sumar program's universal coverage: achievements & new goals towards 2020
Post on 27-Jul-2015
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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)
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