"The achievements did not reach the expected maturity." The General Audit Office (AGN, for its acronym in Spanish) was this resounding when evaluating the results of Birth Plan (known as Plan Nacer in Spanish), a program under the aegis of the Ministry of Health since 2005 that aims to "reduce maternal and infant mortality."

It was because in 2009, on average, "indicators barely exceeded 50% of compliance." What are these indicators? They are also called "tracers", and are used to measure the progress of a particular process. A parameter is set at the beginning of the program and throughout the program will be evaluated always comparing it to the starting point.

The indicators with less coverage and monitoring are those of healthy children from one to six years of age, with rates not exceeding 30%.

It is with high relevance and severity that "the calculation of each tracer was amended in 2011 in order to reduce the requirements of the plan, a situation that contradicts the Operational Manual which tends to increase them."

On the analysis of province’s target, the AGN observed "very different behaviors." While Chubut has coverage of 70%, Santa Cruz has 32%.

The Birth Plan is partially funded by the International Bank for Reconstruction and Development (BIRF, for its acronym in Spanish) in the amount of $435.8 million dollars from two different loans. One for the first phase, that lasted from 2007 to 2010, and included the provinces of the Northeast and Northwest region of Argentina, which are the most "unfavorable". The second part was implemented in 2007 until December 2012 and covered the rest of the national jurisdictions, expanding the scope to all of Argentina.

The audit also evaluated the implementation of these resources and found that "financing conditions foresaw that five years in the contributions from the State would have to gradually diminish and on the fourth year the provinces should contribute the difference, in the sixth year, it would be up to them to finance the entire Plan." However, the reality does not meet these expectations because "for the fifth and sixth year the provincial contribution did not increase and remained at 30%, contrary to the initial goal."

Since its implementation, "infant mortality in children under one year decreased from 16.8 per thousand live births in 2004 to 11.9 in 2010 in the small infants of 0-4 years of age with the same parameter, from 3.4 to 3". In the case of maternal deaths "the rate remained almost unchanged: 0.5 in 2004 and 0.4 in 2010."

Native People

Among the objectives of Birth Plan is to "guarantee the natives access to health, therefore proclaiming respect for communities, avoiding discrimination, and respecting their customs and knowledge of medicinal practices."

But one of the first issues that the watchdog highlighted was that "the methodology used to identify members of the community is insufficient to meet the target, because they are using exclusively a self-definition", i.e. those who are recognized as members.

The AGN had already made an assessment of the Birth Plan in 2009. In comparison with that assessment, now they are looking to improve "with the identification and inclusion of natives” by, for example, the development of outreach media in their native language.

However, "we could not measure the compliance of the actions" because the information from the provinces are only on a global scale, "without specifically identifying the Plan for Indigenous People."

Training Seminars

"The activities with the lowest level of implementation are the training seminars, reaching only 37% while the Goods and Property Consultants reach on average 90% of execution."

The Auditors "were unable to assess the correlation between planned and actual activities" because "they failed to get data such as dates and locations of the seminars, participants, and others." Partial information delivery occurred despite the insistence of the watchdog that "requested it three times in writing." This remains the same since 2009, when it had also been observed.

About the seminars, the AGN also noted that "only the effectors were given orientation, the beneficiaries were left out." Therefore, it still "remains a challenge, in the population, to generate changes in health habits such as prevention and assistance to primary care centers."