Nutrition and health programs in Latin America : targeting social expenditures

The various methods used by the countries are reviewed, including targeting by geographic location, age, health problems, and self-selection. The report also evaluates the different food programs implemented (general price supports, school lunch programs, and mother/infant supplements) as well as efforts to provide adequate public health interventions and curative care. Of the countries examined - Argentina, Brazil, Chile, Costa Rica, the Dominican Republic, and Mexico - Chile and Costa Rica stand out as the most successful in program targeting. Their achievements are attributed to the following: (1) avoidance of general food price subsidies, which create a heavy drain on the budget relative to the amount of aid targeted to the poor; and (2) wide provision of health insurance coverage, aggressive delivery of public health goods, and precise targeting of nutrition interventions by adding a sliding scale of fees or a self-selection mechanism that differentiates levels of need. As a result, both countries have experienced declines in mortality and fertility that far exceed what could be expected on the basis of income growth alone.