For new mothers, the health and wellbeing of their newborns and themselves is a priority. Thanks to Plan Nacer, Argentina’s health coverage program for pregnant women and children under six years, mothers can be confident in coverage that allows them to receive quality care when they need it—and the rigorous results are here to prove it.
Pregnant with her first child and lacking health coverage, Fernanda had initially worried about how she would access the health care that she and her newborn would need. The 2001 economic crisis, which plunged half of Argentina’s population into poverty, had been hard on her and her family. Like many other Argentinians, she and her husband lost their jobs and their health coverage. Going to the doctor for prenatal check-ups meant paying high out-of-pocket fees or seeking care at the public hospital, whose capacity to deliver services was strained by increased demand. The country’s health indicators also deteriorated during that period: 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, where Fernanda lived, infant mortality was as high as 25 per 1,000. Fernanda did not need to worry, however, because she enrolled in Plan Nacer.
The Government of Argentina launched Plan Nacer in 2005 in nine of Argentina’s poorest provinces and scaled it up in the 15 remaining provinces and the Federal District of Buenos Aries in 2007. Plan Nacer introduced results-based financing (RBF) mechanisms, which typically tie payment of service providers to the achievement and verification of specific results or delivery of pre-agreed services. The program offered two levels of incentives to ensure that those who needed services received them: 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. Health facilities received fee-for-service payments from the provincial government according to the number and quality of services they provided.[i] 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 their facilities and service delivery. Plan Nacer has provided 4.7 million pregnant women and children with health coverage, and has delivered 37 million maternal and child health services.
Plan Nacer’s Impact
The newly published results from Plan Nacer’s impact evaluation, which was funded in part by the World Bank’s Health Results Innovations Trust Fund (HRITF), shows that birth weights have improved, neonatal mortality has decreased, and the use of prenatal services is up. For example, incorporating clinics into Plan Nacer reduced the probability of low birth weight by 23% for beneficiaries. The program’s impact on birth weight is particularly important because low birth weight can hurt a child’s long-term success—it is associated with poor cognitive development, persistent health problems, low school achievement, and reduced lifetime earnings.
Neonatal mortality has also decreased due to Plan Nacer. Birth records from larger maternities show that Plan Nacer reduced the probability of in-hospital neonatal death by 74 % for Plan beneficiaries. Better prenatal care, which prevented low birth weight and better post-natal care contributed to the reduction in neonatal mortality.
Plan Nacer also increased the use and quality of prenatal care services, which was measured by the number of prenatal care visits and the probability of receiving a tetanus vaccine.
Health Equity in Argentina
Based on Plan Nacer’s success, the Government of Argentina has launched Program SUMAR, a follow-up initiative. SUMAR uses RBF mechanisms to expand health coverage to uninsured children and adolescents under 19 and to uninsured women between the ages of 20 and 64; uninsured pregnant women continue to be covered. By providing insurance to those who were previously uninsured and by promoting efficiency and quality in health facilities, Plan Nacer and now Program SUMAR are helping to close the health equity gap in Argentina.
[i] Gertler, P. Giovagnoli, P. and Martinez, S. 2013. Rewarding Performance To Enable a Healthy Start: The Impact of Plan Nacer on Birth Outcomes of Babies Born into Poverty. Under Review for Publication, The World Bank.