Strengthening Argentina’s Health Response Capacity during the COVID-19 Pandemic and Beyond
Results Highlights
- Enhanced preparedness capacity – In April 2020, Argentina’s COVID -19 Response Project supported the strengthening of the country’s intensive care (IC) capacity to respond to the surge in demand from COVID-19 acute patients as well as improvements in the national vaccination system, including the nominalization of vaccine records, the strengthening of the National Vaccine Registry and improving the cold chain infrastructure.
- Financial support for the purchase of COVID-19 vaccines - As of May 2024, 82.5 percent of Argentina’s population had been fully vaccinated against COVID-19.
- Reduced excess mortality due to COVID-19 – This operation helped contain the death toll from COVID-19 in Argentina. During 2020-2022, Argentina's excess mortality due to COVID-19 was less than half the average for Latin American countries.
Synopsis
The World Bank provided $535 million to strengthen Argentina's health response to the COVID-19 pandemic1, supporting intensive care capacity, equitable vaccine access, and the national vaccination system. As a result, 82.5 percent of the population was fully vaccinated against COVID-19 as of May 2024, with targeted improvements reaching vulnerable regions. This project also laid the groundwork for sustainable health system enhancements, building on two decades of collaboration in Argentina’s health sector.
Beneficiary Quote & Picture
After receiving the second dose of the COVID-19 vaccine, Carmelo Agüero explained that “For us, the most difficult thing is not being able to go out to get work. We do not have a permanent job. Our wages depended on being hired by the day in the construction industry. Having the second dose of the vaccine makes me more confident to look for a job, which in turn, can bring me the next job.”
Challenge
The COVID-19 pandemic hit Argentina in March 2020 as the country was undergoing its worst economic crisis in almost 20 years. Reductions in public health expenditures had already negatively impact the delivery of public health services across the country, including the provision of critical inputs for treatment for HIV and tuberculosis as well as vaccines. Reduced health care expenditures had also made it more challenging to address ongoing dengue outbreaks in the country’s Central and Northern regions. Budgetary restrictions also had the potential to hinder the country’s ability to limit the spread of COVID-19 and provide emergency care and treatment for COVID-19 patients.
Approach
Approved on April 2, 2020, the Argentina COVID-19 Emergency Response operation was among the first to be approved as part of the World Bank’s global response to the COVID-19 epidemic. It was prepared at the record speed of three weeks under the World Bank’s Strategic Preparedness and Response Program. This achievement was the result of the commitment exhibited by both the Bank Task Team and its counterparts in the Ministry of Health, who had to rapidly adapt at working remotely and under intense pressure while facing the same pressures as the rest of the population, such as the lack of childcare. The Bank Team’s intimate knowledge of Argentina’s health sector, which had been built over decades of engagement, as well as the close working relationship with staff at the Ministry of Health that was responsible for the implementation of two ongoing Bank-financed operations, also proved critical to the Project’s quick preparation.
Due to the novelty of COVID-19, the operation was also prepared in an environment of exceptional uncertainty. The technical design adequately responded to this uncertainty by providing financial support to a menu of critical goods and services to address a wide range of potential emerging needs. This approach provided much needed flexibility to Argentina’s health authorities, who were able to optimize the use of resources according to the evolving needs during different stages of the pandemic. In September 2021, an additional IBRD loan was approved to ensure the provision of COVID-19 vaccines.
Results: 2020-2024
The Project strengthened the capacity of Argentina’s health system to respond to increased levels of demand for IC for acute COVID-19 patients. Through the provision of ventilators, medical equipment, and supplies - including personal protective equipment - 90 percent of public hospitals with IC units received critical support. This enabled Argentina to maintain adequate IC capacity throughout the pandemic, even as IC unit occupancy peaked in 2021 at 76.9 percent nationwide and 77.9 percent in the Buenos Aires Metropolitan Area, the region where the health system was under the most stress.
In addition, the Project facilitated the purchase of 33,397,056 vaccines, enabling approximately 50.5 percent of the population to be vaccinated with Project-supported doses. These mRNA vaccines were the only ones approved at the time for the immunization of adolescents, and the Bank's support was pivotal in introducing them to Argentina. To ensure effective vaccine distribution, the Project also funded the acquisition of 800 ice-lined vaccine refrigeration units, which strengthened the country’s cold chain infrastructure. Project support led to broader improvements in Argentina’s vaccination system. For the first time, vaccination records became fully nominalized (i.e., with data at the individual level) and the proportion of vaccine records transmitted electronically increased from 15 percent in 2018 to 75.3 percent in 2021. The Project also bolstered the pharmacovigilance system, which saw an almost 30-fold increase in reported adverse events between 2019 and 2021, ensuring greater monitoring of vaccine safety. These efforts contributed to the successful rollout of Argentina’s COVID-19 Immunization Campaign, positioning Argentina eighth in vaccination rates (full vaccination scheme) among 33 Latin American and Caribbean countries as of September 2021. As of April 15, 2024, a total of 117,760,029 COVID-19 vaccine doses had been administered, with 95.7 percent of the population having received at least one dose.
