PHA-Exchange> Are Health and Nutrition Programs Reaching the Neediest?

[claudio at hcmc.netnam.vn]

 "Ruggiero, Mrs. Ana Lucia (WDC)" <ruglucia at PAHO.ORG> -----

Aluísio J.D. Barros, Cesar G. Victora, Juraci A. Cesar, Nelson Arns Neumann and 
Andréa D. Bertoldi

Health, Nutrition and Population (HNP) Discussion Paper, The World Bank - May 
2005 

 

Available online as PDF file [38p.] at: 
http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627
-1095698140167/BarrosBrazilFinal.pdf 

".....Social inequalities are a major problem in Latin America. As pointed out 
in the Human Development Report 2003 (UNDP 2003), 6 of the 12 highest ranking 
countries in terms of income concentration are from the region; the other 6 are 
in Africa. Among the Latin American countries, Brazil, Nicaragua, Honduras, 
Paraguay, Chile, and Colombia presented, in this order, the highest Gini 
coefficients, ranging from 60.7 to 57.1.

Health inequalities are also acknowledged as "the leading health problem" in 
the Americas by Pan American Health Organization (PAHO 1998). Reducing such 
inequalities, however, is not a simple task. There is an important gap in 
knowledge about the impact of health interventions on health inequalities. In 
fact, some interventions may actually increase inequalities instead of reducing 
them (Victora et al. 2000).

Nutritional supplementation programs are classic examples of this strategy: 
milk supplementation programs, family ration distribution, school meals in poor 
neighborhoods. In Brazil, such programs were popular until about 10 years ago. 
But, beset by difficulties in the management and distribution of food, they 
have given place to programs that offer money allowances to the poorest 
families, conditional upon keeping their children in school and bringing them 
to health facilities regularly....."



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