World Bank’s Thematic Group on Health, Nutrition and Population and Poverty REACHING THE POOR CONFERENCE, February, 2004
ASSESSING CHANGES IN TARGETING IN HEALTH AND NUTRITION POLICIES:
THE CASE OF ARGENTINA
(Part B)
Leonardo Gasparini Mónica Panadeiros
Fundación de Investigaciones Económicas Latinoamericanas Buenos Aires, Argentina
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
I. Introduction
• Argentina suffered a deep recession from 1998 to 2002: GDP fell 18.4% between those years.
Real GDP, 1990=100
180 160 140 120 100 80
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
Source: authors´ calculations based on Ministerio de Economía.
2002
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
• In concordance, inequality and poverty have substantially increased. The poverty headcount ratio was 20.1% in 1998; four years later that rate had increased to 54.3%.
Gini coefficient Household per capita income Greater Buenos Aires, 1990-2002
0.55 0.50 0.45 0.40
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Poverty headcount ratio Greater Buenos Aires, 1990-2002
60 50 40 30 20 10 0
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Source: CEDLAS (2003)
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
• In this scenario, it is very relevant to target the (scarce) public resources to the needy. • This study contributes to the understanding of the distributional incidence of social policies in Argentina. In particular, we focus the analysis on health and nutrition policies directed to pregnant women and children under 4. This presentation deals with nutrition programs.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
II. Nutrition programs
• Public nutrition programs have been rather small in size and coverage. • Pregnant and breast feeding women up to 6 months after delivery, and children from 6 months to 2 years old are provided with milk at the time of medical controls in minor public health care centers. This program aims at: i) inducing periodic controls of this population; ii) promoting attendance to public health care centers others than hospitals. • Children benefit from nutrition programs delivered through selected kindergartens and schools, local feeding centers (“comedores”) and in some cases directly to the house.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
• There are some nutrition programs targeted to localities with high poverty levels. • The recent economic crisis and the increase in malnutrition problems pushed the government to implement some emergency nutrition programs in 2002. • In this paper we study three nutrition services provided through the public sector: – Food in kindergartens – Meals in local feeding centers – Milk for children in health facilities
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
III. Methodology
• One of the main questions the study is intended to contribute to the answer is: “Who are the beneficiaries of public nutrition programs directed to children under 4?” • To tackle this question, we perform a traditional benefitincidence analysis of public spending on these programs.
• A benefit-incidence analysis allows an assessment of the degree of targeting of average public spending.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
• An usual assumption is that users of the subsidized service and their families are the beneficiaries of the public program.
• Benefits from a specific program are assigned to individuals according to their answers to a household survey on the use of that program.
• Information from two Living Standard Surveys with questions on the use of various nutrition services (1997 and 2001) is used in this study.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
• A crucial stage in a benefit-incidence analysis is sorting households by a welfare indicator. • We mostly use household income adjusted for demographics, or equivalized household income, as the individual welfare indicator. • Total population and children are grouped in quintiles of the distribution of equivalized households income. By construction, quintiles have 20% of total population. Instead, since the number of children per household is decreasing in income, the share of children is not uniform along income distribution.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
Population and children by quintiles
Distribution of equivalized household income
1997
Shares All Children under 2 Children under 4 1 20.0 29.7 30.1 2 20.0 24.6 24.5 3 20.0 19.1 18.4 4 20.0 13.6 14.8 5 19.9 13.0 12.1 Total 100.0 100.0 100.0
2001
Shares All Children under 2 Children under 4 1 20.0 27.6 27.8 2 20.0 21.7 21.6 3 20.0 20.1 20.4 4 20.0 15.6 15.6 5 19.9 15.1 14.6 Total 100.0 100.0 100.0
Source: authors´ calculations based on the EDS and ECV.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
