Suchergebnisse

The focalization of social expenditure acquires special importance in the context of high poverty rates and a tight government budget. This article reviews theoretical concepts on social expenditure and explains the two possible "errors" of a social program: to exclude those who need it and to include those who do not. The minimization of the cost-effectiveness ratio of social expenditure demands the reduction of these errors and, according to this effort, the article points out the danger of considering the beneficiary as passive agents. The transfers of resources have "incentive-effects" that generates reactions in the population that can harm (or favor) the initial objectives of the program. In this regard, the authors propose a methodology of analysis in regards to the effectiveness of social programs for children care and transfers on the decision to work by the mother, taking in consideration the incentive-effects already mentioned. Surveys of new homes are being used to evaluate the scope and degree of focalization of Peruvian social expenditure. ; La focalización del gasto social adquiere especial importancia en el contexto de altos índices de pobreza y de un ajustado presupuesto estatal. El presente artículo revisa conceptos teóricos sobre el gasto social y desarrolla los dos posibles "errores" de un programa social: excluir a quienes lo necesitan e incluir a quienes no lo requieren. La minimización del ratio costo-efectividad del gasto social exige reducir estos errores y, en torno a este esfuerzo, el artículo resalta el peligro de considerar a los beneficiarios como agentes pasivos. Las transferencias de recursos tienen "efectos-incentivos", los cuales generan en la población reacciones que pueden perjudicar (o favorecer) los objetivos iniciales del programa. En este contexto, los autores plantean una metodología de análisis de la efectividad de los programas sociales de cuidado de niños y transferencias sobre la decisión de trabajo de la madre, que tome en consideración los efectos-incentivos mencionados. Se utilizan encuestas de hogares recientes para evaluar el alcance y el grado de focalización del gasto social peruano.

The focalization of social expenditure acquires special importance in the context of high poverty rates and a tight government budget. This article reviews theoretical concepts on social expenditure and explains the two possible "errors" of a social program: to exclude those who need it and to include those who do not. The minimization of the cost-effectiveness ratio of social expenditure demands the reduction of these errors and, according to this effort, the article points out the danger of considering the beneficiary as passive agents. The transfers of resources have "incentive-effects" that generates reactions in the population that can harm (or favor) the initial objectives of the program. In this regard, the authors propose a methodology of analysis in regards to the effectiveness of social programs for children care and transfers on the decision to work by the mother, taking in consideration the incentive-effects already mentioned. Surveys of new homes are being used to evaluate the scope and degree of focalization of Peruvian social expenditure. ; La focalización del gasto social adquiere especial importancia en el contexto de altos índices de pobreza y de un ajustado presupuesto estatal. El presente artículo revisa conceptos teóricos sobre el gasto social y desarrolla los dos posibles "errores" de un programa social: excluir a quienes lo necesitan e incluir a quienes no lo requieren. La minimización del ratio costo-efectividad del gasto social exige reducir estos errores y, en torno a este esfuerzo, el artículo resalta el peligro de considerar a los beneficiarios como agentes pasivos. Las transferencias de recursos tienen "efectos-incentivos", los cuales generan en la población reacciones que pueden perjudicar (o favorecer) los objetivos iniciales del programa. En este contexto, los autores plantean una metodología de análisis de la efectividad de los programas sociales de cuidado de niños y transferencias sobre la decisión de trabajo de la madre, que tome en consideración los efectos-incentivos mencionados. Se utilizan encuestas de hogares recientes para evaluar el alcance y el grado de focalización del gasto social peruano.

En el marco de la teoria de las decisiones economicas del hogar, en el presente estudio se pretende examinar la relacion del estado nutricional de un nino con el grado de educacion de su madre, distinguiendo cada efecto y evaluando su significancia en el caso peruano. La segunda seccion desarrolla un marco teorico apropiado. La tercera seccion presenta los resultados que se derivan del analisis econometrico a los datos de la Encuesta Nacional de Niveles de Vida 1994 y estima la magnitud de los efectos directos e indirectos de la educacion materna sobre el estado nutricional de los ninos. Finalmente, la cuarta seccion presenta las conclusiones del estudio. (Ibero Am/DÜI)

