Pan American Health Organization

Argentina

  • Overall Context
  • Leading Health Challenges
  • Health Situation and Trends
  • Outlook
  • References
  • Full Article
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Overall Context

Flag of ArgentinaThe Argentine Republic covers an area of 3,761,274 km2 and consists of 23 provinces located in five geographic regions: Noroeste, Noreste, Cuyo, Centro or Pampeana, and Patagonia. The form of government is representative, republican, and federal.

Nearly 65% of the population is concentrated in the Centro region, particularly in the province of Buenos Aires, where 38.9% of the country’s population lives, and, more specifically, in the Autonomous City of Buenos Aires (Ciudad Autónoma de Buenos Aires, or CABA) and its surrounding area. In 2010, the country’s population was 40,117,096, of which 91% lived in urban areas, with a male-to-female ratio of 0.95:1. The population estimate for 2014 was 42,669,000.

As of 2010, the composition of the population by broad age groups varied significantly between provinces. The lowest percentage of children and young people was in CABA (16.3%), and the highest, in the province of Misiones (32.5%). CABA also had the highest proportion of adults aged 65 years and older (16.4%), while the province that includes Tierra del Fuego, Antarctica, and the South Atlantic Islands had the lowest (3.8%).

Figure 1. Population structure, by age and sex, Argentina, 1990 and 2015

Between 1990 and 2015, the country’s population increased by 32.7%. In 1990, the population pyramid was expansive in the over-15 age groups, with a trend toward stationary in the younger age groups. In 2015, this latter trend expanded to include the under-40 age groups, reflecting lower fertility and mortality rates and increasing life expectancy at birth over the last four decades.

Source: Pan American Health Organization, based on data from the United Nations Department of Economic and Social Affairs. Population Division. 2015 Revision.

According to the 2010 census, migrants accounted for 24.3% of the population, a figure comparable to that seen in the previous three censuses. Immigrants from bordering countries and from Peru accounted for 3.5% of migrants, with immigrants from elsewhere representing 0.9%.

The indigenous population is 955,032, or 2.38% of the total population; they belong to 31 groups who live in different parts of the country. Patagonian is the region with the highest proportion of persons who identify as indigenous (6.9% of that region’s population), while the highest absolute number of indigenous people (248,516) reside in the metropolitan region that includes CABA and the 24 administrative divisions (partidos) of greater Buenos Aires. Approximately 149,493 people identify as being of African descent ().

The main threats to public health in Argentina are volcanic eruptions, floods, earthquakes, landslides, and mudslides after major snowfalls, tornados and storms, heat waves, wildfires, toxic materials in facilities or in transit, disease outbreaks, epidemics, and pandemics.

The Health System

Argentina’s health system is one of the most fragmented and segmented in the Region of the Americas. It includes the public and private sectors and the social security sector. Such fragmentation is largely determined by the country’s federal structure, in that each of the 23 provinces functions independently and has constitutional responsibility for the leadership, financing, and delivery of health services. Historically, the social security system, which also has developed in a fragmented fashion, includes about a 100 different agencies.

The public sector comprises the national and provincial health ministries, plus a network of hospitals and public health centers that provide free care to anyone who needs it, particularly those in the lower income quintiles who lack social security coverage or who cannot pay for services (36% of the population) ().

The compulsory social security sector is organized around national and provincial obras sociales. There are more than 200 of such entities at the national level, accounting for expenditures of 1.59% of the gross domestic product (GDP); expenditures of the 23 provincial obras sociales, which cover civil servants in their own jurisdictions, represent 0.74% of GDP. National-level obras sociales are regulated by the Superintendency of Health Services (SSS, for its Spanish acronym), which is charged with ensuring that health services offered to its beneficiaries adhere to current policies and regulations.

The private sector consists of health professionals and facilities that offer services to private clients and to beneficiaries of the obras sociales and private insurers. This sector also includes more than 100 voluntary insurance entities known as medical prepayment companies; they are financed through premiums paid by families or companies and by funds from contracts with obras sociales. Private insurance entities serve 8% of the population.

The health system’s fragmentation falls into three broad areas: i) coverage, since not all the population has access to the same health benefits and services; ii) regulatory functions, since leadership and regulatory authority are spread throughout 24 jurisdictions and various subsectors; and iii) geographic disparities, given the extreme economic-development differences from region to region. The national health authority—given the resources it administers and the country’s federal structure—is limited in how effectively it can require provincial governments to adhere to new national legislation that involves structural change. The only way to effect such changes is through broad consensus, something that has been attempted through federal health plans and by strengthening the role of the Federal Health Council (COFESA). The 12 objectives of the national health sector include universal health coverage, development of an agency to evaluate health technology, and creation of a quality accreditation system.

