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Business Processes or the “how to”: 1. Implementing Program

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Business Processes or “how to”:
2. Implementing Coordination in
Program operations: The case of CCTs
Washington, D.C.
December 7, 2012
Rogelio GГіmez Hermosillo M
WB Consultant
Contents
•
•
•
•
•
Why coordination? And why in CCTs?
Rationale of CCTs
Business processes in CCTs
Coordination in targeting, enrolment
The business process of verification of
compliance
• Institutional arrangements for coordination in
CCTs
Coordination is a rare “bird”
• Coordination in government is always a nice
intention
• In practice coordination between different areas
(inside a Ministry or between Ministries) is difficult
because every agency has its own mandate, goals,
obligations, priorities, rules, culture and agenda
• Coordination requires will and intention, but those
are not enough
Coordination is important for SSN
• Many SSN interventions require coordination:
• Between the entity in charge of the RoB and the entity in
charge of the “program”
• Between the Ministry (or entity) responsible of Social
Assistance (social development, social protection) and the
Ministries that deliver some of the services: e. g. health
services, nutrition services, ECD services, education services,
public works projects, labor placement services, vocational &
training services
CCTs require coordination because they
are “demand” driven interventions that
require supply side services
Ministry
of
Health
Ministry
of
Education
Health facilities
Access to
Health &
Education
Services
(supply)
Cash
transfers
(incentives
for
demand)
Schools
Conditional Cash Transfers
Why? Rationale of CCTs
School attendance by income
(Q1 & Q5) and age
Mexico 2000
Chronic Malnutrition (stunting)
by income – México 2006
Linked to demand driven constraints
6
Gains of a CCT as main SSN
• Cash assistance that improves basic consumption (food)
renders also changes in children human capital (next
generation).
• Early childhood development (ECD) and nutrition (0-3) are the
most effective, basic social interventions. Severe malnutrition
causes death. Chronic malnutrition affects brain development
and long-term capacities.
• Education up to secondary (11-12 grades) is the second most
effective, basic social intervention. Incomplete education up
to 11-12 grade is the most higher predictor of future poverty
and complete education renders long-lasting income
improvements (depending on the country)
• CCTs when well implemented have demonstrated significant
impacts in health services, nutrition and education
ECD Health & Nutrition intervention
requires detailed coordinated planning
• Note the difference between Education & Health services. In Health
you need a definition about What is the package of services? Which
is the frequency of attendance to those services?
• Evidence shows that attendance of mothers and infants (from -9 to
24 months of age = 1000 days) to health facilities is critical for ECD
and the prevention of malnutrition (infant mortality)
• Vaccination, Height and weight monitoring, counseling in feeding =
exclusive breast feeding 6 months and complementary feeding from
month 6, counseling and simple treatments for common diseases
(diarrhea, respiratory) and micronutrient supplementation are the
“basic package”
• It may be delivered every month or every 2 months for children up
to 2 years old, most of the “package” do not require a doctor
• Referrals system for severe and acute malnutrition cases is required
What? CCTs set incentives for the use
of HD services
Health/
Nutrition
Interventions
Education
Periodic attendance to:
• Health services according
to protocols
• Orientation and
information sessions
• Enrolment to school
• Regular attendance to
school (more than 80%)
Health /
Nutrition
Grant
Education
Grant
9
CCT Operations
Beneficiary
Selection
(Targeting)
Enrolment
Registry of
Beneficiaries
Payment
Claims and
requests
Compliance
verification
Data update
10
How? Coordination in CCTs
• Targeting – Select beneficiaries in locations where there is
access to schools and/or health services
• Enrolment – Assign beneficiaries to health facility and record
school of children
• Compliance with conditions – Set simple, verifiable conditions
• Verification of compliance – Establish an information
exchange practical system with schools and health facilities
Targeting + Supply side capacity
• Geographical targeting of CCTs require also to guarantee
supply side capacity
• Oportunidades in Mexico sends the localities and an
estimated number of HH to be enrolled to Health and
Education Ministries to ask for the confirmation of capacity
• TASAF CB CCT in Tanzania develops a supply side capacity
assessment to know if villages have access to health facilities
and schools using a questionnaire to local authorities
• Comunidades Solidarias in El Salvador funds the provision of
health services through NGOs in the most isolated zones
• Several CCTs include funds to “strengthen” and improve
supply side capacity
What if there is no capacity?