• To find the beneficiaries of each public program, we proceed in three stages by identifying (i) the potential users of the service (children under 4), (ii) the effective use of the service, and (iii) the public/private choice. • The fact that the number of children per household (potential users) is decreasing in income, will have a fundamental consequence on the distributional incidence of public programs directed to children. Even a universal program to all children will be pro-poor, given the negative correlation between the number of children and household income. This relationship became less strong between 1997 and 2001, implying a potential reduction in the targeting of social policies.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
IV. Findings
Food in kindergartens
• This program seems to be the less targeted of the ones considered: in 1997, 31.4% of benefits accrued to the poorest 20% of the population (30.1% of children under 4). • The differences in attendance rates to kindergarten along the income distribution would explain this result: there is a positive correlation between these participation rates and household income. • This program seems to have become more targeted over time: in 2001, 41.7% of benefits accrued to the bottom quintile of income distribution. This change is likely due to a large increase in enrollment rates in kindergartens of poor children.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
Food in kindergartens
By quintiles of the equivalent household income distribution
1997
1 Children under 4 Attend kindergarten? Public kindergarten Number of meals Incidence 30.1 10.3 70.8 1.6 31.4 2 24.5 13.1 55.2 1.3 20.0 3 18.4 21.1 56.5 1.2 24.2 4 14.8 27.0 33.5 1.3 16.0 5 12.1 38.9 20.6 1.0 8.3 Total 100.0 18.9 44.8 1.1 100.0
2001
1 Children under 4 Attend kindergarten? Public kindergarten Number of meals Incidence 27.8 33.3 86.2 1.7 41.7 2 21.6 36.9 69.5 1.3 21.0 3 20.4 41.3 61.0 1.2 19.2 4 15.6 45.4 52.3 1.1 12.6 5 14.6 49.2 24.5 1.0 5.5 Total 100.0 41.4 54.7 1.3 100.0
Source: authors´ calculations based on the EDS and ECV.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
Meals in local feeding centers
• This program is the most pro-poor among the three types considered: in 1997, 78.1% of its benefits accrued to the bottom tail of the income distribution. However, by that time, its coverage was very low: only 2.6% of poor children attended local centers to get free meals. • The coverage of this nutrition program has substantially increased between 1997 and 2001: attendance rate of poor children to local feeding centers reached to 20.1% in 2001 (public and private programs). • In spite of this, changes in targeting seem to have been somewhat neutral.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
Meals in local feeding centers
By quintiles of the equivalent household income distribution
1997
1 Children under 4 Get food in local centers? Public local centers Incidence 30.1 2.6 35.3 78.1 2 24.5 1.9 8.9 16.2 3 18.4 0.6 14.5 4.1 4 14.8 0.1 50.3 1.7 5 12.1 0.3 0.0 0.0 Total 100.0 1.4 24.2 100.0
2001
1 Children under 4 Get food in local centers? Public local centers Incidence 27.8 20.2 25.9 77.3 2 21.6 12.2 14.9 19.4 3 20.4 10.4 2.5 2.3 4 15.6 9.0 1.6 1.0 5 14.6 1.5 0.0 Total 100.0 12.0 16.0 100.0
Source: authors´ calculations based on the EDS and ECV.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
Milk for children in health facilities
• The benefit-incidence analysis shows that this program is in between the others two: it is less pro-poor than meals in feeding centers and more pro-poor than meals in kindergartens. • This program have become less targeted over time. It is due to a fall in fertility rates of poor couples and a large increase in the use of it by wealthier households, likely triggered by the economic crisis.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
Milk for children in health facilities
By quintiles of the equivalent household income distribution
1997
1 Children under 2 Get milk? Publicly financed Incidence 29.7 24.1 91.8 55.0 2 24.6 16.6 80.4 26.9 3 19.1 12.8 74.7 14.5 4 13.6 8.8 28.2 3.0 5 13.0 11.6 4.7 0.5 Total 100.0 16.4 74.2 100.0
2001
1 Children under 2 Get milk? Publicly financed Incidence 27.6 35.8 92.0 49.7 2 21.7 29.4 82.4 28.4 3 20.1 23.8 54.2 14.2 4 15.6 24.6 31.6 6.6 5 15.1 21.6 6.2 1.1 Total 100.0 28.2 65.5 100.0
Source: authors´ calculations based on the EDS and ECV.
REACHING THE POOR CONFERENCE (February 18-20, 2004) Gasparini-Panadeiros, Part B
Summarizing incidence results
• All nutrition programs considered are pro-poor. However, there are very large differences in the distribution of benefits among them.
• The share of total benefits accrued to the poorest 20% of the population ranges from 77.3% for meals in local feeding centers to 41.7% in public kindergartens (2001).
• The coverage of these nutrition programs has dramatically increased in the last 4 years. For instance, while only 2.6% of poor children attended local centers to get free meals in 1997, that share was 20.2% in 2001.
• The program of milk delivery in public health facilities seems to have become less targeted over time. Instead, changes seem to have been pro-poor in the case of food in kindergartens and somewhat neutral in the case of meals in local feeding centers.