Program to Support the Strengthening of the National Health System

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Health outcomes in the DR have shown improvements over the last two decades, but still lag the LAC regional average, particularly in maternal and neonatal outcomes. Despite global declining trends in maternal mortality, the maternal mortality ratio in the DR increased from 80 deaths per 100,000 live births in 2000 to 95 deaths in 2017, surpassing the LAC regional average of 74 deaths per 100,000 live births in the same year. Similarly, the DR suffers from an under-five mortality rate that is more than double the LAC regional average, with 34 per 1,000 live births in 2020, compared to a regional average of 16. The neonatal mortality rate is 2.5 times higher, with the DR reporting 23 deaths per 1,000 live births in 2020, compared to LAC’s average of nine in the same year. These concerning figures take place in the context of an epidemiological transition where non-communicable diseases (NCDs) and climate change impacts are increasingly placing stress on the health system. This worrying performance takes place in a context of epidemiological transition, and as non-communicable diseases (NCDs) place increasing pressure on the health system, there is an even greater need to improve these basic health outcomes.The limited capacity to deliver quality public health care services begins at the primary level of care. The MISPAS certifies that healthcare providers are licensed or “habilitated” based on their capacity to meet minimum standards related to infrastructure, equipment, human resources, and documentation (e.g., permits, certificates). However, only 21 percent of the SNS health centers (390 of 1887), possess a license, indicating a significant gap in basic quality assurance. Common concerns cited include infrastructure that does not meet minimum required standards (insufficient space, storage, warehouses, etc.) and multiple occupational hazards for workers. Promoting habilitation is needed not only to improve the capacity to deliver quality health services, but also to strengthen the financial sustainability of the SNS as this licensing would enable SNS hospitals to receive financing from SENASA (and private ARS) and for SENASA to pay lower tariffs than if it were to purchase the same services in the private sector. The PDOs of the Project are improve the capacity of public healthcare providers to deliver quality services, with an emphasis on maternal and neonatal care, and to strengthen the stewardship capacity of the Ministry of Public Health and Social Assistance. The Project is structured around four components: (1) strengthening the capacity to deliver quality public healthcare services; (2) strengthening the stewardship and public health oversight function of the MISPAS; (3) reinforcing health information systems and digital health tools; and (4) project management. Component 1. Strengthening the Capacity to Deliver Quality Public Health Care Services. This component will finance activities aimed at improving the capacity of public health care providers to deliver quality services. Project financing will mainly support (a) investments in health infrastructure, equipment and documentation that are necessary to enable targeted public health providers (both hospitals and primary health centers) to obtain their MISPAS habilitation certification (i.e., accreditation); and (b) the implementation of an integrated strategy to improve the quality of maternal and neonatal care in targeted health facilities. Component 2. Strengthening the Stewardship and Public Health Oversight Function of the MISPAS. This component focuses on investments aimed at strengthening the stewardship and public health oversight function led by MISPAS at the central level and implemented through its DPS/DAS at the local level. The component includes investments to improve DPS/DAS and MISPAS HQ in terms of infrastructure and equipment, increase storage and distribution capacity, and strengthen the skills of MISPAS personnel through capacity building. The component also includes strategies to improve management and care models and activities to improve the knowledge generation capacity of the MISPAS. Component 3. Reinforcing Health Information Systems and Digital Health Tools. This component is transversal, as it contributes to enhancing the capacity to deliver quality public health care services, as well as to strengthening the stewardship and public health oversight functions of the MISPAS. Activities of component 3 include contributing to the development of a unified electronic health record system and to the MISPAS digital transformation process through investments in health information systems and digital tools and technological infrastructure. Component 4. Project Management. This component would finance the coordination, implementation, and management of project activities, including fiduciary tasks, env ironmental and social risk management, and monitoring and evaluation (M&E).