September 19, 2013 --- The results are in and they are decisive: a program combining results-based financing (RBF) approaches with strong stewardship from the Ministry of Health, technical assistance and investments on service delivery can help improve maternal and child health outcomes and use of health services.
The impact evaluation of Plan Nacer – Phase I, Argentina’s health coverage program for uninsured pregnant women and children under the age of six, shows that the use and the quality of prenatal services is up, resulting in reduced incidence of low birth weight (less than 2500 grams) and lower in-hospital neonatal mortality.
The 2001 economic crisis plunged more than half of Argentina’s population into poverty and resulted in high unemployment. Many Argentines lost their health coverage, and turned to the public health system for care. The increased demand strained the system’s capacity to deliver services, and basic health indicators deteriorated. Between 2000 and 2002, Argentina’s infant mortality rate increased from 16.6 to 16.8 per 1,000, and in the country’s poorer northeastern and northwestern provinces, infant mortality was as high as 25 per 1,000. As a result, the Government of Argentina developed Plan Nacer to both reduce infant mortality by increasing access to health care to uninsured pregnant women and children under age six; and to improve the efficiency and quality of the public health system by introducing changes in the incentive framework .
Plan Nacer’s RBF mechanisms created two levels of incentives: one between the national and provincial governments, and the other between the provincial governments and health facilities. Provincial governments received capitation payments from the National Ministry of Health based on the number of beneficiaries enrolled in Plan Nacer, and on the achievement of specified health indicator targets. Health facilities received fee-for-service payments from the provincial government according to the number and quality of services they provided. These health facilities benefitted from substantial autonomy in deciding how to use the RBF incentives. Some paid bonuses to health workers, while others reinvested in the facility to make improvements in infrastructure and service delivery.
The Government launched phase I of Plan Nacer in nine of Argentina’s poorest provinces in 2005, and brought the program to the 14 remaining provinces and the Autonomous City of Buenos Aries in phase II in 2007. Plan Nacer has since provided 4.7 million pregnant women and children with health coverage, and has facilitated the delivery of 37 million maternal and child health services.