How can free basic health care to poor pregnant mothers and children be provided in the midst of an economic crisis? How can a country expand such a program to provide more comprehensive services to a wider group of beneficiaries? A new delivery case study about Plan Nacer/Programa Sumar analyzes the “silent revolution” that changed the organizational culture of the health system in Argentina in a way that improved health outcomes, improving the lives of millions of people. The case traces the implementation of Plan Nacer—Argentina’s health coverage program for uninsured pregnant women and children under the age of six—tracking its evolution into the much more comprehensive Programa Sumar. It examines how complex health sector reforms were successfully conceived, designed, and executed and how the program was implemented in a way that achieved results.
The impetus for the launch of Plan Nacer came from Argentina’s experience in the financial crisis of 2001–02. With many people thrown into poverty due to unemployment and becoming part of the informal sector, thus losing their insurance and the overburdened public health system was stretched beyond its limits. This was shown perhaps most importantly in a spike in maternal and infant mortality rates. Faced with a clear problem, reform-minded specialists saw this as an imperative issue to confront, and also as an opportunity to innovate and experiment. The case shows the ways in which important delivery challenges such as fragmentation of service delivery and poor intergovernmental coordination were tackled. It explains how the program developed and extensive audit system to ensure course correction and how several iterations were critical in achieving results. The case provides useful insights for colleagues working on results-based financing as well as those dealing with important constraints that affect maternal and child mortality.