Approximately 7 million Mexican families with a per capita monthly income below the minimum welfare line (USD $55 for rural areas and USD$85 for urban areas) receive Conditional Cash Transfers (CCTs) under the government´s Prospera program. Prospera is a nationwide program that benefits more than 30 million Mexicans in poverty. Every two months, the head of the beneficiary household—over 95% are women—receive these payments under the condition that their children attend school regularly and take their children to visit the clinic. As a result, Prospera has improved school enrolment and children nutrition rates in the country.
Did you know that Prospera is the largest social program in Mexico and the second largest CCT in the world? It has been extensively studied and rigorously evaluated by independent academic institutions. Studies show that the program has a positive impact in 1) school enrolment and education levels, 2) improvements in nutritional status, 3) better health prevention, and 4) reduction of income poverty in rural areas.
Challenges of improving maternal and newborn health
Despite the public budget and social policy programs targeted to achieve the Millennium Development Goals (MDGs) on maternal and children health, Mexico has lagged behind in these indicators:
- The maternal mortality ratio has declined since 1990 from 89 deaths per 100,000 live births to 43 in 2011, but Mexico did not reach the MDG goal of 22 by 2015.
- Under-five mortality decreased from 47 per 1,000 live births to 16.7 between 1990 and 2011, however it remains high in the poorest southern states of the country.
- Stunting remains at 14% of all Mexican children (almost 1.5 million), with the highest incidence in the southern rural areas (28%).
The problem is the huge disparities at the subnational and municipal level: The probability for pregnant mothers to die during childbirth in the disadvantaged southeastern states of Mexico is five times higher than in the industrialized northern states.
UNICEF´s #RapidPro: A tool to implement data-driven social policy
UNICEF Mexico is implementing Prospera Digital, which seeks to use new data-driven tools and mobile technologies to promote digital and financial inclusion of Prospera’s 7 million household beneficiaries. With the generation of direct automated SMS communication, Prospera Digital will send timely, personalized and targeted information to low-income women, enabling them to make better-informed decisions that can improve their behavior and amplify their opportunities for social development.
By using RapidPro, an open source tool that enables automatized and large scale two-way mobile messaging flows through SMS developed by UNICEF, Prospera Digital will enable the government to create customized texts and interactions to automatically deliver strategic information, tailored to individual profiles. Each message will address the specific needs of the end user and improve the government’s capacity to respond.
Test before scale-up: Prospera Digital Pilot Program
Prospera Digital is currently being implemented through a Randomized Controlled Trial pilot program that will measure the effect of message content and the response to technology in two components:
Maternal and child health, and financial education and inclusion, which you can read about here.
Maternal and child health component
This pilot is designed to evaluate the impact of channeling targeted, personalized and timely information to pregnant Prospera beneficiaries, with the aim of improving maternal and infant health outcomes. This will enable Prospera to improve the provision and deepen the impact of its health services. With RapidPro, the pilot aims to strengthen the communication between Prospera and its beneficiaries by providing a tool that allows them to: 1) receive relevant information given their particular socio-demographic and health needs; 2) provide follow-up and reinforce the program’s required co-responsibilities; and 3) evaluate the quality of the health services they receive as part of the program.
This component will test the overall health effects and behavior changes associated with receiving information and interacting with Prospera through a mobile phone. Some of the desired behavior changes to be evaluated include: attendance to mandatory and non-mandatory prenatal consultations and health workshops; regular consumption of nutritional supplements; and timely detection of potential symptoms and risks.
RapidPro will also allow beneficiaries to rate the quality of the services received, linking their assessment to incentives for health service personnel. In order to tap into the trust system among beneficiaries, health community liaisons will be able to send important information to their corresponding beneficiaries through this tool.
The evaluation of this pilot phase will take into account the highest quality standards. For this reason, we will be implementing a Randomized Controlled Trial (RCT) to understand the impacts and possible limitations of this intervention.
Through the RCT, the 600 participating localities will be randomly assigned to a control group and three treatment groups as follows:
- Two-way information
- Two way information + information through community health liaisons
- Two way information + incentives to health personnel based on quality of service reported through the platform
Health Component Pre-pilot (September 21-28th, 2015)
The maternal health component of Prospera Digital was launched during a pre-pilot stage on September 21-28th 2015 in 12 health clinics in the State of Mexico that cover a population of 150 women from more than 30 different localities.
During this pre-pilot, we tested the protocols designed for training and enrollment and collected information on platform usage and adoption with the aim of collecting feedback.
- Training 30 Prospera promoters, health jurisdiction chiefs and health clinic directors.
- 8 health community liaisons.
- 150 pregnant women or with newly born children.
- 7,638 messages sent and received through RapidPRO.
- 75% response rate to message
- 10 possible health complications channeled to the Health Ministry pregnancy hotline.
- 70 pregnant women have received health clinic visit reminders.
This is what some of the women had to say about Prospera Digital:
“I feel much safer knowing I have this tool I can use”
“I´m very happy that someone is interested in how I´m feeling”
“Now I know what to ask during my consultations”
“Before this, my mother used to remind me about my doctor visits, and she used to forget sometimes”
“Someone is interested on how I am, so that makes me want to take care of myself more”
“If they hadn’t told me about it, there are many things I wouldn’t have done”
“Now I know what to do if something happens to me”
During the pre-pilot we conducted semi-structured interviews with the beneficiaries to identify areas of opportunity to improve Prospera Digital pilot’s implementation.
We found that beneficiaries say that Prospera Digital makes them feel safer, better informed and empowered by the communication tools that they have now.
The pilot of the maternal and newborn health component of Prospera Digital will officially launch on November 23th with daily enrollments for 7 weeks and will include 400 health clinics with a total of 5 thousand beneficiaries in the states of Mexico, Puebla, Guanajuato, Hidalgo and Chiapas.
This is an international partnership to innovate the largest social program in Mexico. Studies and impact evaluations are available: https://prospera.gob.mx/EVALUACION/es/docs/docs2012.php