NOVEMBER 2009



                  RESULTS-BASED FINANCING AT THE WORLD BANK
                                                                                                                                            54080
                  Argentina: Plan Nacer
PREPAREDBYANTHONYMEASHAMANDCLEAREDBYRAFAELCORTEZ

PROJECT NAME:ProvincialMaternal-ChildHealthInvestmentProject    TIME PERIOD:Jun2004­Dec2012      LENDING INSTRUMENT:AdaptableProgramLoan(APL)phase1and2
PROJECT ID: P071025                                             TTL: RafaelCortez                RBF COMPONENT OR PROJECT:Project
UNIT: LCSHH                                                     AMOUNT (USD): $435.8million      PILOT (Y/N):No


  Characteristic             Description
                             1) Haltrecentincreasesinthenationalrateofinfantmortalityandreducetherateby20%atthenationallevelandbyatleast30%intheparticipatingnorthern
  RATIONALE                     provincesoveraperiodof10years;and
                             2) Changethedynamicoffinancingandprovidinghealthservicesattheprovinciallevel.

                             TocontributetothereductionoftheinfantandmaternalmortalityrateintheBorrower'sterritory,aswellastointroducechangesintheincentiveframeworkof
                             healthcareprovidersintheBorrower'sParticipatingProvinces,throughtheimplementationoftheMaternal&ChildHealthInsuranceProgram(MCHIP).MCHIP
                             isbuiltaroundperformanceandaccountabilitymechanisms(e.g.,annualperformanceagreementsbetweenNation&ParticipatingProvincesandbetween
  OBJECTIVE OF THE RBF
                             ParticipatingProvincesandHealthCareProviders),linkingfinancing(flowofresources)toboth,servicesdeliveredtothetargetpopulationandtheachievement
                             oftheMCHIPselectedindicators(tentracers).

                             EnrollmentintheMCHIPhasbeensuccessfulunderAPL1(P071025),onavoluntarybasis,inthe9participantprovincesoftheNorthwest(NOA)andNortheast
                             (NEA)Regions,toalluninsuredchildrenuptotheirsixthbirthday,toalluninsuredpregnantwomen,andtoalluninsuredmothersforupto45dayspasttheir
  BENEFICIARIES
                             dateofdeliveryormiscarriage.APL2(P095515),approvedinNovember2006,coversthesameeligiblepopulationsintheremaining15provinces.Asof
                             September,2009,13ofthe15provinceshadjoinedPlanNacer,andtheremainingtwoarepreparingtodoso.

                             Apackageofbasicinterventions(CPB­preventiveandcurativeservices-)isprovidedtothetargetpopulationthroughauthorizedpublicandprivateproviders.

                             ConditionsandinterventionsincludedintheCPBare:
  INTERVENTION
                              · Prenatal,delivery,perinatalandpostnatalcareofthepregnantwoman;
                              · Neonatalcare,immunization,nutritionanddevelopment,andtreatmentofdiseaseforchildrenunder6;
                              · Visitstoindigenouspopulationlackingaccesstohealthcare;sexualandreproductivehealthcounseling,includingtreatmentofsexuallytransmitted
                                infections.

                             TheestimatedcostoftheCPBis$10percapita-month.ThenationalMinistryofHealth(MOH)finances50%ofthiscost,whiletheprovincialMOHscover
  TYPE AND AMOUNT            theother50%.ForthepurposeoftheProject,theMOHfinances$5ofthecostoftheCPBpercapita,duringthefirstthreeyears.Inthefourthyearthe
  OF INCENTIVE PROVIDED      MOHfinances70%,whiletheprovincialMOHscovertheother30%.Thereafter,theformerfinances40%whereastheprovincialMOHscoverthedifference.
                             DisbursementfromthenationaltotheprovinciallevelismadeonacapitationbasisforeacheligiblebeneficiaryactuallyenrolledintheMCHIP.

                             Thecashtransferismadeintwoinstallments:(a)60%isdisbursedimmediatelyaftertheprovincesendstheregisterwiththeenrolleeseachmonthandafter
                             suchregisterhasbeencertifiedbytheauditingsub-unitofthenationalMCHIPPrograminthePMU;and(b)40%isdisbursedperiodically,aboutevery4
  PAYMENT RULES
                             months,afterverificationandcertificationbythesameunitthattheprovinceactuallymettheproductiontargetsforthe10typesofinterventionsselectedas
  AND MECHANISM
                             tracersofserviceproduction.Achievingthetargetforonetracerwouldentitletheprovincetoreceiveupto4%ofthecapitationpayment:achievingall10
                             targetswouldgiveuptothefull40%.

