CURRENCY EQUIVALENTS Exchange Rate Effective April 30, 2015 Currency Unit = Argentine Peso ARS$8.90 = US$1 US$0.11 = ARS$1 FISCAL YEAR January 1 – December 31 ABBREVIATIONS AND ACRONYMS AMI BOD Myocardial Infarction Burden of Disease COFESA Federal Health Council (Consejo Federal de Salud) COPD Chronic Obstructive Pulmonary Disease CPS CVA Country Partnership Strategy Cerebral-Vascular Accident Trial
Maria Eugenia Team Leader (ADM Responsible) Senior Economist Senior Economist Luis Orlando Perez Team Leader Sr Public Health Spec. Senior Public Health Specialist GHNDR Alvaro Larrea Procurement Specialist Senior Procurement Specialist Senior Procurement Specialist Alejandro Roger Solanot Financial Management Specialist Sr Financial Management Specialist Sr Financial Management Specialist GGODR Daniela Paula Romero Team Member Operations Officer Operations Officer GHNDR Fabiola Altimari Montiel Counsel Senior Counsel Senior Counsel Isabel Tomadin Social Specialist Consultant Consultant, Social Specialist GSURR Marcelo Hector Acerbi Environmental Specialist Senior Environmental Specialist Senior Environmental Specialist GENDR Marcelo Roman Morandi Environmental Specialist Consultant Consultant, Environmental Specialist GENDR Maria Gabriela Moreno Zevallos Team Member Program Assistant Program Assistant GHNDR Silvestre Rios Centeno Team Member Team Assistant Team Assistant LCC7C Vanina Camporeale Team Member Senior Operations Officer Senior Operations Officer GHNDR Victor Manuel Ordonez Conde Team Member Senior Finance Officer Disbursement WFALN Extended Team Name Title Office Phone Location Juan Sanguinetti Economist La Oscar Lopez IT health specialist Buenos Aires Pedro Osvaldo Rico Cordeiro . Locations Country First Administrative Division Location Planned Actual Comments Argentina Misiones Provincia de Misiones X Argentina Formosa Provincia de Formosa X X
Indicator Name Core Unit of Measure Baseline Cumulative Target Values Frequency Data Source/ Methodology Responsibility for Data Collection YR1 YR2 YR3 YR4 End Target Prevalence of tobacco consumption among vulnerable population. Percentage 33 N/A N/A 32 N/A 31 Annual Prevalence data from National Risk Factor Survey and telephone surveillance system DNCDs Prevalence of sodium consumption among vulnerable population. Percentage 29 26 22 20 18 16 Annual Prevalence data from National Risk Factor Survey and telephone surveillance system DNCDs
Table A2.3 Multisector Interventions Designed to Reduce NCD Risk Factors, Organization for Economic Cooperation and Development and the Americas Risk factor Cost- effectiveness Intervention Examples of successful interventions at the international level Interventions selected in Component 2 Sectors involved Unhealthy diet Best buya Salt-reduction strategies North Karelia, Finland, community program subsequently extended nationwide Salt-reduction strategies focused on foods consumed by the poor (i.e., breads, cold cuts, canned foods) Agriculture, health, food industry, food retail industry, advertising industry, city governments, the legislature, others Replacing trans fats • New York City, ban on fats • Denmark, legislation regulating trans fat levels in processed foods • Puerto Rico, ban on trans fats Monitoring of Food Code application to reduce amount of trans fats in processed foods Nutrition labeling • United Kingdom, food labeling (Traffic Light System) • United States, 1994 Nutrition and Education Bill • New York City, regulation on calorie content in restaurants • United States, 2010 Health Care Act extended requirement of nutritional labels on to chain restaurants nationwide Social-media campaigns • United States, “5-A-Day” campaign to increase consumption of fruits and vegetables • Wheeling, West Virginia (U.S.), “1% or less” campaign to switch to low- or no-fat dairy products to reduce heart disease • Europe, EPODE project Social campaigns focused on dietary habits more prevalent among the poor Other Regulating advertising on marketing of foods and beverages high in salt, fat, and sugar, especially to children • Industry self-regulation: International Chamber of Commerce Code, School Beverage Guidelines, Children’s Food and Beverage Advertising Initiative • United Kingdom, statutory regulation on advertising Taxes and subsidies to promote healthy diets • United States, taxes on sodas • Poland, elimination of butter and lard subsidies
