Pursuing Universal and Effective Health Coverage through Results-Based Financing (RBF)

Session: Using Results Based Financing to Scale-up Changes for Maternal and Neonatal Health: What Have We Learned?

Presenter: Martín Sabignoso,Ministry of Health, Argentina
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Background: Programa SUMAR is a public health program implemented by the National Ministry of Health of Argentina which provides coverage to uninsured children, adolescents and adult women. The program started in 2004 as Plan Nacer, a maternal-child health program, focused on reducing gaps in access and quality of health services in the most disadvantaged provinces. In 2015 the Program will reach universal coverage by including men, providing explicit coverage to more than 14 million people.

Methodology: Programa SUMAR strengthens public universal coverage embodied in the National Constitution of Argentina. It guarantees a list of health services and provides funding through a Results-based financing model (RBF). The main goal is to improve access and quality of basic health services, while simultaneously strengthening the incentive framework to increase efficiency in the use of public health funds. The Program pursues a cultural change in the management of public health policy and aims to transform existing public coverage into effective universal health coverage.

Results: The Program has achieved high population coverage, reaching 9.4 million of beneficiaries in the whole country, representing 94% of the eligible population. 7,500 public health facilities are successfully engaged across the country with signed management agreements, currently working with high motivation. An external impact evaluation of the program was conducted by the University of Berkeley, revealing positive impacts in terms of early detection (pregnant beneficiaries from Programa SUMAR are identified earlier than non-beneficiaries), prenatal check-ups (pregnant women with Programa SUMAR received 16% more prenatal checks that uninsured pregnant women), as well as a significant reduction of low-birth weight children (23%), whose mothers had coverage from the program.

Conclusion: In the experience of Argentina, RBF programs focusing on the poor and maternal and child health can be successfully scaled-up to the national level and additional areas of health.