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

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

Plan Nacerin the Provincesin the North(700,000 people)

Plan Nacer nationwide

Coverage ofCongenital heartdiseasetreatment

Incorporation of children, teenagers and women up to64 years of age

Incorporation of adult men(14 millionpeople)

SUMAR Program’s road to Universal Coverage

+10.5MILLION

BENEFICIARIES

+500 HEALTH

SERVICES COVERED

+7,300 HEALTH

PROVIDERS UNDER

AGREEMENT

USD400MILLION

INVESTED

100 MILLION

HEALTH SERVICES BILLED & PAID

+800 PROFESSIONALS IN

25 MULTIDISCIPLINARY

TEAMS

Main figures (april 2015)

SUMAR’s contributionto the three universal coverage axes

What do we understand byeffective health coverage?

Transforming universal coverage into effective coverage

Universal coverage14 million

Population: Who is covered?

Services: What services are covered?

Implicitcoverage

Explicitcoverage(500 services)

Financial protection(2% of provincial health budget)

Enrollment Access toprioritizedservices

Qualitystandards

Effective Health Coverage

Prevention, diagnosis and beginning of treatment of breast, cervical and colorectalcancer

NCD research, identification of risk level and follow-up

Care of low and high-riskpregnancy

Care of childbirth and itscomplications in safeMaternities

Health promotion and riskprevention actions

Family planning Care of alchohol and

other substanceconsumption

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 respiratoryinfections

Diagnosis and treatmentof overweight and obesity

Control of vaccine-preventable diseases

Immunoprevention of HPV

Diagnosis and treatment of overweight and obesity

Care of alchohol and other substanceconsumption

Care of suicide attempt

Effective Coverage of Effective Health Interventions

Aging1 year

10 years

20 years

PregnancyReproductiveage

Adulthood

Birth

Childhood

Adolescence

Ongoingcare duringthe entirelifecycle

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 theuse of funds

BALANCE

External verification External verification

Capitation payment based on performance

Enrollment(monthly payment)

Health outcomes –Tracer indicators

(every four months)

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 theactual growth of children in real time throughSUMAR Program

It is essential to reinforce individual followupstrategies based on such information.

Assessment of the nutritional status of children between 1 and 5 through anthropometric data of SUMAR Program

Year

Nation

Pre

vale

nce

ofc

hro

nic

mal

nu

trit

ion

(% )

Outline the right to health

Improve equity

Improve efficiency

Facilitate purchasesand payments

Tool to guide and articulate efforts

Prioritized, brief and revisable contents

Evaluation of the population and offer

Rigurous and systematicmeasurementof costs

Services linked toquality standardsgrouped by care lines

Participatory and coordinated process

Allocation of sufficient resources

Pay for performance(as service strategy)

Monitoring and evaluationmechanisms

Empowerment of health teams

Empowerment of the population

To expand coverage of coveredcare lines (emphasis on NCDs)

Innovation in pay for performance mechanisms for health providers(emphasis on integrity and equity)

To continue strengtheninginformation systemsand monitoring skills

Institutional framework for the prioritization and definition of HSP

Harmonization of HSP with theSocial Security Insurances

From promises to deliveryThe Health Service Plan as the backbone for SUMAR Program’s strategy

Role of the HSP Definition of HSPMechanisms forturning HSP intoeffective access

Next Steps

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 satisfaction67,2 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.

6 enablers to develop RBFbased on Plan Nacer and Programa SUMAR experience

Cooperative leadership

Harmonic integration

Autonomy

New skills

Gradual implementation

Evaluation

CHANGETowards Universal and

Effective Health Coverage

“Monitoring Strategy for Integral coverage”

Lic. Humberto SilvaNational Coordinator of Strategic Planning Area

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

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 PROVIDEDLAST 12 MONTHS

‘Every achievementposes a new challenge.’

Basic EHC BY PROVIDED

SERVICE

20%37.5%APRIL 2015

BASIC EFFECTIVE HEALTH COVERAGE

Indicator 1b: Proportion of eligible men with effective coverage - - - 15%

MEASURAMENTPERIOD 2014

GOAL2014

GOAL2017

CORE INDICATORS IN PROGRAMA SUMAR. PDOS:

Indicator 6: Percentage of provinces achieving the targets of their Annual

Performance Agreements2014

DECEMBER 33% 33% 58%

PDOs

Indicator 1a: Proportion of eligible population with effective coverage2014

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 years2014

OCTOBER 9,4% 20% 20%

AG

E G

RO

UP

S

61%

37%

31% Adolescents

25% Women

Basic EHC

35%GOAL PDO

2014

Basic EHC2014

DECEMBER

GOALNB2014

60%

39%

17%

37%

Basic EHC BY PROVIDED

SERVICE2014

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

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- 2014-2015For the whole country

GOAL2014 = 35%

GOAL2013 = 20%

GOAL 2015 = 40%

MOVING TOWARDS EFFECTIVE UNIVERSAL HEALTH COVERAGE

MONITORING STRATEGY FOR INTEGRAL COVERAGE

26%

3%

13%

Minimum comprehensive health coverage

Proper comprehensive health coverage

Basic EHC

Children Under Age 1Secondary 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 newborntracking (exit)

SUMAR ProgramMore public health

for millions of Argentines