Leading Health Challenges

Critical Health Problems

Emerging Diseases

As of this writing, dengue, chikungunya, and Zika viruses are in circulation in Argentina (). Dengue transmission is characterized by sporadic major outbreaks, such as those in 2009 and 2013, interspersed with periods of low transmission. In 2016, the first autochthonous cases of chikungunya virus infection were reported; they occurred only in the provinces of Salta and Jujuy. Vector-borne autochthonous transmission of Zika in the province of Tucumán was also reported, with sexual transmission reported in the province of Córdoba.

Because large portions of the population have no immunity to these arboviruses, which are associated with the presence of the Aedes mosquito in extensive areas, there is a good likelihood that future outbreaks will occur, with potentially serious consequences for the country.

Given the absence of autochthonous cases of malaria since 2010, transmission of this disease may be considered interrupted, although post-elimination surveillance is a significant challenge, especially in the border areas, where new cases must be detected in a timely manner to prevent reestablishment of the disease.

Neglected Diseases and Other Infections Related to Poverty

Addressing Chagas disease is considered to be a high priority for Argentina. In 2014, infection by Trypanosoma cruzi affected 2.5% of pregnant women and 5.7% of children through congenital transmission (). Action needs to be expanded to combat the vector and control congenital transmission, which is estimated to infect 0.21 infants per 100 live births (). The interruption of vector-borne transmission has already been achieved in 8 of the 19 endemic provinces¾Entre Ríos, Jujuy, La Pampa, Misiones, Neuquén, Río Negro, San Luis, and Santa Fe.

Visceral leishmaniasis is a new phenomenon in the Noreste region. Although there are few reported cases—an average of 11 per year over the past five years—the disease is a matter of concern, given the difficulties involved in controlling it.

Maternal Mortality

In 2015, the maternal mortality rate for the country as a whole was 3.9 deaths per 10,000 live births, ranging from a high of 8.1 in Salta to a low of 1.9 in CABA, Santa Fe, and La Pampa; this disparity highlights the extreme inequalities that persist from province to province, even though the causes of death themselves remain the same (). Direct obstetric causes were responsible for over 50% of maternal deaths in 2010-2014 (Table 1). The high numbers recorded in 2015 in the provinces of Formosa (7.5 per 10,000), Chaco (7.3 per 10,000), Misiones (5.9 per 10,000), and San Juan (5.9 per 10,000) reflect these provinces’ precarious socioeconomic conditions, low levels of education, and access to basic information, and difficulties in accessing quality health services. Despite the existence of national and/or provincial plans designed to reduce the maternal mortality ratio, there is a need to implement comprehensive and sustained actions that reach all of society.

Malnutrition

According to the 2009 and 2013 national risk factor surveys, the prevalence of overweight in the population older than 18 years rose from 35.4% in 2009 to 37.1% in 2013, while obesity rose from 18.0% to 20.8% in the same period. This calls for the development and implementation of public policies that deal with the regulation of food advertising directed at children, the taxation of sugar-sweetened beverages, and the prominent placing of package label warnings.

A 31.6% reduction in the consumption of salt between 2009 and 2013 attests to a cultural change that represents a victory for the Ministry of Health’s campaigns to change the use of saltshakers at table, such as the “Menos Sal, Más Vida” (“less salt, more life”) initiative. In addition to the decline in the amount of salt that consumers add to their food, the salt content of various processed foods has been reduced by between 5% and 18% through voluntary agreements with the relevant industries.

As part of the “Argentina 2014 Free of Trans Fats” campaign, the Ministry of Health; the Ministry of Agriculture, Livestock, and Fishing; representatives of provincial food protection agencies; and industry worked together to modify the Argentine Dietary Code (Código Alimentario Argentino). The new standards mandated that trans-fatty acids in industrially produced foods should not exceed 2% of total fats in vegetable oils and margarines intended for direct consumption, and not exceed 5% of total fats in other foods ().

Human resources

There are 3.6 physicians and 3.2 hospital beds per 1,000 inhabitants in the country overall, with significant differences between jurisdictions. The Autonomous City of Buenos Aires, for example, has 10.2 physicians and 7.3 beds per 1,000 inhabitants, compared with 1.2 physicians and 1.1 beds in the province of Misiones ().

Health Knowledge, Technology, and Information

Argentina has a long tradition of human resource education and the development of basic research in the biomedical sciences. In recent years, private financing for scientific activity has steadily increased, though the public sector remains the most important source of funding; the National Scientific and Technical Research Council (CONICET) awards most of the country’s fellowships for basic and applied research. Currently, 30.3% of that institution’s researchers are working in the biomedical sciences, with their numbers having increased by more than 200% in the last 12 years.

