The Ministry of Health of Argentina and the Inter-American Development Bank hosted a consultative meeting on July 5, 2019 at the National Center for Science in Buenos Aires to launch the report of the Lancet Global Health Commission on High-Quality Health Systems in the SDG Era and deliberate on improving health system quality in Argentina. In attendance were the State Secretary for Health, Prof. Adolfo Rubinstein, the State Secretary for Science, Technology and Productive Innovation, Dr. Lino Barañao, the Director of Health and Social Protection of the Inter-American Development Bank, Dr. Ferdinando Regalia, HQSS Chair Prof. Margaret Kruk, HQSS Commissioner and Director for Health Care Quality and Patient Safety at the Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Ezequiel Garcia-Elorrio, National Director of Quality in Health Services and Health Regulation, Dr. Mariela Barani, several functionaries from the national and provincial governments and a section of Argentine academics, researchers and health providers from the public and private sectors. Dr. Kojo Nimako, Doctor of Public Health Candidate at the Harvard Chan School of Public Health and member of the HQSS team, joined the visit.
Dr. Barañao, in his welcome address, noted that the translation of research into practice is important for the improvement of healthcare in the country. He indicated that the National Scientific and Technical Research Council (CONICET) of Argentina is increasingly interested in the transfer of knowledge from the bench into clinical practice and from there to a high-quality health system.
In his remarks, State Secretary for Health, Prof. Rubinstein noted that Argentina guarantees access to healthcare for all its citizens, but there remain significant concerns about quality and equity. The government’s goal for the health sector is to move from nominal to effective universal health coverage. This is to be done through three main initiatives: 1) expansion of primary care, 2) ensuring care continuity through interoperable information systems, and 3) enhancement of monitoring and evaluation of quality. Additionally, the government is developing a set of indicators to monitor the country’s progress towards effective UHC, which will include measures on patient experience and satisfaction with the health system. Prof. Rubinstein commented that the timing of the HQSS report is opportune since it provides a resource for thinking through strategies to improve health system quality in Argentina.
Presenting the HQSS Commission’s findings, Chair of the Commission, Prof. Margaret Kruk, stated that in Argentina in 2016, there were 39,000 deaths that could have been prevented by the health system, about three-quarters of which were due to poor quality. While Argentina had exceeded the global SDG targets for maternal and child health on average, there were considerable inequities across provinces and wealth strata and the health system was struggling under a large burden of non-communicable diseases. Prof. Kruk identified the strong base of investments, policies, and leadership, the urban and literate population, the push towards effective universal health coverage, and the presence of local and regional quality improvement examples as assets in Argentina’s efforts to improve system-wide quality.
The presentation was followed by a panel discussion involving health regulators, policy makers, researchers, funders and a patient representative. A common theme was that quality in Argentina needed to be measured in a systematic, ongoing and transparent way, with the patient voice playing a central role. Further, patients needed a reliable means to obtain redress for poor-quality care and health system research capacity needed to be enhanced.
In addition to the main launch event, a technical working session was hosted by the Inter-American Development Bank on July 4 to present key national policies on quality improvement and to identify challenges and propose solutions to improving health system quality. Participants included health system managers and policy makers from the national and provincial health ministries. Presentations were given on the UHC strategy of Argentina, Argentina’s national quality guarantee, initiatives to strengthen vital registration and measurement of health indicators and on regionalization of maternal and newborn care. A presentation was also given on the experiences of San Juan Province in improving the quality of primary care.
After the presentations, breakout sessions were held during which participants deliberated on the quality of Argentina’s health system. The principal bottlenecks identified to be hindering health system quality were the fragmentation of health financing and service delivery (between public, social security and private sectors), the non-central role of quality in health system strategies, lack of dedicated funding for quality improvement and poor-quality fragmented health system data. Some of the proposed solutions included empowering patients to demand quality, engendering a quality culture among health providers and increasing funding for quality improvement.
On the sidelines of the main events, Prof. Kruk and Dr. Nimako visited two primary health centers and one specialized care hospital in Buenos Aires where they interacted with healthcare providers and facility managers to understand the facilitators and barriers to quality care. All the facilities visited were well-equipped to provide quality care to the patient population. Managers at the specialist hospital indicated that the demand for care from lower levels of the health system was far greater than they could provide, suggesting sub-optimal care capacity in general hospitals . Health center managers indicated that the zoning of the city eased planning, but there was significant utilization from people outside the assigned zones and even from outside Buenos Aires, suggesting that access and/or quality were concerns for these patients where they lived. Prof. Kruk also met with staff and researchers at the Institute for Clinical Effectiveness and Health Policy (IECS) to discuss ongoing and future research.
The IDB and the Ministry of Health are exploring potential opportunities for collaboration with the HQSS and local researchers in the areas of redesigning urban primary care and updating measurement of health system quality, particularly patient voice.