Question

Randomized trials were used in the Progresa Program. Explain how the result impacted the policy and decision making in the Mexican government. Cite other examples where regression and randomized trials can be used.

Define Randomized Trial and Progresa Program? and how it impacted the policy and the decision making in the Mexican government?

Please advise.

Answer 1

Randomization

Randomization is a quantitative, comparative, controlled experiment in which investigators study two or more interventions in a series of individuals who receive them in random order.It aims to reduce bias when testing a new treatment.It randomly assigns participants into an experimental group or a control group. As the study is conducted, the only expected difference between the control and experimental groups in a randomized controlled trial (RCT) is the outcome variable being studied.

PROGRESA

In 1997 the government of Mexico implemented PROGRESA (Programa de Educación, Salud, y Alimenación), an integrated approach to poverty alleviation through the development of human capital. It combined Education,Health and Nutrition in one program.

It was one part of a larger poverty alleviation strategy, and its role was to lay the groundwork for a healthy, well-educated population who could successfully contribute to Mexico’s economic development and break the intergenerational cycle of poverty. The program offered conditional cash transfers to the rural poor in exchange for sending their children to school and for regular attendance at health clinics and pláticas (small group sessions focusing on health and nutrition education).

Overall, the program was found to be quite successful in improving conditions of the poor. For instance, attendance in secondary school has increased by more than 20 percent for girls and 10 percent for boys in beneficiary households.

How it impacted the decision making and policy of Mexican government?

PROGRESA involves a cash transfer that is conditional on the recipient household engaging in a set of behaviors designed to improve health and nutrition. The family only receives the cash transfer if: (i) every family member accepts preventive medical care; (ii) children age 0-5 and lactating mothers attend nutrition monitoring clinics where growth is measured, nutrition supplements are distributed, and they are provided education on nutrition and hygiene; and (iii) pregnant women visit clinics to obtain prenatal care, nutritional supplements, and health education.

Progresa selected a sample of 506 communities across 7 states as sample,which corresponded to 24,077 households.Out of 506 communities,320 cwere assigned to treatment group and 186 to control group.The experiment lasted for a year and a half.

A survey was conducted to indentify beneficiary houleholds..Within each community all house holds irrespective of their poverty status were interviewd. A number of core questions about the demographic composition of households and their socio-economic status were applied in each round of the survey. These core questions were accompanied by specific questionnaires, focused on collecting information critical to a thorough evaluation of the impact of the program. The topics of these modules included collecting information about family background, assets brought to marriage, schooling indicators, health status and utilization, parental attitudes and aspirations towards children's schooling, consumption of food and non-food items, the allocation of time of household members in various activities, and self-employment activities.

Conclusion

Impact on preventive care utilization: According to administrative data, in the first full year in which PROGRESA was operational in all treatment localities, there were 2.09 more visits per day (a 60 percent increase) to clinics in PROGRESA areas than in non-PROGRESA areas. This result is further confirmed by the results from the household survey, which suggest that PROGRESA increased utilization of public clinics by 53 percent.

Impact on child health: Children in treatment households had about a 23 percent reduction in the incidence of illness, an 18 percent reduction in anemia, and between a 1 and 4 percent increase in height.

Impact on adolescent and adult health: Adults in treatment households experienced a significant reduction in the number of days on which they had difficulty with daily activities due to illness, and in the number of days spent in bed due to illness. Adults in the treatment group also reported a significant increase in the number of kilometers able to walk without getting tired. Program impact varied across age group, with the strongest impact being felt by those over 50.

Impact on incidences of serious illness: By increasing utilization of public clinics and lowering rates of illness, PROGRESA reduced the demand for curative care. Total visits for 0-2 year olds in treatment households decreased by 25 percent, and hospital inpatient stays for this group fell by more than a half. The results suggest a similarly large reduction in hospitalization for individuals age 18-50 and for those over 50.