9
51,9
93,6
85,5
Mujeres
25,7
38,8
53,4
81,0
Total
29,7
45,3
72,4
83,1
100
80
60
40
20
0
66,6
51,1
49,6
Universitario
100
Secundario
Riesgo Relativo de Hipertensión y
Relative Risk of Hypertension and
Diabetes
según
Diabetes
according
to escolaridad
education
High and very high Cardiovascular Risk
Básico
7 - 9 10 -12
años
%
hasta 3 4 - 6
Nivel Educacional
Universitaria
Fuente: Encuesta Nacional de Salud, MINSAL
Protección Integral a la Infancia
Nacional: 54.9%
Hombres: 64.2%
Mujeres: 46.2%
It is not expenditure it is an investment
Countries with
generous
familiar public
policies have
less levels of
poverty
Protección Integral a la Infancia
Fuente: NEWS The Nordic Experience and Public Health, Lundberg et al 2007
Child Development National Survey
2006. A base line
45
Quintil 1
Quintil 5
40
35
Prevalencia %
30
25
20
39,7
37,0
35,6
15
34,0
31,0
30,0
22,5
21,8
10
14,9
14,4
5
0
6 – 11 meses
1 año - 1 año 11 meses
2 año - 2 año 11 meses
3 año - 3 año 11 meses
4 año - 4 año 11 meses
Grupos de edad
Protección Integral a la Infancia
Fuente: Informe Final II ENCUESTA NACIONAL DE CALIDAD DE VIDA Y SALUD 2006. División de Planificación Sanitaria. Ministerio de Salud.
Governmental Priority 2006 - 2010
I desire a government which
continues constructing a
Chile as an inclusive society,
that does not discriminate
and does not forget those
who are left behind. A State
that not only enumerates the
rights but that guarentees
them for all its citizens.
Critical and conscious
citizens that put forth/express
their ideas and their
demands
Protección
Integral a lade
Infancia
Michelle Bachelet Jeria.
Presidenta
la Republica.
Discurso presidencial, Mayo, 2006.
“My goal, towards the end of my
government, is that we have been
able to establish a childhood
protection system aimed to equaling
the development opportunities of
the Chilean boys and girls in their
first eight years of life,
independently of their social origin
gender or the structure of their
families
(President of the Republic, Michelle Bachelet, on
the occasion of the constitution of the Advisory
Board for the Reform of the Childhood Policies).
Protección Integral a la Infancia
Council for Child Policy Reform
Protección Integral a la Infancia
HEALTH REFORM
• To mantain and improve the
Health
Objectives
obtained health acheivements
• To face the challenges posed
by aging and the changes in
the society
Tool
•
Auge Law
AUGE System
Planning Instrument
To decrease inequality
• To satisfy needs and
expectations
Requirements
Modelo de Atención
NEW PARADIGM:
Social Determinants – Prevention and Promotion n
APPROACH REGARDING RIGHTS
Components
Health Authority Law
•Regional Health Authority
•Manager of the Health Care Network
Financing Law
Law of Rights and Duties
Private Health Insurance
Regulation
Protección Integral a la Infancia
Social Protection System
Work and Income
Protection
Basic
Solidarity
Pension
Chile Crece
Contigo
Chile Solidario
Unemployment
insurance
Families
Homeless
People
Seniors
Children
from the
more
poorest
homes
Children
from
gestation
to prekinder (0-4)
Cash Transference
Social Protection Card
Integrated Social & Health Information System
Protección Integral a la Infancia
All citizen
SOCIAL PROTECTION BASED ON RIGHTS
 The advances and the social changes, together with the democratization
process have contributed to the composition of a citizenship that has more
rights and is more aware of them and therefore demands their exercise and
makes them demandable.
 From a social policy limited to the satisfaction of basic needs towards a
social policy based on citizens’ rights: this is the most important change in
the social policies. (Plan Auge, 12 years of compulsory schooling, guarantee
of educational qualityand the Chile Solidary System)
 The establishment of a Social Protection System is a political
agreement in which the society comes together to set up the bases on
which it wants to build and regulate its coexistence: it determines which
rights are for everybody, how they are guaranteed and how they are
made viable.