Argentina ranks second among Latin American countries in terms of the number of national medical journals indexed by the Thomson Institute for Scientific Information (ISI), with six such publications. The National Health Sciences Information Network (Red Nacional de Información en Ciencias de la Salud, or RENICS), which is coordinated by the Library of the National Academy of Medicine of Buenos Aires, brings together 87 different documentation centers. The Virtual Health Library (VHL) is used to provide input for the database of the National Health Sciences Bibliography (Bibliografía Nacional en Ciencias de la Salud, or BINACIS) ().

The Scientific Electronic Library Online (SciELO) has a total of 128 journals that can be consulted through its website, of which 15 are in the health sciences ().

The Electronic Library of Science and Technology makes it possible for the country’s researchers to access the full text of books, scientific and technical journals, and reference databases through the Internet ().

The National Statistical System, which is coordinated by the National Institute of Statistics and Census, gathers all entities that produce statistics. Information relevant to health is coordinated at the national level by the Ministry of Health’s Directorate of Health Statistics and Information (Dirección de Estadísticas e Información de Salud, or DEIS), which is responsible for producing vital statistics, statistics on the population’s living conditions and health problems, and information on the availability and use of resources. DEIS is responsible for coordinating and regulating the collection of specific statistical data on health programs; since 1996 it has participated in the Pan American Health Organization (PAHO)/World Health Organization (WHO) initiative on basic health indicators, including Argentina in a common database for the Region of the Americas ().

The Ministry of Health has worked to strengthen health surveillance by implementing the National Health Surveillance System. The system, which operates through an online platform, integrates clinical and laboratory surveillance strategies and strategies involving sentinel units and specific programs, as a way to make information available online to various decision-making entities ().

The Environment and Human Security

Argentina’s geographic location and production profile makes the country particularly at risk for the effects of global warming. In the last 50 years, average temperatures rose an average of half a degree, and in the case of Patagonia, by one degree. If the current trend continues, forecasts for the 2080 decade call for possible increases of up to 4°C in the north and 2°C in the south, bringing higher levels of hydric stress and increased drought, and desertification. The incidence of waterborne diseases and the distribution of food and vectors could be affected by this change (). In recent decades, the spread of the Aedes aegypti vector in the country and the historical dengue outbreak in 2016 are examples of such changes ().

Of the nearly 43 million inhabitants, 84.4% have access to water provided by a public network; 58.4% have access to sanitation services. In the last decade, the increase in sanitation coverage (6%) exceeded the expansion of water coverage (4%), reducing the gap. For urban areas, the objectives for 2019, established in the National Water Plan launched in 2016, call for 100% coverage of drinking water and 75% sanitation coverage ().

With regard to solid waste, approximately four million people in Argentina have no regular collection, and over 20 million lack waste disposal service. Per capita generation of solid waste is 0.85 kg per day, which amounts to some 37,631 tons per day and 13,735,337 tons per year ().

Only 6.6% of the country’s land and marine areas are protected. Furthermore, between 2010 and 2015, Argentina ranked ninth worldwide in annual net loss (1.1%) of forested land. In 2010 alone, 301,000 hectares of forest were lost, all due to human activity. This phenomenon is caused by various factors, including intensification of productive systems, expansion of the agricultural area, mining of metals, and urbanization of forested areas ().

Over the last two decades, most of the spread of agricultural and livestock activity has occurred in the country’s Noroeste and Noreste regions, where land was cleared for productive activities, specifically for agriculture, particularly for growing soy (). These areas continue to bear the brunt of land clearing.

The country has a growing carbon footprint, associated with a pattern of rapid growth in sectors such as agriculture and transportation, as well as inefficient energy use. An increase of 149% is projected between 1990 and 2030, principally due to CO2 emissions in the energy sector from the burning of fuels and from automobile emissions (). In urban areas, air pollution is a significant challenge. In Buenos Aires, average particle pollution (PM2.5, particulate matter with a diameter < 2.5 µm) is almost six times higher than the limit of 10 µg/m3 recommended by WHO (); in Córdoba it is three times higher and in Mendoza twice as high. The estimated cost of the societal impact of air pollution is 1.8% of GDP ().

Monitoring the Health System’s Organization, Provision of Care, and Performance

Financing of public-sector health care (national and provincial ministries) accounts for 2.2% of GDP, with funds primarily derived from provincial taxation, with the social security system contributing when providing care to those enrolled in its system. Some of the public sector’s many programs are financed with international credits such as the SUMAR plan, the World Bank’s support for Essential Public Health Functions, and the Inter-American Development Bank’s REDES program, all of which aim to ensure coverage for the most vulnerable populations.

Most of the obras sociales operate through contracts with private providers and are financed with contributions from workers and employers. Together they insure and provide services to 42% of the population (workers and their families).