While the COVID-19 pandemic undoubtedly took a heavy toll in terms of deaths and morbidity, the World Bank’s support, along with contributions from other international institutions and bilateral agencies, helped limit the number of lives lost due to COVID-19. Argentina's excess mortality rate due to COVID-19 in 2020-2021 was 0.85 deaths per 1,000 population, less than half the average for Latin American countries (1.79). Although these results were determined by multiple factors, including the early, extended lockdown measures, Argentina’s preparedness and effective response were essential contributors to these positive outcomes.
Graphs and Data Visualization
Collaboration across the World Bank Group
The Bank capitalized on the advantage of having several ongoing operations in the health sector by quickly aligning them to support the health emergency response. As an illustration, the SUMAR Project was modified to include health care services for COVID-19 prevention and care as eligible expenditures. It also established a mechanism to create a Provincial Sanitary Emergency Fund to strength health care services at the provincial level. In addition, the Proteger Project financed the purchase of supplies, medicines, and medical equipment to help ensure access to prevention, detection, and treatment of Non-Communicable Diseases, including COVID-19 during the pandemic.
World Bank Group Contribution
In addition to providing quick access to financial resources for the purchase of medical equipment, supplies and COVID-19 vaccines, the Bank helped ensure their timely procurement despite interruptions in supply chains and logistics services. The Bank also helped ameliorate market information imperfections at critical times by providing information on suppliers and prices of essential medical inputs. Finally, the adoption of a new innovative procurement procedure--the Bank Facilitated Procurement--also provided agility through innovations such as "ready to go" contracts and payments by the Bank directly to suppliers and payments by the Bank directly to suppliers, which not only served to expedite procurement but also to grant added guarantees to suppliers.
Partnerships
In addition to the World Bank, numerous other donors and international financial institutions provided technical and financial support to strengthen Argentina’s response to the COVID-19 pandemic. The Pan-American Health Organization (PAHO/WHO) provided support for the preparation of Argentina’s Strategic Plan Against COVID-19 as well as training and technical guidance for the deployment of COVID-19 vaccines. The Global Alliance for Vaccines and Immunizations (COVAX) and PAHO Revolving Fund helped ensure broad access to vaccines. Financial support was also provided by the Inter-American Development Bank, the European Investment Bank, the Development Bank for Latin America as well as bilateral support.
Looking Ahead
The success of COVID-19 Emergency Project is grounded on the Bank’s long-term support to Argentina’s health sector. Starting with the Plan Nacer in 2004, a series of results-based financing operations supported the incremental development of national universal health coverage for the uninsured. The Bank has also recently approved a Program for Results aimed at the promoting equitable and effective coverage of public health services and the efficiency of the health system. This PforR will be pivotal in institutionalizing previous results from previous. operations, transitioning them from program-based initiatives to a national policy and ensuring their sustainability.
Key Words
Pandemic Preparedness, Climate Resilient Health Systems, Universal Health Coverage, Primary Health Care, Digital Health, Resilience, Health System
After receiving his second dose of the COVID-19 vaccine, Carmelo Agüero explained that “For us, the most difficult thing is not being able to go out to get work. We do not have a permanent job. Our wages depended on being hired by the day in the construction industry. Having the second dose of the vaccine makes me more confident to look for a job, which in turn, can bring me the next job.” |
Challenge
The COVID-19 pandemic hit Argentina in March 2020 as the country was undergoing its worst economic crisis in almost 20 years. Reductions in public health expenditures had already negatively impacted the delivery of public health services across the country, including the provision of critical inputs for treatment for HIV and tuberculosis as well as vaccines. Reduced health care expenditures had also made it more challenging to address ongoing dengue outbreaks in the country’s Central and Northern regions. Moreover, budgetary restrictions had the potential to hinder the country’s ability to limit the spread of COVID-19 and provide emergency care and treatment for COVID-19 patients.
Approach
Approved on April 2, 2020, the Argentina COVID-19 Emergency Response operation was among the first to be launched as part of the World Bank’s global response to the COVID-19 pandemic. It was prepared at the record speed of three weeks under the World Bank’s Strategic Preparedness and Response Program. This achievement was the result of the commitment exhibited by both the World Bank and its counterparts in the Ministry of Health. The World Bank team’s deep knowledge of Argentina’s health sector, built over decades of engagement, also proved critical to the project’s quick preparation.
Due to the novelty of COVID-19, the operation was also prepared in an environment of exceptional uncertainty. The technical design adequately responded to this uncertainty by providing financial support to a menu of critical goods and services to address a wide range of potential emerging needs. This approach provided much needed flexibility to Argentina’s health authorities, who were able to optimize the use of resources according to the evolving needs during different stages of the pandemic. In September 2021, an additional World Bank loan was approved to ensure the provision of COVID-19 vaccines.
