A presentation by Martín Sabignoso of Argentina's Ministry of Health delivered at the RBF Health Seminar, QOn the Road to Effective Universal Health Coverage: What’s New in Argentina’s Use of Performance Incentives? on June 11, 2015.

1. SUMAR Program’s Universal Coverage:
achievements and new goals towards 2020

2. 1. Argentina is a federal country where provincial governments are
responsible for the provision of healthcare.
2. Plan NACER is a national program that provides health coverage
for pregnant women and children up to 5 years of age without
formal insurance.
3. Programa SUMAR is the expansion of Plan NACER including new
population groups.
4. This Results Based Financing (RBF) aims to transform the
existing free universal coverage into effective coverage.
4 Introductory Concepts

3. Plan Nacer
in the Provinces
in the North
(700,000 people)
Plan Nacer
nationwide
Coverage of
Congenital heart
disease
treatment
Incorporation of
children,
teenagers and
women up to
64 years of age
Incorporation of
adult men
(14 million
people)
SUMAR Program’s road to Universal Coverage

4. +10.5
MILLION
BENEFICIARIES
+500 HEALTH
SERVICES
COVERED
+7,300 HEALTH
PROVIDERS
UNDER
AGREEMENT
USD400
MILLION
INVESTED
100 MILLION
HEALTH SERVICES
BILLED & PAID
+800
PROFESSIONALS IN
25
MULTIDISCIPLINARY
TEAMS
Main figures (april 2015)

5. SUMAR’s contribution
to the three universal coverage axes
What do we understand by
effective health coverage?
Transforming universal coverage into effective coverage
Universal coverage
14 million
Population: Who is covered?
Services: What services are covered?
Implicit
coverage
Explicit
coverage
(500 services)
Financial protection
(2% of provincial
health budget)
Enrollment Access to
prioritized
services
Quality
standards
Effective Health Coverage

6.  Prevention, diagnosis and
beginning of treatment of
breast, cervical and colorectal
cancer
 NCD research, identification of
risk level and follow-up
 Care of low and high-risk
pregnancy
 Care of childbirth and its
complications in safe
Maternities
 Health promotion and risk
prevention actions
 Family planning
 Care of alchohol and
other substance
consumption
 Care of suicide attempt
 Neonatal care
 Treatment of NB in critical
condition
 Treatment of CHD and
congenital malformations
 Control of vaccine-
preventable diseases
 Care of respiratory
infections
 Diagnosis and treatment
of overweight and
obesity
 Control of vaccine-
preventable diseases
 Immunoprevention of
HPV
 Diagnosis and
treatment of
overweight and obesity
 Care of alchohol and
other substance
consumption
 Care of suicide attempt
Effective Coverage of Effective Health Interventions
Aging
1 year
10 years
20 years
Pregnancy
Reproductive
age
Adulthood
Birth
Childhood
Adolescence
Ongoing
care during
the entire
lifecycle

7. Results-Based Financing – Separation of functions
NATION
Sets a per
capita value
USD 2.8
PROVINCE
Provincial
Health Insurance
HEALTH PROVIDER
Fee for
Service
(monthly payment)
Stewardship
Incentives and Autonomy
Consensus
Autonomy in the
use of funds
BALANCE
External verification External verification
Capitation payment based on performance
Enrollment
(monthly payment)
Health outcomes –
Tracer indicators
(every four months)

8.  Over 13 million health checkups from over 1,4
million children under 5 years of age in more
than 6,500 health facilities nationwide (2005 to
2013)
 Prevalence of stunting (chronic malnutrition)
decreased by 45% (from 20.6% to 11.3%)
 Development of a surveilance system of the
actual growth of children in real time through
SUMAR Program
 It is essential to reinforce individual followup
strategies based on such information.
Assessment of the nutritional status of children between 1 and
5 through anthropometric data of SUMAR Program
Year
Nation
Prevalenceofchronicmalnutrition(%)

9. Outline the right to
health
Improve equity
Improve efficiency
Facilitate purchases
and payments
Tool to guide and
articulate efforts
Prioritized, brief and
revisable contents
Evaluation of the
population and offer
Rigurous and
systematic
measurement
of costs
Services linked to
quality standards
grouped by care lines
Participatory and
coordinated process
Allocation of
sufficient resources
Pay for performance
(as service strategy)
Monitoring and
evaluation
mechanisms
Empowerment of
health teams
Empowerment of the
population
To expand coverage of covered
care lines (emphasis on NCDs)
Innovation in pay for performance
mechanisms for health providers
(emphasis on integrity and equity)
To continue strengthening
information systems
and monitoring skills
Institutional framework for the
prioritization and definition of
HSP
Harmonization of HSP with the
Social Security Insurances
From promises to delivery
The Health Service Plan as the backbone for SUMAR Program’s strategy
Role of the HSP Definition of HSP
Mechanisms for
turning HSP into
effective access
Next Steps

10. The importance of Autonomy
Encourages
creativity
At Christmas, a health center of La
Pampa draws bicycles (purchased
with Plan Nacer funds) for all those
children whose vaccines and
checkups are up to date and a
health center of Entre Ríos hired a
taekwondo coach for adolescents
Increases satisfaction
67,2 Index Satisfaction Northern Region
“Only satisfied health workers can bring the system towards satisfied patients”
Favours the building of new skills
“Plan Nacer has changed our way of thinking
and doing things, we all became managers” Patricia García, MD.

