Challenge
Despite Argentina's recovery after the 2001 economic crisis and the strong progress in the health sector, the country still faced many public health challenges in 2006. Health outcomes were lagging behind comparable countries in the region, and there were significant inequalities among the provinces. Simultaneously, the increasing burden of non-communicable diseases and communicable diseases such as HIV, TB and other preventable vector-borne diseases posed a major challenge for the control of epidemics. This health crisis exposed and intensified existing public health system inefficiencies and highlighted the need to improve the stewardship of the National Ministry of Health (MSN) and the provincial health ministries.
Solution
Recognizing the strategic importance of improving public health functions, such as disease surveillance, health promotion, disease prevention, and program monitoring to reduce the burden of disease, the first Argentina Essential Public Health Functions and Programs Project (FESP I) supported the implementation of the Government’s health sector strategy. The project’s main goals were to increase coverage of ten priority programs, reduce the population’s exposure to the main health risk factors, and to improve national public health system management.
The project introduced and expanded several disease surveillance and program monitoring systems to improve efficiency. The Integrated Health Information System of Argentina (SIISA), a database that consolidates health sector resources information, including health facilities and human resources, was created through the consolidation of existing information systems.
Upon common agreement on public health results and targets, the project included output-based disbursements from the national Ministry of Health (MSN) to the provinces. Disbursements were linked to the delivery of 63 public health activities. The output-based disbursement mechanism proved to be an innovative solution to implement public health programs. Unifying norms and quality standards reduced inequalities between provinces, and health system managers benefited from greater access to management tools and training. The supervision mechanism implemented to generate health data was also an important information source for policy makers.
Results
Argentina’s public health sector made great progress towards improving health indicators between 2006 and 2012:
- Tobacco smoking prevalence declined from 33% to 30%, and second-hand smoke exposure fell from 52% to 40.4%.
- The partnership between the Bank and the Government was instrumental in reversing the dengue outbreak of 2009.
- No cases of congenital rubella were reported during the life of the project.
- No cases of autochthonous measles were reported during the life of the project.
- In 2010, there was a 96 percent reduction in dengue cases from its peak during the 2009 outbreak, with no deaths reported. The number of cases continued to decline in subsequent years.
- Transfusion-transmitted infections declined from 10.5 percent to 6.5 percent between 2006 and 2011, a clear expression of reduced risk related to a significant increase in voluntary blood donations, from 6 percent to 30 percent in the same period.
- The number of TB patients receiving directly observed therapy increased from 58% to 95%. Directly observed therapy means that a trained health care worker or other designated individual provides the prescribed TB drugs and watches the patient swallow every dose.
- The project held 32 situation rooms nationwide for Health Surveillance and Vector-Borne Disease Control.
- The project provided for the certification of 20 out of 24 provinces for essential public health functions and programs.
- The project’s emergency response component was crucial in responding to dengue and Influenza A/H1N1 emergencies.
In addition, several of the management tools introduced by the project have made a lasting impact in increasing governance and stewardship in the health sector.
Bank Group Contribution
The Bank supported the project with a loan of US$220 million, in addition to strong technical support to the public health programs and close engagement on the ground. The Bank also contributed significantly to advancing the health intelligence agenda through the introduction of national risk factors surveys, burden of disease studies, and by strengthening the Integrated Health Information System of Argentina (SIISA). Most of the Bank team consisted of country-based staff members, who were constantly engaged with the Government team.
Partners
Cooperation from the Pan American Health Organization Project strengthened implementation and improved epidemiological surveillance and deliver training on essential public health functions. A distinguishing feature of the project was its implementation in the context of a federal system, thus requiring partnerships and annual negotiations between the 24 provincial governments and the national government. The World Bank remained involved on the ground throughout the implementation.
Moving Forward
The follow-up FESP II Project was approved in 2011 and is currently under implementation. This project works to further develop public health functions and continues the FESP I project’s support of the stewardship role of the national and provincial public health systems, and the increased coverage, quality, and effectiveness of priority health programs, including prevention of non-communicable diseases and high cost and low incidence health care services.
Beneficiaries
This project benefits the Argentine population as a whole. While the Project does not specifically target the poor, the Project invests in health-related public goods, which have externalities that bring benefits to those not benefiting directly (e.g., immunizing all sectors of the population benefits the poor even if 100 percent are not immunized).