Physical inactivity Best buya Social campaigns • United States, VERB campaign • Brazil, “Agita São Paulo” program Social campaigns focused on physical activity habits more prevalent among the poor City governments, urban planning, transport, health, civil society organizations, the media Effective with insufficient evidencec Modifying the built environment to increase physical activity • New York City, bike lanes and bike paths • Bogotá, Colombia, sustainable public transportation, Ciclovía, CicloRutas, and outdoor gyms Modifying the built environment to promote physical activity among vulnerable groups programs to improve nutrition and increase physical activity Effective with insufficient evidencec Work-based programs United States, “Treatwell 5-a-Day” program to increase fruit and vegetable consumption Agriculture, health, food industry, food retail industry, schools, work places, food retailers, others School-based programs • United States, and Adolescent Cardiovascular Health (CATCH) • United States, Pathways (randomized control among American Indian schoolchildren) Other programs • North Karelia, Finland, decreasing salt and fat consumption and increasing fruit and vegetable consumption • Europe, EPODE • Mexico, National Accords for Food Health; Technical Guidelines for the Sale and Distribution of Food and Beverages in Education Establishments Tobacco use Best buya • Fiscal measures banning smoking in public places • Raising awareness and increasing knowledge about dangers of tobacco use • Several successful examples worldwide • Uruguay’s tobacco-control policy may be Latin America and the Caribbean’s most successful effort in this regard Support to tobacco- control policy application Finance, health, legislature, international organizations, tobacco industry, civil society organizations Source: Bonilla-Chacin 2014. Note: The table includes most of the programs reviewed for this study. a. “Best buys” are interventions that the World Health Organization (WHO) considers as “cost-effective, low cost, and can be implemented in low resource settings.” World Health Organization, Global Status Report on Noncommunicable Diseases (Geneva: WHO, 2011). b. These are other cost-effective interventions that are not among WHO’s “best buys.” c. are effective interventions for which there is insufficient evidence on their cost-effectiveness.
monitoring of patients’ conditions; the continuity of care; when combined with clinical support systems, could also support the implementation of evidence-based clinical guidelines; and when combined with other eHealth tools to communicate with patients, could also support self-care. The implementation would be a lengthy process, at the moment, the paper-based adult clinical record is relatively new and it is not commonly used. Percentage of public PHC facilities certified to provide quality services for the detection and control of patients with NCDs • The indicator will be constructed as: Numerator: Number of selected PHC facilities that have developed in the province. Denominator: Total number of selected public PHC facilities in the province. • PHC facilities that have developed the chronic disease care model refer to those that offer a minimum set of conditions that favors the implementation of MAPEC. This will be evaluated with an instrument designed from the adaptation of the Assessment of Chronic Illness Care (ACIC) internal client version 3.5. A facility will meet the minimum set of conditions to provide quality services if it scores 10 points in this instrument. • The selected public PHC facilities are that concentrate 70 percent of all the care Biannual Report from certification teams validated by the provincial area for NCDs and certified by DNCDs. The information provided in the report will be verified by a third-party agent.
by contributory social insurance schemes. Regular analysis and reporting of integrated information on NCDs, injuries, and risk factors have been carried out During the first year, this indicator refers to the identification and integration of various sources of information at the provincial level related to NCDs, injuries, and their risk factors and the production of a first report. For the next years, it refers to production of regular reports each semester. Annual Report presented by the provincial NCDs area and validated by DNCDs The information presented in the report does not require third-party verification. Note: DNCDs = Directorate of Health Promotion and Control of NCDs; MAPEC = Care Model for People with a Chronic Condition (Modelo de Atención de Personas con Enfermedades Crónicas); NCD = noncommunicable disease; PDNCD = Provincial Directorate of Noncommunicable Diseases; PHC = primary health care; PMOH = Provincial Ministry of Health.