Results: 2020-2024
Argentina’s COVID -19 Response Project strengthened the capacity of Argentina’s health system to respond to increased levels of demand for intensive care for acute COVID-19 patients. Through the provision of ventilators, medical equipment, and supplies—including personal protective equipment—90 percent of public hospitals with IC units received critical support. This enabled Argentina to maintain adequate IC capacity throughout the COVID-19 pandemic, even as IC unit occupancy peaked in 2021 at 76.9 percent nationwide and 77.9 percent in the Buenos Aires Metropolitan Area, the region where the health system was under the most stress.
In addition, the project facilitated the purchase of nearly 33.4 million vaccines, contributing to extensive vaccine COVID-19 vaccine coverage in Argentina. Approximately 50.5 percent of Argentina’s population received at least one vaccine dose through the project’s support. The mRNA vaccines procured through the project were the only ones approved at the time for the immunization of adolescents, and the World Bank's support was pivotal in introducing them to Argentina. To ensure effective vaccine distribution, the project also funded the acquisition of 800 ice-lined vaccine refrigeration units, which strengthened the country’s cold chain infrastructure.
Project support led to broader improvements in Argentina’s vaccination system. For the first time, vaccination records became fully nominalized (i.e., with data collected at the individual level) and the proportion of vaccine records transmitted electronically increased from 15 percent in 2018 to 75.3 percent in 2021. The project also bolstered the pharmacovigilance system, which for the first time became widely used, as reflected by an almost 30-fold increase in reported adverse events between 2019 and 2021, ensuring greater monitoring of vaccine safety.
These efforts contributed to the successful rollout of Argentina’s COVID-19 Immunization Campaign, positioning Argentina eighth in vaccination rates (full vaccination scheme) among 33 Latin American and Caribbean countries as of September 2021. As of April 15, 2024, a total of nearly 117.8 million COVID-19 vaccine doses had been administered, with 95.7 percent of the eligible population having received at least one dose.
The successful implementation of this project was closely linked to the World Bank’s long-term sector engagement in Argentina’s health sector. Knowledge of the structure of Argentina’s health sector derived from previous and ongoing operations provided a sound foundation for the Bank’s rapid response. Equally important, the World Bank’s longstanding support to the health sector at the national and provincial level had contributed to the development of information systems that proved critical to the country’s emergency response. Among them was the National Health Surveillance System, which effectively provided real-time epidemiological data to support evidence-base decision making at both the policy and operational levels, as well as the National Vaccine Registry NOMIVAC, which supported the rollout of the COVID-19 vaccine.
Graphs and Data Visualization
2020-2021 Excess Mortality Rate due to COVID-19 in Latin American Countries (Deaths per 1,000 people)
Source: Based on data from Global Demographics Collaborators (2021), “Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021,” The Lancet, March 11, 2024
Percentage of Utilization Intensive Care Beds 2020-2022
(Adults; All conditions; Private and Public Establishments)
Source: Based on Daily Epidemiological Reports from national Ministry of Health.
Collaboration across the World Bank Group
World Bank Group Contribution
In addition to providing quick access to $535 million for the purchase of medical equipment, supplies and COVID-19 vaccines, the World Bank helped ensure their timely procurement despite interruptions in supply chains and logistics services. The World Bank also helped ameliorate market information imperfections at critical times by providing information on suppliers and prices of essential medical inputs.Finally, the adoption of a new innovative procurement procedure—the Bank Facilitated Procurement—also provided agility through innovations such as "ready to go" contracts and payments by the Bank directly to suppliers and payments by the Bank directly to suppliers (normally, the Bank would provide money to the government and then the government would carry out purchases). These innovations not only served to expedite procurement but also to grant added guarantees to suppliers.
Partnerships
In addition to the World Bank, numerous other donors and international financial institutions provided technical and financial support to strengthen Argentina’s response to the COVID-19 pandemic. The Pan-American Health Organization (PAHO/WHO) provided support for the preparation of Argentina’s Strategic Plan Against COVID-19 as well as training and technical guidance for the deployment of COVID-19 vaccines. The Global Alliance for Vaccines and Immunizations (COVAX) and PAHO Revolving Fund helped ensure broad access to vaccines. Financial support was also provided by the Inter-American Development Bank, the European Investment Bank, the Development Bank for Latin America as well as bilateral support.
Looking Ahead
The success of the COVID-19 Emergency Project is grounded on the World Bank’s long-term support to Argentina’s health sector.Starting with the Plan Nacer in 2004, a series of results-based financing operations supported the incremental development of national universal health coverage for the uninsured. The World Bank has also recently approved a Program for Results aimed at promoting equitable and effective coverage of public health services and the efficiency of the health system. This project will be pivotal in institutionalizing previous results from previous operations, transitioning them from project-based initiatives to a national program fully embedded within government systems; thus, cementing their sustainability.