Protección Integral a la Infancia
CONCEPTUAL FRAMEWORK
Environmental Comprehensive Development Model
for Boys and Girls (H Molina;R. Mercer)
STATE
COMMUNITY
FAMILY
•Social milieu
•Cohesion
Comprehensive •Services
•Quality
Child
•Culture
•Values
•Policies
•Intersectorial
Collaboration
•Distribution of
wealth
Development
..
Life Cycle
..
Genetic Care
Accessibility-Participación
Health – Education – Work – Environment– Justice – Sanitation
Protección Integral a la Infancia
Salud
Salud
Salud
Protección Integral a la Infancia
Entrance Point of Social Determinants of Health (SDH)
Social Protection
Social protection
systems
WORK
MARKET
EDUCATIONAL
SYSTEM
WELLBEING
STATE
Social-economic
Position
Gender
Living
conditions
Workplace
conditions
Ethnic
minorities
Behaviours
Social
Cohesion
Health care
and Social
services
NATIONAL STRATEGY OF SOCIAL DETERMINANTS
WITH AN APPROACH OF RIGHTS
SOCIAL
STRUCTURE
SOCIAL STATUS
OF THE
INDIVIDUAL
Structural Determinants
Protección Integral a la Infancia
Ref: Modified of Briefing paper Health inequalities: concepts,
frameworks and policy authors H. Graham , M P. Kelly 2004, NHS.
Health
and Wellbeing
AUGE, Public
Health Plan
THE HEALTH
REFORM TODAY
INTERMEDIATE
FACTORS
Intermediate
Determinants
EQUITY IN
HEALTH
Social determinats of health: entry points for public policies
Intersectoral
action
Country and regional level
Social protection)
Community
Individual
Social
participation
Educatión
Stratification influence
Work conditions,
gender
Policies to reduce Exposition to risk factors Housing, tobaco
,nutrition
Polícies to reduce vulnetability in
disadvantages groups
Vaccines, food,day care
preeschool education
Policies to reduce iniqual consecuences in
health and development
Health attention
Monitoring of inequities
Cost efectiveness of interventions
Healthand education in all policies
Protección Integral a la Infancia
Fuente: Equipo Equidad, OMS
Comprehensive dealing with social determinants
Labor improvements:
Benefits((subsidies) for young people
jóvenes,
subcontracts
Education
Welfare
System’s
reform
Childhood protection
Código Trabajo
Seniors’ Protection
Solidary
Chile
Social
Security
Workers´Health
Social
subsidies
Universal
access to
Health:
To deepen
the Reform
Social
Houses
200 Neighborhoods:
Housing and
Town Planning Policy
Comprehensive Social Protection System
Construction of a social protection system that establishes social guarantees for
the basic essential conditions for human development.
Protección Integral a la Infancia
Non
integrated
services
Intersectoral
Integrated
Action
Based on the people needs
Protección Integral a la Infancia
Towards a Childhood Protection System in Chile:
methodological stages and questions (for each stage of the cycle
1.
–
–
–
–
Map of the development needs of children, their
parents and the determining factors.
Quantitative and Qualitative background of the current
situation of the children, identifying the magnitude and
nature of the inequities that they face.
Origin, determining factors of the inequities and gaps.
Family and upbringing of their children, educational
/schooling level and labor insertion of the parents, in
particular, the mother.
Responsibilities of the family, of the public policy and other
agents. Needs and demands.
Protección Integral a la Infancia
2.
Map of the programmatic offers and actions for children
and their family
– What does and what doesn’t the public policy do today?
Current priorities.
– Critical knots, difficulties, obstacles, etc. that are faced?
– Private offers, non governmental and from the local level.
What does exist and what is their contribution?
– Normative and legal framework.
– Costs and financing of the provisions and services.
– Management, following up and evaluation instruments.
– Citizens´ participation and social control.
– What do we know about the quality and effectiveness of th
interventions?
– What has been missing in politics?
Protección Integral a la Infancia
3.
Adaptation between politics and the
population’s needs.
4.