Table A3.1 EEPs, Project Activities, and TLIs under Components 1 and 2 EEPs Component Project activities TLIs Personnel Payroll: Permanent Personnel Temporary personnel Non-personnel services: Basic services i. Water ii. Electricity iii. Gas iv. Telephone, Internet, videos v. Cellular phones vi. Post Component 1 training of PHC facility personnel on early detection and effective control of NCDs, including support for patients’ self-care Hands-on training in clinical process reforms needed to ensure coordination, continuity of care, support for patients’ self-care, etc. Creation, adaptation, distribution, and implementation of NCD clinical guidelines at PHC facilities and hospitals, to ensure clinical decision making Training of PHC facility personnel to adopt electronic medical records to support the coordination and continuity of care Seminars on NCDs for PMOH personnel Gatherings, consultations, and working meetings between health centers and hospital teams Percentage of public PHC facilities with personnel trained to provide quality health services Percentage of public PHC facilities that are implementing electronic medical records Percentage of public PHC facilities certified to provide quality services for the detection and control of patients with NCDs Provincial PHC facilities certification teams working according to an approved action plan
Component 2 Gatherings, consultations, and working meetings with municipal authorities, councilors, and society groups at the local level Participation in the intersector groups at the municipal that are part of the National Program on Healthy Municipalities and Communities Design and/or adaptation of national health promotion policies and implementation Support for the municipal authorities in the creation of ciclovías (i.e., temporary closings of main roads to transport vehicles, providing security to the users) Lobbying for regulation enactment at the municipal level related to tobacco control and sodium and trans-fat control Gatherings, consultations, and working meetings with the food industry to for inclusion in agreements to reduce sodium and trans fats Percentage of vulnerable population groups with increased opportunities for physical activity in participating municipalities Percentage of vulnerable population groups protected against secondhand tobacco smoke in participating municipalities Percentage of vulnerable population groups protected against excessive sodium consumption in participating municipalities
of various promotional materials Component 1 and Component 2 Development of an overview of the NCDs and injuries situation in the province Development of a diagnostic of the situation of NCD promotion, prevention, and control activities (i.e., the situation at PHC facilities, care networks, regulation, promotion activities at schools and municipalities, and others) Development of NCD-related lines of work and their execution plans Creation of an institutional structure responsible for the execution of the activities included in the plan Definition of and responsibilities Development and dissemination of bulletins or reports describing the health situation in the provinces related to NCDs, injuries, and their risk factors, with the aim of helping identify priority action areas and decision (i) Provincial units in charge of surveillance, promotion, prevention, and control of NCDs and their risk factors are functioning; and (ii) the participating province has signed its Annual Performance Agreement Regular analysis and reporting of integrated information on NCDs, injuries, and risk factors have been carried out.