   1                                                                                                                         COUNTRY SNAPSHOT ARGENTINA
Characteristic           Description
                         PerformanceObjectives

                          ·   Atleast50%oftargetpopulationineachparticipatingprovince;
                          ·   Reductionofatleast30%intheinfantmortalityrateintheparticipatingNOAandNEAprovincesandatleast20%atnationallevelattheendof10years;
                              similarindicatorsforAPL2;
                          ·   AnnualPerformanceAgreement.Atleast50%ofallparticipantprovincesattheendofAPL1andAPL2;
                          ·   AuthorizedProviders.Atleast50%ofallauthorizedprovidersineachparticipatingprovince;and
                          ·   %ofTracerTargetsachieved.Atleast50%ineachparticipantprovinceattheendofAPL1andAPL2.

                         Thekeyhealthinterventions(tracers)forcashflowadjustmentforparticipatingprovincesare:
INDICATORS AND TARGETS
FOR RECEIVING PAYMENT
                          ·   Timelyinclusionofeligiblepregnantwomeninprenatalcareservices;
                          ·   Effectivenessofearlyneonatalanddeliverycare;
                          ·   Effectivenessofprenatalcareandpreventionofprematurebirths;
                          ·   Qualityofprenatalanddeliverycare;
                          ·   Medicalauditingofmaternalandinfantdeaths;
                          ·   Immunizationcoverage;
                          ·   Sexualandreproductivehealthcare;
                          ·   Wellchildcare(1yearoldoryounger);
                          ·   Wellchildcare(1to6yearsold);
                          ·   Includingindigenouspopulation.

                         Indicatorsofprogramresultstracklevelsofcoverageofthebeneficiarypopulationandtheeffectivenessoftheservicesprovided.Dataonlevelsofcoverage
MONTORING AND            arebasedonbaselinesurveys,updatedperiodically,andreportsfromserviceproviders.ThePMUconductsperiodicinternalauditstoverifythework
VALIDATION PROCESS       performedbytheprovidersandprovincesthroughdatabasescrosscheck,whileanindependentagencyofauditorscompletesthisprocessthroughregular
                         detailedreportsmonitoringtheprogressoftheprogram.

                         TheprojectisimplementedbytheMinistryofHealth,throughitsMCHIPmanagementunitwhichservesasthespecializedPMUandwillcontinueasthe
INSTITUTIONAL            "healthservicepurchasingunit"afterprojectcompletion.ThePMUworkswithparticipatingprovinceswhicharedirectlyresponsibletopurchaseCPBservices
ARRANGEMENTS             providedtobeneficiariesbythepublicandprivatesectors.TheGovernmentandtheBankmeetannuallytoreviewtheexperienceofthepreviousyearwith
AND ROLES                thecapitationsystemingeneralandaboutthecapitationamount,thelistoftracersandservicesincludeintheCPB,anddecideonspecificadjustmentsas
                         appropriate.

                         1) UmbrellaagreementsbetweenMOHandparticipatingProvincialMOHscoveringallpermanenttechnical,financial,administrativeandfiduciaryaspectsof
                            provincialparticipation;
CONTRACTUAL              2) AnnualperformanceagreementsbetweenMOHandparticipatingprovincesincludingannualtargetsfortracerconditions,enrollmenttargets,workprograms
ARRANGEMENTS                andresourcerequirements;and
                         3) Performanceagreementsandcontractualorquasi-contractualagreementsbetweenProvincialMOHsandauthorizedhealthcareproviders(publicand
                            private)coveringtheBPC,qualitystandards,paymentmechanisms,expectedresults,reportingrequirementsandsupervisionandinspection.

EVALUATION STRATEGY      TheBankloanfinancesimpactevaluationsinparticipatingprovinces.ThebaselinesurveyforAPL1wascompletedanddatacollectionfortheAPL2baseline
AND RESULTS              surveyisdone.

                         Resultstodatehavebeenexcellent.Enrollmentincreasedfrom50,000inJanuary2005toabout1,031,000inSeptember2009forAPL1andAPL2.The
                         programhasbeenexpandedto13additionalprovinces.ItappearsthattheIMRamongthetargetedpopulationunderAPL1hasdeclinedfasterthanforthe
STATUS REPORT            countryasawhole.

                         Implementationperformanceratings:SatisfactoryforbothDOandIPintheJune2009ImplementationStatusandResultsReport(ISR).




  2                                                                                                                    COUNTRY SNAPSHOT ARGENTINA