Bridging the gap Bridging the gap between the between the

poorest families poorest families and their rightsand their rights

Reaching The Poor Conference

Washington D.C., February 18 – 20, 2004

In Chile, the poverty, like in all Latin American and Caribbean In Chile, the poverty, like in all Latin American and Caribbean countries, is measured based on an income poverty line, the countries, is measured based on an income poverty line, the

CASEN survey.CASEN survey.

Chile has had significant achievements in reducing poverty over the last decade, but there has been an stagnation in extreme poverty reduction since 1998

38.6

32.6

27.5

23.221.7 20.6

5.75.65.87.6

8.8

12.914.9

16.117.4

19.9

23.825.7

0

5

10

15

20

25

30

35

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1990 1992 1994 1996 1998 2000

Extreme Not extreme Total poverty

• In 2000, 850.000 people were living in extreme poverty (5.7% of population).

• These people are more vulnerable and social excluded than they were at the beginning of the 90’s

• Social policies have been successful in targeting poor people, but not the poorest of them.

• Social services and benefits have been allocated to those poore people who applied for it.

• But it es very difficult for the extreme poor people to demand these benefits, because their are excluded of social networks.

Extreme poverty in ChileExtreme poverty in Chile

Health in ChileHealth in Chile

20% richest people 20% poorest peoplePublic system: 29,6% Public system: 87,5%Private system: 54,2% Private system: 3,1%

Health auto- perception Good: 79,6% Good: 57%

Risk of malnutrition: 0,6% Risk of malnutrition: 4,0%Malnourished: 0,2% Malnourished: 1,4%Overweighed: 5,1% Overweighed: 11,2%Obese: 0,5% Obese: 1,6%

Access to health services It was not necessary: 32,2% It was not necessary: 18,5%Lack of money: 6,5% Lack of money: 15,1%

Lack of time: 5,4% Lack of time: 5,8%Could not book an hour: 1,9% Could not book an hour: 5,7%

Difficult to attend: 0,5% Difficult to attend: 4,9%Forget to do it: 43% Forget to do it: 40,9%Not interested in: 27,2% Not interested in: 19,5%Fear or dislike: 10,4% Fear or dislike: 9,1%Did not know the test: 7,7% Did not know the test: 19,6%Did not know where do the test: 0,5%

Did not know where do the test: 3,1%

Source: CASEN Survey, 2000

Reasons to not consult a doctor

Papanicolau test (reasons to not do the test - women

between 25 and 64 years old)

Nutrition (children up to 6 years old)

Type of health system

Poverty targeting Poverty targeting strategies in Chilestrategies in Chile:

• Vulnerable groups (1990 – 1996) – indigenous, poor, women, youth, elderly, etc.

• Vulnerable territories (1996 – 2002) – rural areas, slums, etc.

• Families living in extreme poverty (2002 until today).

Targeting the poorest familiesTargeting the poorest families

In Chile, two important instruments In Chile, two important instruments are used to identify people living in are used to identify people living in extreme poverty:extreme poverty:

• CASEN: is a survey based in a large sample of the chilean population, that allows us to estimate the total number of people living in poverty (based on income). It does not identify the individuals.

• CAS records: are a complementary instrument that is periodically applied by Municipalities, in order to determine families’ living situation (based on a variety of poverty indicators). Each family is given a unique score that enables public institutions to focus their interventions.

“It is necessary to identify on the communal, regional and national level the families living in conditions of extreme poverty as the priority priority subjects of public policysubjects of public policy, orienting preferential action of the State towards them through selective interventions with a strong emphasis on inter-sectorality and integrality.

Considering the aforementioned background, the Considering the aforementioned background, the Government of Chile resolved that...Government of Chile resolved that...

How do we work with this population group, How do we work with this population group, considering their vulnerability and exclusion? considering their vulnerability and exclusion?

• The intervention carried out should be integral and intersectoral.

• It should be focused on a subject of intervention that allows for integrality. This subject of intervention is the family.

• A basic condition required is the complementarity of actions and interventions. Different interventions for the same beneficiaries.

• It should maximize the use of the public program offering existent in the country that is directed to the poor.

• It should bring about concrete and verifiable results in the beneficiary individuals and families.

• It should be founded upon a focus of integration.

It is necessary to take the following elements into It is necessary to take the following elements into considerationconsideration

Chile in Solidarity SystemChile in Solidarity System is a governmental initiative that came about as a means to approach extreme poverty in an attempt to bring together the following elements in one intervention:

• The progressive installation of an integral social protection system for Chilean families living in extreme poverty.

• The personalized atention to these families, which allows them to effectively integrate themselves into the service networks and programs intended for them.