The focalization of social expenditure acquires special importance in the context of high poverty rates and a tight government budget. This article reviews theoretical concepts on social expenditure and explains the two possible "errors" of a social program: to exclude those who need it and to include those who do not. The minimization of the cost-effectiveness ratio of social expenditure demands the reduction of these errors and, according to this effort, the article points out the danger of considering the beneficiary as passive agents. The transfers of resources have "incentive-effects" that generates reactions in the population that can harm (or favor) the initial objectives of the program. In this regard, the authors propose a methodology of analysis in regards to the effectiveness of social programs for children care and transfers on the decision to work by the mother, taking in consideration the incentive-effects already mentioned. Surveys of new homes are being used to evaluate the scope and degree of focalization of Peruvian social expenditure. ; La focalización del gasto social adquiere especial importancia en el contexto de altos índices de pobreza y de un ajustado presupuesto estatal. El presente artículo revisa conceptos teóricos sobre el gasto social y desarrolla los dos posibles "errores" de un programa social: excluir a quienes lo necesitan e incluir a quienes no lo requieren. La minimización del ratio costo-efectividad del gasto social exige reducir estos errores y, en torno a este esfuerzo, el artículo resalta el peligro de considerar a los beneficiarios como agentes pasivos. Las transferencias de recursos tienen "efectos-incentivos", los cuales generan en la población reacciones que pueden perjudicar (o favorecer) los objetivos iniciales del programa. En este contexto, los autores plantean una metodología de análisis de la efectividad de los programas sociales de cuidado de niños y transferencias sobre la decisión de trabajo de la madre, que tome en consideración los efectos-incentivos mencionados. Se utilizan encuestas de hogares recientes para evaluar el alcance y el grado de focalización del gasto social peruano.

The aim of the study is to understand the sexual and reproductive health (SRH) behavior and determinants among adolescents in El Salvador using data from a survey of 1,258 adolescents' aged 10-19 and 12 interviews with representatives from the Ministry of Health (MOH), Ministry of Education (MOE), nongovernmental organizations (NGOs), and United Nation (UN) agencies. The study found that adolescents were not educated enough on their sexual and reproductive health rights (SRHR), and have limited use of and access to contraceptives. Alcohol and violence were found to be associated with risky sexual behavior, requiring a multisectoral response from the government and civil society. Adolescents need to receive earlier and more accurate information on their SRHR; and this information should be disseminated in a way that empowers adolescents to make responsible decisions about their sexual reproductive health. The MOE can play a vital role in informing adolescents in this area, and adjust these programs when necessary. Further, the role of parents is critical, as the study found that adolescents are not receiving adequate and enough SRHR information from their parents. In addition, the MOH needs to offer adolescent-friendly health services, which includes trained health personnel. Although adolescents stated that the maternal and child health programs offered were satisfactory and the government has made an effort at educating adolescents on human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), both the promotion of contraceptive methods and monitoring adolescent SRHR remain as key challenges to be addressed by multisectoral interventions.

En este artículo, se lleva a cabo un análisis de los factores que obstaculizan la efectiva y eficiente administración de los recursos del Estado, y se realiza una propuesta de un nuevo paradigma para la gestión pública. Múltiples obstáculos impiden alcanzar el bienestar de la ciudadanía con atención a su diversidad; eliminarlos; y redefinir la gestión pública con un cambio de prioridades de las políticas públicas que permitirá alcanzar crecimiento con inclusión. El vector de inclusión requiere inversiones importantes en capital humano –educación, salud y tecnología– para elevar el bienestar y la calidad de vida, y en infraestructura física, para alcanzar mayor productividad y absorción del progreso tecnológico. Las prioridades son: empleo registrado (formal) y productivo, reforma del sector salud, educación e inversiones con criterio de integración social. Estas prioridades son comprendidas por siete lecciones de la política macroeconómica que pueden adaptarse a la nueva gestión pública.

This study examines the determinants of adolescent sexual behavior and fertility in Nigeria, with a special focus on knowledge, attitudes and behaviors of adolescents aged 10-19 years old in Karu Local Government Authority (LGA), a peri-urban area near the capital city of Abuja. Using the last three waves of Demographic and Health Surveys (2003, 2008, 2013), focus group discussions, stakeholder interviews, and a specialized survey of 643 girls and boys aged 10-19 years old in Karu LGA, the study narrows in on key challenges to and opportunities for improving adolescent sexual and reproductive health outcomes. The national median age at sexual debut for adolescent girls and boys is between 15 and 16 years of age. This is closely emulated in Karu LGA with a median age of 14.8 years for girls and 15.3 years for boys. While data on pregnancies was limited in the Karu sample, DHS data show that for girls, sexual debut is closely associated with marriage or cohabitation, which in turn is a strong predictor of adolescent fertility. Poverty is another strong predictor, with the odds of becoming pregnant being twice as high for adolescents in the lower wealth quintiles compared to their counterparts in the richest quintile in the country. While adolescents' knowledge of contraception has increased from under 10 percent to over 30 percent, use of health services among adolescents for SRH (and contraception) is limited due to factors such as fear of stigma, embarrassment, and poor access to services, something also emphasized in focus group discussions. Challenges for improving adolescent SRH outcomes relate to: (i) the paucity of data, especially on the 10-14 year olds; (ii) availability and access to youth-friendly services and the Family Life and HIV Education (FLHE); (iii) reaching out-of-school adolescents with SRH information; and (iv) addressing ambiguities and gaps in Federal law and customs on age at marriage, and generating support for the legal age at marriage of at least 18 years old. Addressing these barriers at the State and sub-regional levels is going to be critical in improving adolescent well-being.

