Argentina: Plan Nacer Improves Birth Outcomes and Decreases Neonatal Mortality among Beneficiaries
September 18, 2013
WASHINGTON, September 18, 2013 – Improved health services and accessibility for poor pregnant women and children in Argentina led to a significant decrease in low birth weight and in-hospital deaths of babies in the first 28 days of life for program beneficiaries, according to the initial results of an evaluation of the Plan Nacer program by the World Bank Group.
Argentina’s Plan Nacer, launched in 2004 after an economic crisis that increased poverty and worsened health outcomes for women and children, provides public health insurance to uninsured pregnant women and children under the age of six. Plan Nacer uses an innovative pay for performance model that provides incentives to the provinces and health care centers to promote better access and quality of health services.
“We now have concrete evidence that results-based financing approaches can have a profound impact on health outcomes and on the quality, provision, and utilization of health services,” said Martin Sabignoso, National Coordinator of Programa Sumar at Argentina’s Ministry of Health. “This is possible thanks to strong technical assistance, autonomy in the use of the funds, and mechanisms to strengthen the capacity of health centers to deliver services.”
The evaluation shows that Plan Nacer had large positive effects on birth outcomes. Specifically, the research team estimates that incorporating clinics into Plan Nacer reduced the probability of low birth weight by 9 percent for users of those clinics, and by 23 percent for Plan Nacer beneficiaries. Low-birth weight is associated with poor cognitive development, persistent health problems, low school achievement, and reduced lifetime earnings.
Birth records from large maternity wards also show that Plan Nacer reduced the probability of in-hospital neonatal death by 22 percent for users of Plan Nacer clinics, and by 74 percent for Plan Nacer beneficiaries. Approximately half of the reduction in deaths is attributed to better prenatal care that prevented low birth weight, while the other half is the result of better post-natal care.
The program also increased the use and quality of prenatal care services as measured by the number of prenatal care visits and the probability of pregnant women receiving a tetanus vaccine.
“Plan Nacer has had a dramatic impact on the lives of Argentina’s poorest children by leveling the playing field and giving them a healthy start in life,” said Keith Hansen, World Bank Group Acting Vice President for Human Development. “The lessons emerging from Argentina, and other countries around the world, are that shifting the focus from paying for inputs to paying for results leads to better health care.”
Plan Nacer started in nine provinces in Argentina in response to the deterioration in maternal and child health indicators during the 2001 economic crisis, when more than half of the country’s population fell into poverty. In 2007, the program was expanded to cover the rest of the country. Both phases of the program were supported by US$435.8 million in loans from the World Bank Group.
“The results show that Plan Nacer is a successful program for ensuring that uninsured pregnant women and children under the age of six have access to quality health services, resulting in significant improvements in health outcomes,” said Paul Gertler, Li Ka Shing Professor in the Business and Public Health Schools at the University of California Berkeley, and the main author of the report.
As a follow up to Plan Nacer, Argentina launched Program SUMAR in 2012 to extend coverage to 5.7 million children and adolescents, and 3.8 million women 20- 64 years, including 230,000 pregnant women. Program SUMAR also uses results-based financing mechanisms to improve the quality of health services.
The impact evaluation report was funded by the World Bank Group’s Health Results Innovation Trust Fund (HRITF) and the Spanish Impact Evaluation Fund (SIEF).