Documerit of
The World. Bank
Report No.: 25106
PROJECT COMPLETION NOTE
REPUBLIC OF ARGENTINA
HEALTH INSURANCE FOR THE POOR PROJECT (LIL)
[Ln. 45230-AR]
January 23, 2003
Country Management Unit for Argentina, Chile, Paraguay and Uruguay
Human Development Sector Management Unit
Latin America and the Caribbean Regional Office



Currency Equivalent
(as of January 23, 2003)
Current Unit       =     Argentine Peso
US$1.00         =     3.2 pesos
FISCAL YEAR
January 1- December 31
ABBREVIATIONS AND ACRONYMS
GoA                      Government of Argentina
PCN                      Project Completion Note
PIU                      Project Implementation Unit
Vice President:         David de Ferranti
Country Unit Director:  Axel van Trotsenburg
Country Sector Leader:  Ariel Fiszbein
Task Manager:           Daniel Cotlear



FOR OF1FICIAL USE ONLY
PROJECT COMPLETION NOTE
REPUBLIC OF ARGENTINA
HEALTH INSURANCE FOR THE POOR (LIL: Ln. 45230-AR)
1.    This is the Project Completion Note for the Argentina Health Insurance for the Poor
Project (LIL: Ln. 45230-AR). The Project was approved by the Board of Directors on
November 24, 1999. The Loan was withdrawn as of November 11, 2001. This note is in lieu of
an Implementation Completion Report reflecting the fact that the withdrawal of the Loan took
place before meaningful project implementation.
2.    Total project costs were estimated at US$7.07 million, including US$4.9 million to be
financed by the Loan. No disbursement was made from the Loan.
3.    The main objective of the project was to pilot the development of health insurance for the
poor in selected provinces of Argentina. The LIL would have aimed to assist the Government of
Argentina (GoA) in developing the legal, institutional and financial framework to establish the
proposed health insurance scheme which could eventually have been replicated throughout the
country.
4.    The Project would have consisted of three main components: (i) Enrollment Database
to: (a) identify eligibility criteria based on different poverty measures; (b) design a questionnaire
and implementing on-site surveys; (c) establish the enrollment database of the uninsured poor
and implementing the mechanisms for its regular updating; (d) design and distribute
identification cards to the beneficiaries; and (e) design and implement communications
campaigns targeted to the beneficiary population and to the provider networks; (ii) Health
Insurance for the Poor to: (a) establish the legal framework for the proposed health insurance;
(b) identify a fiscally affordable minimum health benefits package for the beneficiary population
as well as alternative health plans for the uninsured, non-poor households; (c) select the network
of providers in the public and private sectors; (d) design payment systems to providers, including
at the primary health care level, that would have included appropriate incentives; and (e)
establish, within the selected Agency, the capacity to manage the proposed health insurance; and
(iii) Preparation, Monitoring, Evaluation and Administration to support diagnostic and
preparation activities in provinces, other than the two pilot ones of Rio Negro and Salta, and to
support monitoring and evaluation activities that would have allowed evaluation of the impact of
the project and capitalized upon the learning opportunities that the project would have provided.
5.    After Board Approval on November 24, 1999, the GoA changed and requested
modifications to the concept of the Project, which necessitated minor revisions to the draft Loan



Agreement (specifically, the name of the Project was changed from Health Insurance for the
Poor to Health Insurance for the Uninsured). These changes, and the Government's transition
period, delayed Loan signing. In May 24, 2001, when the first deadline to sign the Loan
Agreement lapsed, the GoA requested a three-month extension of the signing date. Since many
activities to be funded by the Loan were considered relevant and involved interested and eligible
provinces, the Bank extended the signing date to August 28, 2001. The revised Loan was
expected to contribute to achieving the conditionalities of the Provincial Reform Loans
(Catamarca, Cordoba and Santa Fe), and to continue and extend the health insurance reform
efforts which were underway in the country.
6.    During the three months of the extension, the authorities at the Ministry of Health
diligently took the necessary internal actions to review and agree on the content of the
Presidential Decree needed to approve the terms of the Loan Agreement and proceed with the
signing of the said document. The Bank closely monitored the actions required for the issuance
of the Decree and coordinated its efforts with the authorities of the Ministries of Health and
Economy. However, due to the delay in issuing such Presidential Decree before August 28,
2001, the Loan Agreement failed to be signed within the maximum period established by the
Bank's policies of 18 months after the Board Approval. Consequently, the Bank's management
decided to withdraw the Loan as of November 11, 2001.