Strategy, recommendations and proposals
for the future policy.
–
–
–
–
–
–
–
–
Meaning/Sense of the policy and new priorities.
Result standards that shoulod be stimulated.
Incorporation of more actors
New management models
Revisions of the legal and normative framework.
Institutional proposal.
Financing strategies.
Necessary Instruments (information system, costseffectiveness, observatories)
Protección Integral a la Infancia
Services of Chile Crece Contigo
1.
2.
3.
4.
Educational program for all citizens
Information provided on the internet
Legislative improvements to protect maternity and paternity
rights
To all the childrens
Programa de Apoyo al Desarrollo Biosicosocial – A
longitudinal accompany
To child and their
families using public
heath services
5.
6.
7.
8.
9.
10.
Home visits by primary care team
Cash transference
Free childcare of accredited quality
Referent access to public services
Support to disability child
Special support for adolescent parents
Protección Integral a la Infancia
To the most
vulnerable childrens
and their families
THE HEALTH COMPONENT OF CHILE GROWS WITH
YOU : Support to biopsicosocial development of
children
1. Strengthening of prenatal control for all the users of the
public health system
2. Improvement in the quality of the care in the maternities
and new born services.
3. Better support of the children’s normal growth and
development, with a family approach.
4. Improvement in the quality of the care of hospitalized
children.
5. Continuous support in the implementation and
management of the system in all levels of the health net
and in the intersector.
Protección Integral a la Infancia
Chile Grows with you: an integrated network of social
services
Public education
Public
health
Family ntervention
unit
FAMILY
Other
social
services
Protección Integral a la Infancia
Coordination office of
social services at the
municipality
Protección Integral a la Infancia
Program of Support for
Biopsychosocial Development
A
Pregnancy
Birth
I.Strengthening Prenatal
Developmentl
II. Personalized Care
in the birth process
B
C
PRIMARY HEALTH CARE
A
0 to 4 years of age
III. Care in the
hospitalized child’is
comprehensive
development
B
A
B
HOSPITALS
A. Personalized Birth
care
A. Comprehensive
New Born care
(hospitalized in
neonatology
B. Comprehensive
Care in the
puerperium
B. Comprehensive
Care for
hospitalized
children
A. Strengthening Prenatal Care
B. Development of a Health plan
with a family approach
C. Education for the pregnant
woman and her partner or
companion
Protección Integral a la Infancia
IV. Strengthening
the child’s
comprehensive
development
A
V. Care for children
in vulnerable
situations
B
A
PRIMARY HEALTH CARE
A. Strengthening of
Children’s Health
Controls for
comprehensive
development.
B. Educative
interventions
supporting
upbringing
A. Strengthening
of the interventions
in children in
vulnerability
situations. Falling
behind and deficit
in their
comprehensive
development.-
Del Programa: bed , breastfeeding pillow, bandolera, massages oils , parenting book and didactic
flyers and ressources for early psicosocialm estimulation
Support newborn
program .84% of the
chilean newborn
Protección Integral a la Infancia
Access to Early Childhood development Information
Protección Integral a la Infancia
Access to Early Childhood development Information
Protección Integral a la Infancia
Parenting Skills Program in
Primary Care
The parent/child relationship
is the most powerful influence
on children's
early brain development,
particularly in the first two years.
Protección Integral a la Infancia
A new generation of food programs
for development: Purita mamá
The PNAC incorporated as part of
the implementation of the CHCC
Purita Mom, a drink semi skimmed
milk added with Omega 3 fatty acids
(DHA). Coverage This initiative is of
17,200 nurses and 95,600 pregnant
women with an investment annual
$11,132,823,000. (22.000.00 US)
Protección Integral a la Infancia
CHILE GROWS WITH YOUIT IS A LOW
FROM SEPTEMBER 2009
VERY GOOD NEWS
Protección Integral a la Infancia
Fotografías: Prensa
“Many things we need can wait. The child cannot. Now is the
time his bones are formed, his mind developed. To him we
cannot say tomorrow, his name is today."
Gabriela Mistral, 1948 Novel Prize of literature
Protección Integral a la Infancia