• No CCT
• Start in villages with access to services and
A. Government should prioritize the provision of
services in villages without access and/or
B. A non conditional cash transfer may start as preCCT
Enrolment records relevant
information and triggers the process
• Enrolment forms include forms to confirm school of
attendance of all children in HH and
• Forms to assign health facility to HH with children under 3
years (4-5)
• The first attendance to the health facility is used to establish
“appointments” according to protocol (every month, 2
months or other)
• Health facilities require a “list of beneficiaries” to record
attendance: children under 3 (or x years old)
Verification of compliance requires a
detailed logistical cyclical system
• The source of the information are the sectors (health staff and
school responsibles)
• Reporting compliance must be agile, simple and periodical
(most programs use two-months periods)
• The best option is exchange through systems, but often that is
not feasible in the early stages
• In which case, paper exchange is required
• A timeline (“Master Calendar”) is critical to asign
responsibilities and follow up on the flow
Two-month process in Oportunidades
State Program Offices
Health and
Education
organizations at
the State level
Schools and
Health Units
Schools
Printing formats
E2 y S2
(572 000)
105 000
(3В° a
9В°)
Health Units
15 000
Formats read by the
system
(572 000)
Certify compliance of
conditionalities
Calendar 1-2-3
BIMESTRE 1
Month 1
month 2
Beneficiaries attend to
health units and
Schools
BIMESTRE 2
month 3
month 4
BIMESTRE 3
month 5
month 6
The process of each two-month period
takes 3 two-month periods and
organizes activities in a continuous flow
Verification of attendance
Information collection
Cash transfer calculations
Cash transfer delivery
to beneficiaries
17
1 – 2 – 3 Calendar was established to organize every activity in
the process in a continuous flow with fixed time limits
Two-Month Process
BIMESTRE 3
month 6
BIMESTRE 1
month 1
BIMESTRE 2
month 2
month 3
Beneficiaries attend to
health units and
Schools
Forms delivery
to health and
Education
sectors
(S2 y E2)
Registry
movements
BIMESTRE 3
month 4
month 5
BIM
month 6
month1
Collection of S2
and E2 Forms
S2 and E2 Forms
read by system
Money disbursement
to paying institutions
Calculations of
Cash Transfers
Cash transfers’
delivery
Conciliation of
cash transfers’ delivery
18
1 - 2 - 3 calendar is a permanent and simultaneous cycle
Ene
Feb
3
Sep-Oct
2
Nov-Dic
1 Ene-Feb
Mzo
Abr
May
Jun
Jul
Ago
Sep
Oct
Nov
Dic
1 Corresponsibility
2 Information process and benefit
calculations
3 Cash transfer delivery
3 Nov-Dic
2 Ene-Feb
3 Ene-Feb
1 Mar-Abr
2 Mar-Abr
1 May-Jun
All the steps are happening all the time
It is a regular – cyclical process
3 Mar-Abr
2 May-Jun
3 May-Jun
1 Jul-Ago
2 Jul-Ago
3 Jul-Ago
1
2 Sep-Oct
Sep-Oct
1 Nov-Dic
Simple form is important
20
Register ONLY non attendance
Gray areas are prefilled by MIS
21
Coordination requires Institutional
arrangements
• Design working group (taskforce) with participation
of Health and Education representatives
• Interinstitutional Committee – As Authority in the
Program
• Detailed rules of interactions and service provision
enforceable as “contracts”
• Budget for supply side interventions (it may not be
“accounted” or “assigned” in the Program)
• Monitoring of all the “pieces” including health and
education services provision
Thank you!
Rogelio Gomez Hermosillo
gomezh.rogelio@gmail.com
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