Strengthening the purchasing function through results-based financing in a federal setting: lessons from Argentina’s Programa Sumar

Overview

Following a profound economic crisis in 2001, Argentina launched a set of reforms to strengthen the budget-funded, decentralized government health system to ensure effective coverage for the growing population without explicit health insurance.  Programa Sumar provided conditional budget transfers from the central level to provincial governments, linked to performance indicators. These were introduced to improve the coverage of a package of prioritized preventive health services by incentivizing the use of more strategic purchasing methods by provincial health authorities, with the ultimate objective of reducing morbidity and mortality.

Argentina’s Programa Sumar has contributed to the development of strategic purchasing within each of its provincial ministries of health, using the conditions attached to a small amount of central level funding to induce change in how the provinces used their own resources.  A key contributor to the success of this program has been to empower both providers and the provincial purchasers the autonomy to decide how to use the additional funds.  As implementation has progressed, the benefits covered have also expanded.  Programa Sumar has shown that it is possible to reconcile the immediate needs of the poor, while introducing ambitious innovations in the health financing system of a federal country through conditional budget transfers based on the idea of results-based financing. As such, this analysis provides important lessons for other countries working to implement health financing reforms in highly devolved or federal settings.