In brief

Chile has had one of the most unequal societies in the world, with a severe poverty gap. The Chilean government has developed a number of policies to address this problem over the last decade, among them the CCC programme. It provides a universal platform that supports the development of under-fives, bringing together education, health, social and community services to help the children and their families.

The challenge

In 2011, Chile had one of the most severe poverty gaps in the world. “With a Gini coefficient of 0.51, Chile has the highest level of income inequality after government taxes and transfers among OECD countries.” [1]

Despite the establishment of universal healthcare coverage in 2005, Chile’s child and infant mortality and morbidity statistics vary widely from region to region, and this is largely a consequence of its socioeconomic disparities.

The initiative

Over the last decade, Chile has taken an intersectoral approach to policymaking, with the aim of decreasing socioeconomic inequality and improving health outcomes. One example of this approach is Chile Crece Contigo [Chile Grows with You] (CCC), which was launched in 2007 by the then president, Michelle Bachelet, which is one of the initiatives leading to universal healthcare. It provides “a universal platform to support early child development for all [under-fives] and for all pregnant women”. [2]

CCC was given legislative force with the passing of Law 20.379 in 2009, which created “the Intersectoral Social Protection System and institutionalised CCC, thus becoming a stable public policy”. [3]  It has the following objectives:

  • To accompany, protect, and fully support all children and their families through universal actions and services.
  • To target special support to vulnerable children and families (“to each according to their needs”).
  • To monitor the developmental trajectory of children, from pregnancy the pregnancy of the mother until the child’s entry into the school system.
  • To take a multidimensional approach, offering support in health, education, social, and community spheres.
  • Providing “an integrated system of benefits, interventions and social services to support the child and his/her family ... to develop their maximum potential, in order to [create equality in] development opportunities”. [4]

CCC was initially rolled out in 159 comunas (small regions) in 2007, then expanded to all in 2008. Mothers enter CCC at their first prenatal checkup, and engage with the system throughout their pregnancy and birth. Before birth, children are enrolled and have access to healthcare and pre-primary education. Any vulnerabilities detected (e.g., postnatal depression, developmental delay in the child, domestic abuse) will trigger the intervention of the appropriate health and social services professionals.

The public impact

The CCC programme has had a significant impact on the health and welfare of low-income Chileans:

  • The poorest 60 percent of households have free access to nurseries and preschools, as do vulnerable families and those with special need.
  • Families across Chile now have guaranteed access to antenatal care, professional care during birth, comprehensive care for children in hospitals, improved children’s health checks, and improved interventions for vulnerable children and those with developmental problems.
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What did and didn't work

All cases in our Public Impact Observatory have been evaluated for performance against the elements of our Public Impact Fundamentals.

Legitimacy

Stakeholder Engagement Strong

The Chilean government is the primary stakeholder. All the relevant government agencies (in education, health and social development) are highly engaged and collaborating to ensure the success of CCC.

The regional governments and comunas are also strongly engaged, as are education, healthcare and social service providers.

Political Commitment Strong

The CCC policy was developed by Michelle Bachelet’s Socialist Party government in 2007, before being enshrined in legislation – the unanimously approved Law 20.379 – by Sebastián Piñera Echenique’s National Renewal government. CCC has continued to grow, despite another change of government in 2013 (a return to Socialist Party rule under Michelle Bachelet).

The government funded CCC, despite its relatively high costs (more than US$10 billion for the first two years alone), which further indicates that there is strong cross-party political commitment. Local government has also shown commitment to the scheme by facilitating its rollout.

Public Confidence Strong

There are a number of indicators of Chilean citizens’ confidence in CCC:

  • Thousands of Chileans attended public consultation events or submitted feedback online during its development.
  • Between 2007 and 2014, nearly one million pregnant women enrolled in CCC.
  • The CCC website had 121,000 visits per month in 2013.
  • There were “high levels of user satisfaction for [the] biopsychosocial programme and newborn programme: 81% and 94%, respectively”. [5]

Policy

Clear Objectives Good

CCC’s objectives were clearly defined and have so far been maintained: providing healthcare to all under-fives and their families, as well as support in the spheres of education, social, and community services.

However, there is no evidence of quantifiable objectives, either for the use of its services or for its role in closing Chile’s poverty gap.

Evidence Strong

CCC is a strong example of evidence-based policymaking:

  • The Presidential Advisory Council assessed scientific literature and case studies from around the world, expert opinions, and feedback from Chilean adults and children to develop the CCC policy.
  • CCC was initially rolled out in a subset of regions before being provided to the whole of Chile.
  • The Chilean government collects statistics on CCC outcomes and uses these to inform future decision-making.
  • “Scientific evidence – consolidation and universal application of successful experiences and services (national and international evidence), ‘window of opportunity’ (high impact of the work done during early childhood), return on investment.” [6]

Feasibility Strong

Before the initial rollout, the CCC team considered financial, HR, technical, and legal feasibility:

  • Financial – CCC was supported by significant government funding. “According to budget performance reporting, spending
    conducted by the Ministry of Social Development in Chile Grows with You [CCC] reached US$2.7 billion for 2007 (the initial installation phase), US$8.1 billion in 2008 (the expansion phase) and US$27.6 billion for 2009.” [7]
  • HR – meetings were held to allow local health practitioners, social workers, childcare providers, and so on to meet each other and learn about their roles in the roll-out of CCC. Training programmes were also designed and delivered to ensure local actors were capable of supporting CCC.
  • Technical – software was designed to allow all providers across the network to enter data about enrolled families and track their children’s progress.
  • Legal – CCC was enshrined in Law 20.379 and became part of the Chilean legislative framework.

Action

Management Strong

CCC is a national initiative, and is managed at national, regional, and local levels:

  • Executive management – a committee of ministers of social development (in the Ministries of Social Development, of Health, of Planning and of Education) is responsible for the development, planning, and budgeting.
  • The Ministry of Health is responsible for executing the biopyschosocial development programme, as well as antenatal care and child health.
  • The Ministry of Education is charged with ensuring the quality of preschool education.
  • Regional and provincial management [is provided] through the regional secretariats for Health, Social Development, and Education.” [8]
  • Municipalities are served by child and family services – “Local Intervention Network, Infancy Unit [and the] Primary Care Centre Entry Point”. [9]

Measurement Strong

CCC collects data about its participants and uses this to evaluate impact and inform policy, and this has been in place from the outset. The relevant IT system, MIDEPLAN, “will follow each child through the system... to monitor the delivery of benefits, intermediate results, and evaluate impact. Since the goal is social equity, this will be measured by a series of indicators, in the process of being developed by each sector with MIDEPLAN’s help. The evaluation system will also include the type of panel survey that will enable comparisons between participants and non-participants.” [10]

Alignment Good

There is good alignment between:

The government departments principally engaged in rolling out CCC, i.e., the Ministries of Social Development, of Health, and of Education.
Between national and regional administrations and the local providers of healthcare, education, and social support.

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