In addition, through the Comprehensive Medical Care Program, the National Institute of Social Services for Retirees and Pensioners provides coverage for retirees in the national pension system and their families; this covers 20% of the population and represents expenditures equivalent to 0.75% of GDP.

Total private health care expenditures represent close to 3% of GDP, of which approximately two-thirds is in the form of direct payments (particularly for the purchase of medications) by people at the time services are provided ().

The national obras sociales and the medical prepayment companies, under the supervision of the SSS, must meet the requirements of the Compulsory Medical Program (Programa Médico Obligatorio, or PMO), which include providing a broad package of services and associated drugs. The program covers 95% of outpatient, surgical, hospital, and dental services, as well as mental health, rehabilitation, and palliative care services (). It does not apply to the private sector, however, which lies outside the medical prepayment system and the public sector; the private sector is regulated at the provincial and municipal levels, and provides services that are set by the various provincial ministries of health. The National Drug, Food, and Medical Technology Administration plays a leading regulatory role, acting as the national authority charged with ensuring the efficacy and safety of drugs, food, and medical devices available to citizens.

Total health care spending constitutes over 8.5% of GDP, one of the highest in Latin America. And, although the entire population has access to the services provided by the public sector, there are significant gaps and problems in the health system, particularly with regard to access (). Further, deep inequities persist between various territories and population groups in terms of the level of expenditure and the human and material conditions for effective access to services ().

Perspectivas

In light of the new challenges brought about by demographic and epidemiological changes, Argentina, as do other middle-income countries in the Region, faces health challenges related to the implementation of sustainable, effective strategies to combat poverty-related problems. Improvements in living conditions, along with developments in vaccines and antibiotics and implementation of control programs, will help reduce indicators of morbidity and mortality from various communicable diseases.

Certain diseases remain challenging, such as AIDS and tuberculosis, whose interaction poses an obstacle to control. The risk of outbreaks of certain known viral diseases, such as influenza, dengue, Zika, and chikungunya, along with potential risks from new pathogens and zoonotic diseases, call attention to the need to adapt and strengthen the surveillance system at all levels. Strengthening the nation’s basic capabilities within the framework of the International Health Regulations (IHR) is of key importance.

Diseases that subsist in pockets of poverty and among marginal populations also remain on the health agenda. In order to deal with those diseases and achieve better results from the implementation of public health programs, efforts must be made to establish human development projects to address poverty-related factors. “Toward Universal Health in the South American Chaco Population 2016–2019,” a joint project developed by Argentina, Bolivia, Brazil, and Paraguay, is an example of such an initiative, and an effort that has useful lessons for its subsequent application in other areas of the country where social and environmental factors affect public health. This is relevant primarily among indigenous, native, rural, and mestizo populations, where there is growing demand for participation in strategic decision-making.

Along with the incomplete agenda for addressing communicable diseases, and the fact that the MDG maternal and child health indicators have not yet been achieved, the problems associated with chronic, noncommunicable diseases (NCDs) pose the greatest burden for the Argentine health system. The real possibility of preventing NCDs makes it essential to strengthen existing preventive programs targeting them in Argentina, as well as programs that target their risk factors, such as measures to control tobacco use and to promote healthy eating and an active lifestyle.

In contrast to the challenges Argentina faces, both old and new, the country has the advantage of a rich history of social policy, great human capacities and talent, solid institutions, and a level of health spending higher than the regional average. Despite these considerable strengths, however, Argentina must overcome remaining obstacles. The country has the most segmented and fragmented health system in the Americas, a problem whose solution calls for enormous governance efforts in the sector and strong leadership in order to bring together a wide range of stakeholders in pursuit of shared health objectives. These objectives currently focus on achieving universal coverage and providing effective, nondiscriminatory access to quality services for the entire population.

A central component of this challenge is updating the benefits package in the Compulsory Medical Program, given the evidence of its impact and effectiveness, while working to make the program universal, thus strengthening the primary health care strategy and the integrated services networks. This effort will require reaching agreements and consensus on such important issues as the distribution and competencies of human resources, problem-solving capacity at the primary care level, and access to health technologies and cost-effective drugs.

With its rich history, Argentina is well aware of the goals it must meet in order to address the needs of its people and communities. As a nation with vast natural resources and exceptional human capital, it shares with other countries in the Region the challenge of solving the health problems caused by socioeconomic inequities and social exclusion. Given the sharp contrasts within the health system itself, major efforts will have to be made to more efficiently and effectively foster cooperation among different sectors, making the right to health a reality for all, without discrimination.

References

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Reference/Note:

1. Obras sociales are entities charged with overseeing medical care for Argentine workers.

2. This acronym refers to the expansion of an earlier program, called “NACER,” that provides coverage for mothers and infants, children and adolescents between the ages of 6 and 19, and adults up to the age of 64.

3. The MDG target was 8.5 per 1,000 live births.

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