Background: It is generally assumed that participation in social programs is the result of an implicit decision based on several driving factors. Determinants of the decision-making process also affect the effectiveness of programs. Based on a behavioral economics (BE) approach, we analyzed the decision to participate in an early childhood development (ECD) program implemented in Mexico by a non-governmental organization (NGO).Methods: We conducted a literature review and a qualitative study of four localities participating in the ECD program. Situated in the state of Oaxaca, these communities were characterized by high and very high levels of social marginalization. From May 20 to 30, 2019, we collected primary data through semi-structured interviews (n=30) and focus groups (n=7) with a total of 61 informants (51 women and 10 men). We then performed an inductive systematic analysis of the data to identify documented cognitive bias associated with the decisions of individuals to participate and remain in or abandon social programs.Results: The interviewees were living in conditions of poverty, facing difficulties in meeting even their most basic needs including food. Program participants attached far greater weight to incentives such as the basic food basket than to the other benefits offered by the program. The four localities visited maintained traditional views of domestic roles and practices, particularly regarding child-rearing, where women were in charge of childcare, home care and food preparation. Problems linked to child malnutrition were a decisive factor in the decision of residents to participate and remain in the program. Testimonials gathered during the study demonstrated that the longer the mothers remained in the program, the more they understood and adopted the concepts promoted by the interventions.Conclusions: In contexts marked by economic vulnerability, it is essential that ECD programs create the necessary conditions for maximizing the benefits they offer. Our analysis suggests that cognitive load and present bias were the biases that most severely affected the decision-making capacity of beneficiaries. Therefore, considering loss aversion and improving the management of incentives can help policy makers design actions that “nudge” people into making the kinds of decisions that contribute to their well-being.

Objective: To generate evidence on the influence of good management of resources in the delivery of maternal health services in Mexico. Material and methods: We studied the managerial processes involved in the provision of maternal health services in four states of Mexico exhibiting differences in maternal mortality, maternal health service coverage, and maternal health expenditure. Analysis was based on five analytical dimensions of the cyclic process model designed by the National Council for the Evaluation of Social Development Policy in Mexico. We describe the processes, identify areas of opportunity, and discuss opinions concerning the relevance, timeliness, and sufficiency of human and material resources employed in the delivery of maternal health services. Results: Managerial performance in the four entities was very heterogeneous. In most of the analyzed entities, implementation of the processes was rated from "average" to "very good." Conclusion: In order to contribute to universal coverage of maternal health services, managerial processes at the state level need to ensure an adequate, timely, and sufficient supply of resources.

Based on a behavioral economics (BE) approach, we analyzed the decision to participate in an early childhood development (ECD) program implemented in Mexico by a non-governmental organization. We conducted a literature review and a qualitative study of four localities participating in the ECD program. Situated in the state of Oaxaca, these communities are characterized by high and very high levels of social marginalization. From May 20 to 30, 2019, we collected primary data through semi-structured interviews (n = 30) and focus groups (n = 7) with a total of 61 informants (51 women and 10 men). We then performed an inductive systematic analysis of the data to identify documented cognitive bias associated with the decisions of individuals to participate and remain in or abandon social programs. The interviewees were living in conditions of poverty, facing difficulties in meeting even their most basic needs including food. Program participants attached far greater weight to incentives such as the basic food basket than to the other benefits offered by the program. The four localities visited maintained traditional views of domestic roles and practices, particularly regarding child-rearing, where women were in charge of childcare, home care and food preparation. Problems linked to child malnutrition were a decisive factor in the decision of residents to participate and remain in the program. Testimonials gathered during the study demonstrated that the longer the mothers remained in the program, the more they understood and adopted the concepts promoted by the interventions. In contexts marked by economic vulnerability, it is essential that ECD programs create the necessary conditions for maximizing the benefits they offer. Our analysis suggests that cognitive load and present bias were the biases that most severely affected the decision-making capacity of beneficiaries. Therefore, considering loss aversion and improving the management of incentives can help policymakers design actions that “nudge” people into making the kinds of decisions that contribute to their well-being.