11. 6 enablers to develop RBF
based on Plan Nacer and Programa SUMAR experience
Cooperative leadership
Harmonic integration
Autonomy
New skills
Gradual implementation
Evaluation
CHANGE
Towards Universal and
Effective Health Coverage

12. “Monitoring Strategy for Integral coverage”
Lic. Humberto Silva
National Coordinator of Strategic Planning Area

13. CORE INDICATORS IN PROGRAMA SUMAR. PDOs:
INCREASE IN THE
UTILIZATION AND QUALITY
OF THE KEY HEALTH SERVICES
FOR THE ELIGIBLE TARGET
POPULATION:
IMPROVEMENT OF
INSTITUTIONAL MANAGEMENT BY
STRENGTHENING RESULTS-BASED
INCENTIVES IN PARTICIPATING
PROVINCES AND AMONG
AUTHORIZED PROVIDERS
1 2
Proportion of
eligible population
with effective
coverage
INDICATOR 1
Proportion of eligible
pregnant women
receiving prenatal
check-ups before the
13th week of
pregnancy
INDICATOR 2 INDICATOR 3
Proportion of
eligible children
under 10 years of
age receiving
complete health
check-ups according
to protocol
Proportion of
eligible adolescents
between 10 and 19
years of age
receiving complete
health check-ups
according to
protocol
INDICATOR 4 INDICATOR 5
Proportion of
eligible women
between 25 and
64 years of age
with at least one
cervical cancer
screening every
two years
Percentage of
provinces
achieving the
targets of their
Annual
Performance
Agreements
INDICATOR 6

14. December 2012
100% of the population were enrolled
but 27% had not reported a health
service in the previous year.
TRANSFORMING UNIVERSAL COVERAGE INTO EFFECTIVE COVERAGE
60%
CAPITATION PAYMENT
ENROLLMENT
+
SERVICE PROVIDED
LAST 12 MONTHS
‘Every achievement
poses a new challenge.’
Basic EHC BY
PROVIDED
SERVICE
20%
37.5%
APRIL 2015
BASIC EFFECTIVE
HEALTH COVERAGE

15. Indicator 1b: Proportion of eligible men with effective coverage - - - 15%
MEASURAMENT
PERIOD 2014
GOAL
2014
GOAL
2017
CORE INDICATORS IN PROGRAMA SUMAR. PDOS:
Indicator 6: Percentage of provinces achieving the targets of their Annual
Performance Agreements
2014
DECEMBER 33% 33% 58%
PDOs
Indicator 1a: Proportion of eligible population with effective coverage
2014
DECEMBER 35,5% 35% 50%
Indicator 2: Proportion of eligible pregnant women receiving prenatal
check-ups before the 13th week of pregnancy
III Q 2014
(W/A) 29,7% 28% 40%
Indicator 3: Proportion of eligible children under 10 years of age
receiving complete health check-ups according to protocol
III Q 2014
(W/A) 47,2% 32% 60%
Indicator 4: Proportion of eligible adolescents between 10 and 19 years
of age receiving complete health check-ups according to protocol
III Q 2014
(W/A) 18,1% 14% 25%
Indicator 5: Proportion of eligible women between 25 and 64 years of
age with at least one cervical cancer screening every two years
2014
OCTOBER 9,4% 20% 20%

16. AGEGROUPS
61%
37%
31%Adolescents
25%
Women
Basic
EHC
35%
GOAL PDO
2014
Basic
EHC
2014
DECEMBER
GOAL
NB
2014
60%
39%
17%
37%
Basic EHC BY
PROVIDED
SERVICE
2014
DECEMBER
47%
32%
23%
17%
35%
2014
DECEMBER
Basic EHC BY
PROVIDED
SERVICE
26%
Children between 0 -5
Children between 6-9
MOVING TOWARDS EFFECTIVE UNIVERSAL HEALTH COVERAGE

17. Basic EHC Basic EHC by provided service
63%
26%
12%
15%
26%
35%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Evolution of the Basic Effective Health Coverage rate vs. Goal December 2013- 2014-2015
For the whole country
GOAL
2014 = 35%
GOAL
2013 = 20%
GOAL
2015 = 40%
MOVING TOWARDS EFFECTIVE UNIVERSAL HEALTH COVERAGE

18. MONITORING STRATEGY FOR INTEGRAL COVERAGE
26%
3%
13%
Minimum comprehensive
health coverage
Proper comprehensive
health coverage
Basic EHC
Children Under Age 1
Secondary
Prevention
Preterm care (500
to 1500 g)
• Care of preterm infants (500 to 1500 g) during the first days of
life with requirement of ARM or CPAP
• Care of preterm infants (500 to 1500 g) during the first days of
life without requirement of ARM or CPAP
• High-risk newborn tracking (admission)
• High-risk newborn tracking (exit)
• Care of preterm infants with
requirement of ARM o CPAP
• Care of preterm infants without
requirement of ARM o CPAP
• High-risk newborn tracking (admission)
• High-risk newborn
tracking (exit)

19. SUMAR Program
More public health
for millions of Argentines