The two elements combined will allow them to move out of their situation of extreme poverty.

Family is an strategic actor for social policiesFamily is an strategic actor for social policies:

• It allows better targeting for public services and benefits.

• Opportunity for better coordination and complementation among public policies.

• It improves sustainability and impact of the achievements.

• It allows to develpo symergic process within the families.

Why are we working with Why are we working with families?families?

Chile in Solidarity is a social protection Chile in Solidarity is a social protection system for the 225,000 poorest families in system for the 225,000 poorest families in

the countrythe country

Psychosocial support and temporary

financial voucher.

CHILE IN SOLIDARITY FAMILIES

Guaranteed monetary subsidies.

Preferential access to

promotional programs.

Bridging the gap: Programa PuenteBridging the gap: Programa Puente

• Puente is a governmental initiative to built up a link between extreme poor families and their social, economical and cultural rights.• Social professionals work with each family for 24 months, bringing them psychosocial support to improve their living conditions, measured by 53 life quality standards.• Promotional initiatives are developed to strength their capabilities and to achieve these 53 standards.• A temporary financial voucher is avalaible for the families to increase their budget and make them possible to participate in solving their needs.• The instrument designed to select Puente’s beneficiary combines the information produced by CASEN (permits to establish the Program coverage in each territory) and CAS records (permits to select specific families beginning with those that have the lowest score).

How do we work with families?How do we work with families?

• Establishing a personal relationship between a professional and each family during 24 months, in their homes.

• Using a methodology designed for allow the family to improve their information, capabilities, motivation ans resources to improve their quality of life.

• Families plan how they will achieve the 53 Puente’s standards and establish compromises wuith the professional identify the family’s efforts needed.

• Local institutional network reorganized and redirect its services and benefits to reach Puente’s families.

The Pamphlet : a tool for facilitate the communication process

Hop-scotch board: deciding family priorities within defined

dimensions

Family Tree: presenting

family members

Storage Shed: recognizing

family capital

Family Bridge: recording family

achievements

networks

Thematic

Game Board

Start

Personal identification

Health

Education

Family dynamics

Housing conditions

Employment

Income

Identification Education

Health Housing conditions

Employment

Income Family dynamincs

Income

Multidimensional StrategyMultidimensional Strategy

The Programa Puente’s outcome is at least 70% of the participating families has reached the 53 minimun quality of life conditions, defined by the Program. These conditions are organized into 7 categories or dimensions:

• Personal identification

• Health

• Education

• Family Dynamics

• Housing Conditions

• Employment

• Income

A family has moved out its condition of

extreme poverty when it has reached all of

the 53 minimum quality of life

conditions, where income is only one of

them.

HEALTH HEALTH STANDARDSSTANDARDS

Family registered in primary health system.

Medical control of:

Children under 6 years old (including vaccination).

Pregnant women.

Women using contraceptives.

Elderly people.

People with chronic illnesses.

Women over 35 years old periodically doing Papanicolau test.

People with any kind of disability participating in a rehabilitation program.

Family wuith basic knowlegde in health and self care.

Relationships within the 53 quality of life Relationships within the 53 quality of life standards, related with health dimensionstandards, related with health dimension

Children health – children performance at school

Adult health - employability

Health – other dimensionsHealth – other dimensions Other dimensions - HealthOther dimensions - Health

Housing conditions – family health

Educational level of parents – parents’ knowlegde of health problems, first aids, etc.

Family relationship – family mental health

Family legal identification – access to health services and benefits.

An effective health policy for poor families An effective health policy for poor families requires to also deal with the other requires to also deal with the other dimensions of their quality of life.dimensions of their quality of life.

Indeed, an effective poverty reduction Indeed, an effective poverty reduction strategy necessarily needs to challenge, at strategy necessarily needs to challenge, at the same tiem, these 7 dimensions of the the same tiem, these 7 dimensions of the family’s quality of life.family’s quality of life.

19 months of program intervention19 months of program intervention

96.548 families participating in Puente. Target: 225.000 96.548 families participating in Puente. Target: 225.000 families in 2005.families in 2005.

In 332 of 341 national districts.In 332 of 341 national districts.

2.347 Family Support Counselors are working with families 2.347 Family Support Counselors are working with families (60% supplied by local institutions and 40% supplied by the (60% supplied by local institutions and 40% supplied by the Program)Program)

31.9% of the families finishing their participation in June 31.9% of the families finishing their participation in June 2004 have already achieved their 53 life standards.2004 have already achieved their 53 life standards.

Puente’s outcomes until todayPuente’s outcomes until today

Some Puente’s outcomes in health Some Puente’s outcomes in health dimensiondimension

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