(i) Provincial units in charge of surveillance, promotion, prevention and control of NCDs and their risk factors are functioning; and (ii) the Participating Province has signed its Annual Performance Agreement. Annual YES/NO Agreement signed and formal document indicating the unit has been created. 30% 7,860,000 YES/NO Agreement signed and formal document giving account of the unit work. 10% 6,550,000 YES/NO Agreement signed and formal document giving account of the unit work. 6% 3,144,000 YES/NO Agreement signed and formal document giving account of the unit work. 6% 2,358,000 YES/NO Agreement signed and formal document giving account of the unit work. 6% 1,572,000 21,484,000 Percentage of vulnerable population groups with increased opportunities for physical activity in participating municipalities. March 2% 3% 786,000 7% 4% 2,620,000 12% 4% 2,096,000 17% 3% 1,179,000 22% 3% 786,000 15,589,000 Sept 5% 3% 786,000 10% 5% 3,275,000 15% 4% 2,096,000 20% 3% 1,179,000 25% 3% 786,000 Percentage of vulnerable population groups protected against second hand tobacco in participating municipalities. 2% 3% 786,000 7% 4% 2,620,000 12% 4% 2,096,000 17% 3% 1,179,000 22% 3% 786,000 15,589,000 Sept 5% 3% 786,000 10% 5% 3,275,000 15% 4% 2,096,000 20% 3% 1,179,000 25% 3% 786,000 Percentage of vulnerable population groups protected against excessive sodium March 2% 3% 786,000 7% 4% 2,620,000 12% 4% 2,096,000 17% 3% 1,179,000 22% 3% 786,000 15,589,000 Sept 5% 3% 786,000 10% 5% 3,275,000 15% 4% 2,096,000 20% 3% 1,179,000 25% 3% 786,000
consumption in participating municipalities. Regular analysis and reporting of integrated information systems on NCDs, injuries and risk factors have been carried out. Annual YES/NO and integration of data bases 6% 1,572,000 YES/NO Definition of the evaluation framework for the data 6% 3,930,000 YES/NO of priority studies 8% 4,192,000 YES/NO of studies 8% 3,144,000 YES/NO of studies 8% 2,096,000 14,934,000 26,200,000 65,500,000 52,400,000 39,300,000 26,200,000 209,600,000 Note: PHC = primary health care; NCD = noncommunicable disease.
Procurement training and supervision Procurement specialist 6 SWs Financial management and disbursement training and supervision Financial management specialist 4 SWs Environmental training and supervision Environmental specialist 2 SWs Social safeguard supervision and reporting Social specialist 2 SWs 12–48 months Task leadership 2 TTLs 15 SWs Task leadership Technical review of Project documents Public health specialist 15 SWs Technical review of Project documents Operations support and supervision Operations officer 20 SWs Operations support and supervision Procurement training and supervision Procurement specialist 6 SWs Procurement training and supervision Financial management and disbursement training and supervision Financial management specialist 2.5 SWs Financial management supervision Environmental training and supervision Environmental specialist 2 SWs Environmental training and supervision Note: NA = not applicable; SW = staff weeks; TTL = task team leader.
countries of the Caribbean and Haiti). In Argentina, the costs of caring for a diabetes patient are estimated at US$3,000 if hospitalized, and US$500 without hospitalization. This represents a total cost for the Argentine health system of at least US$450 million per year. In short, at a conservative estimate, the main NCDs cost the Argentine health system at least US$1.5 billion per year—not counting the expenses incurred by families or productivity losses owing to NCD-related premature death and/or disability. Project Beneficiaries and Expected Impact The Project involves specific primary NCD prevention actions targeting the population at and several improvements in NCD care and prevention in public health establishments. Better NCD care services will benefit an estimated 3.2 million people, considering the population in the highest-risk age bracket (40–64 years) with public health coverage. The proposed interventions will generate significant direct benefits in terms of potential life years gained. The direct benefits are associated with savings in the health system resulting from avoided hospitalizations, medical consultations, and treatment for the population exposed to risk factors and lower (nonmedical) expenses paid by the families for care and services for family members with NCDs. The indirect benefits are associated with productivity gains in the labor market as a result of a reduction in the number of premature deaths and disabilities and better quality of life for the population. The project acts on the main NCD risk factors and NCD care simultaneously. There are two clearly differentiated groups of beneficiaries: first, the general population affected by risk factors such as exposure to tobacco, inadequate diet, or physical inactivity, and, second, persons who are currently suffering from an NCD, or who could suffer from one in the very near future, and are attended in the public health subsector. To estimate the health impact of the interventions proposed in this preliminary economic evaluation, a set of targets was defined relating to the prevalence of certain risk factors directly associated with NCDs, on information obtained from the 2010–16 Federal Health Plan and a recent study on setting NCD risk factor targets. Table A6.3 shows baseline data on the risk factors and a projected scenario for 2024, according to the effectiveness of the proposed interventions. Table A6.3 Prevalence of Risk Factors in Persons over Age 18 Years