The plan nacer program was designed by the Argentine ministry of health to provide health coverage to uninsured women during their pregnancies and for an additional 45 days after giving birth, as well as to children under the age of six. In doing so, it focuses on the most vulnerable populations, addressing a basic inequity in health care. In addition, the program includes three main distinctive features: an explicit menu of health benefits, disbursements linked to achieving agreed-upon targets of enrollment and health results, and audits conducted by an independent external firm to corroborate service delivery and quality. The plan is an innovative way to strengthen health systems. Rather than simply funding more facilities and inputs or adjusting existing insurance mechanisms neither of which have been successful in dealing with the health problems of the poor, the Argentine ministry of health realized that improvements to quality and coverage of health services for the uninsured would require drastic operational changes. To do so, it decided to introduce performance incentives at all levels and to focus on results.

The aim of the study is to better understand adolescents' sexual and reproductive health (SRH) needs in order to inform the design of interventions and policies that improve access to and use of adolescent SRH services in Niger. A mixed-methods study was conducted and included: (i) a quantitative analysis of Niger's Demographic Health Survey/Multiple Indicator Cluster Survey (DHS/MICS) 2012; (ii) 17 focus group discussions conducted in urban and rural areas among 128 adolescents; and (iii) a set of recommendations to improve access to and use of SRH services for adolescents in the country. The study found that age at first marriage among adolescent females is 15.7 years and is followed soon thereafter by sexual debut (15.9 years). According to focus group discussions (FGDs), adolescent's boys and girls start spending time together at 12 years in urban areas and 10 years in rural areas; this may lead to sexual intercourse in exchange for material and financial resources. Over 70 percent of adolescents have given birth by 18 years of age. Although knowledge about modern contraception is high (73 percent among female adolescents 15-19 years of age), the majority of adolescent girls do not use contraception due to societal and cultural beliefs. Moreover, FGDs reveal that the main barriers to use of SRH services is a lack of privacy and confidentiality, as well as finances, despite the government's elimination of user fees. The government has increased supply side interventions for adolescents and prioritized adolescents on the national agenda by approving the Family Planning Action Plan (2012-2020) and the National Plan for Adolescent Sexual and Reproductive Health (2011), however these plans need to be monitored and evaluated to determine their effectiveness in reaching this population group. There is also a need to increase multi-sectoral demand-side interventions in the country.

Cover -- Contents -- Foreword -- About the Authors -- Acknowledgments -- Abbreviations -- Overview -- 1. Introduction -- Going Universal-A Focus on "How" -- Methodology-Countries, Programs, and Data -- Attacking Inequality-The Common Starting Point for Diverse Paths to UHC -- A Guide to the Book -- References -- 2. Covering People-The Bottom-Up Approach -- Segmented Populations, Fragmented Health Systems -- Identifying and Targeting the Poor-And Getting Better at It -- Enrolling People-Two Phases, Two Paths -- Using Fundamentals and Investing in Learning -- Conclusions and Policy Implications -- Notes -- References -- 3. Expanding Benefits: Exercising Choices to Expand the Scope of Health Care Services -- Adding Services-Moving Beyond the MDGs -- Defining Benefits-Toward Explicit Benefit Packages -- Prioritizing Services-Mechanics and Complexities -- Breaking Promises-De Facto Benefit Packages -- Contracting Benefits-Engaging Private Providers, Using Closed-Ended Payments, and Improving Linkages to Performance -- Conclusions and Policy Implications -- Notes -- References -- 4. Managing Money: Financing the Bottom-Up Expansion of Universal Health Coverage -- Spending Some, Leveraging More -- Collecting Contributions-Government and Other Sources -- Sharing Costs-Low Copayments but Still-High OOPE -- Pooling Risk and Allocating Resources -- Conclusions and Policy Implications -- Annex 4A -- Notes -- References -- 5. Improving Health Care Provision -- Introduction -- Human Resources for Health-Trends in Retention and Outreach -- Increasing Managerial Flexibility in Public Facilities -- Increasing Participation of Private Providers -- Accrediting Health Facilities -- Continuum of Care: Integrating the Health System, Strengthening Primary Care -- Conclusions and Policy Implications -- Note -- References -- 6. Strengthening Accountability.