Uruguay COVID-19 Emergency Response Project

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Uruguay has one of the most developed health systems in Latin America. A robust matrix of social programs, relatively low levels of inequality for the region, and low levels of poverty have contributed to making the country a regional leader in several wellbeing indices, such as the Human Development Index, the Human Opportunity Index, and the Economic Freedom Index. Health has been a top priority for the government over the past two decades. Since 2005, public spending on health has increased until almost converging with the OECD average (as of 2017). Total health expenditure reached 9.3 percent of GDP in 2016. In addition, the country embarked on a reform of the health sector that strove to improve institutional, financial, and health service delivery methods. The reform included the creation of the National Health Integrated System (NHIS), unifying the rules for public and private health service insurers and providers (Collective Medical Care Institutions—Instituciones de Asistencia Medica Colectiva) and establishing a common Integrated Health Care Plan, (Plan Integral de Atencion en Salud – PIAS) for everyone through two parallel mechanisms: (i) the National Health Insurance (Seguro Nacional de Salud - NHI), financed through a uniform contributory scheme, which covers formal workers and their families, as well as the retired population—who jointly represent nearly 70 percent of the population; and (ii) the Public Health Provision, a non-contributory scheme that covers the uninsured population (the remaining 30%, including the most vulnerable groups), through the State Health Services Administration (Administracion de los Servicios de Salud del Estado – ASSE), a public network of Health Service Providers (HSP) that also serves about 20 % of NHI beneficiaries, who choose it as their preferred healthcare provider.The Project under the Global MPA will support the country’s COVID-19 response and strengthen the detection and response capacity of the Uruguayan NHIS to the threat posed by COVID-19. It will consist of two components. The first component will provide immediate support to Uruguay in limiting COVID-19 local transmission through containment strategies and strengthening the capacity of the health system to treat COVID-19 critical cases. Subcomponent 1.1 (Case Detection, Confirmation, Contact Tracing, Recording, Reporting) will reimburse the National Health Fund (FONASA) the cost of delivery by NHI beneficiary of specific health services such as COVID-19 tests. Subcomponent 1.2 (Health System Strengthening) will reimburse FONASA the unit cost of delivery of critical healthcare treatments, such as ICU days by NHI beneficiary. Subcomponent 1.2 will also finance the procurement of protective medical supplies, inter alia, Personal Protection Equipment (PPE), mask, globes, testing kits and medical equipment to strengthen the capacity of the public network of HSPs. The second component will support the strengthening of public sector project management and coordination.