1. Integrated action for social equity: Chile Barrio Chile Solidario Chile Emprende Chile Crece Contigo Thematic Session: Intersectoral Action and Health – Global Learnings CPHA Conference Halifax, Nova Scotia June 2, 2008 Dr. Patricia Frenz

2. Poverty and Indigence Indicators: A policy driver Source: MIDEPLAN, CASEN Surveys Stagnation in extreme poverty reduction Chile Barrio Chile Solidario Chile Emprende Chile Crece Contigo

3. Infant Development Gap % of children with deficits, comparing I and V SE quintiles Source: Infant Module, National Health and Quality of Life Survey 2006

4. Policy TimelinePolicy Timeline PresidentPatricio Alywin Eduardo FreiRicardo Lagos Michelle Bachelet Social Emphasis Social debtEradicate poverty Equality and rights Social protection ReformEducation Justice HealthPension ProgramChile BarrioChile Solidario + Chile Emprende Chile Crece Contigo ObjectiveEradicate precarious settlements Social capital and inclusión: families and territories Achieve maximum develop- ment potential Health sector role Occasional, community demands Key in CS Marginal in CE Leading strategic role Exreme Poverty Reduction -5,3%-2,1%-2,4% Income Gini Index 0,570,580,54 19902000200620101994

6. Moving towards an Integrated Policy System for Social Welfare

7. SOCIAL PROTECTION SYSTEM 2006 -2010 SOCIAL PROTECCION CARD INTEGRATED SOCIAL INFO. SYSTEM CASEN: NATIONAL S.E. SURVEY Work and Income Protection Job Intermediation Basic Solidarity Pension Chile Solidario Chile Crece Contigo Monetary Benefits Programatic Benefits Families Homeless People Seniors Children from the poorest homes Children from gestation to pre-kinder (0-4) All citizens Source: MIDEPLAN, adapted by the author based on conversation with the Executive Secretary of Chile Solidario. Biopsicosocial Support

8. From dispersion to integration Sectoral Efforts = Fragmented Services Integrated Intersectoral Action Strategy: organize benefits and accompany families

9. Longitudinal Accompaniment Scheme during the child’s development Universal Benefits (Biopsychosocial Support Program) Differenciated benefits, according to the needs of the child To the health institution To the basic municipal network To the extended network What is ChCC Health control Risk Checklist Gestation Guide Primary Care Center Registry Examples 1° Prenatal Control Enters ChCC 2° Prenatal Control Vulnerability score 1. Late start to prenatal controls Local ChCC Network Home visits Entry into Chile Solidario (Bridge Program) Apply social protection scorecard Receives Family subsidy Employment program Health institution Basic municipal network Extended network 2. Low income family with unemployed adult and no social protection scorecard Vulnerability Score Enters ChCC 4 years Leaves ChCC 4 years Leaves ChCC

10. MINISTERS COMMITTEE ON INFANCY Intersectoral Technical Committee (Social Protection Executive Secretary– MINISTRIES – HEALTH – EDUCATION PRESCHOOL – LABOR – YOUTH – HOUSING – WOMEN – BUDGET OFFICE - PRESIDENCY– REGIONES (INTERIOR) MIDEPLANMINSAL MINEDUC Planning Secretary Health Authority Education Secretary Health Services ChCC Managers Governors Preschool Institutions Social Protection Coordinator Local Network ChCC Lo Municipality Health Educatiob Enc Regional ChCC Municipal level Provincial level Regional level National level Decentralized implementación articulated especially by three central Ministries: Operational Network Intendentes

11. Model of Integrated IA MINISTRY MINISTRY 1 MINISTRY 2 MINISTRY GOVERNOR SERVICE 2 SERVICE 1 BUDGET OFFICE MINISTRY MINISTRY 1 MINISTRY 2 MINISTRY GOVERNOR SERVICE 2 SERVICE 1 BUDGET OFFICE PRIMARY CARE FAMILY UNIT PRIVATE SECTOR EDUCATI ON MAYOR LABOR SERVICE 1 NGO FAMILY UNIT PRIMARY CARE PRIVATE SECTOR EDUCATION MAYOR LABOR SERVICE 1 NGO 1 2 Municipal NetworkCommunity Network National CoordinationNational Network NGO

12. Multidimensional Management Model Shared Outcome Targets Network management Systemic management Knowledge management Information management Budget management Values management Electronic Platform

13. Monitoring and evaluating outcomes Independent evaluation mechanisms

14. Insights on IA from the Chilean experiences Monitoring and evidence as a driver Political will is crucial but not enough Common outcome targets, not just shared objectives (strategic policy framework) The management model and tools determine the results Santiago’s great expectations depend on local capacity and needs Expertise for IA: social policy managers A new culture of respect and dialogue Institutional social capital Strengthening the community: participation and social cohesion Monitoring and measuring success Persist, working together is not easy Effective IA