2015年-世界发展银行全球_Argentina___Can_Performance_Payments_Improve_Newborn_Health__4页_2mb

Argentina: Can Performance Payments Improve Newborn Health?

Core Content

The document discusses the effectiveness of the Plan Nacer program in Argentina, which was designed to improve maternal and newborn health outcomes through a pay-for-performance model. The program, now known as Program Sumar, was launched in 2004 with support from the World Bank and has since been expanded nationwide, benefiting nearly nine million people.

Main Objectives

• Improve maternal and child health outcomes
• Increase access to public health facilities
• Enhance the quality of care through performance incentives
• Reduce newborn mortality rates

Key Features of the Program

• Financial Incentives: Provincial governments received $5 per month for enrolling pregnant women and children under six, and up to $3 per person for meeting health targets.
• Performance Targets: These included indicators such as:
  • First prenatal checkup before week 20 of pregnancy
  • APGAR score of over 6
  • Birth weight more than 2,500 grams
  • Vaccination of children under 18 months
  • Reproductive counseling within 45 days of delivery
  • Preventative checkups for children under 6
  • Staff trained to provide care for indigenous populations
• Accountability Mechanism: Provinces were incentivized to enroll more beneficiaries and ensure quality care, with payments tied to meeting specific health benchmarks.

Impact Evaluation

An impact evaluation, supported by the Strategic Impact Evaluation Fund (SIEF) and the Health Results Innovation Trust Fund, assessed the program's effectiveness. The study used a difference-in-difference approach by comparing outcomes between clinics that joined the program early and those that joined later.

Key Results

• Newborn Mortality: The rate of newborn deaths dropped by 74% among Plan Nacer beneficiaries who gave birth in hospitals with large maternity practices.
• Non-Beneficiaries: Even women not enrolled in the program but receiving care at Plan Nacer clinics saw a 22% decline in neonatal mortality.
• Low Birth Weight: The probability of low birth weight (less than 2,500 grams) decreased by 9% for all women using Plan Nacer clinics, and by 19% for enrolled beneficiaries.
• Improved Prenatal Care: Women in the program had 5.6 more percentage points of likelihood to receive the recommended tetanus vaccine and a 21% drop in cesarean sections.
• Prenatal Visits: For every 100 women enrolled, there were 68 additional prenatal visits.
• Cost-Effectiveness: The program increased healthcare spending to 3.5% of provincial budgets between 2005 and 2008, with a significant portion allocated to services for beneficiaries. Overhead costs decreased over time, indicating improved efficiency.

Broader Implications

• The program demonstrated that performance-based financing can lead to measurable improvements in health outcomes.
• It showed that linking payments to health benchmarks rather than just procedures can drive better care and accountability.
• The success of Plan Nacer has made it a model for other Latin American countries, especially in addressing health disparities among the poorest populations.

Conclusion

Plan Nacer's incentive-based model successfully improved maternal and newborn health, offering a replicable strategy for low and middle-income countries. The program not only enhanced the quality of care but also ensured cost-effectiveness and equitable access to health services, contributing to better long-term health and development outcomes for children.

Additional Information

• The evaluation is detailed in the World Bank Policy Research Working Paper 6884.
• The Strategic Impact Evaluation Fund (SIEF) supports research that informs policy decisions and helps reduce poverty.
• The Evidence to Policy note series is supported by the British Department for International Development.