Argentina: Crisis in the Health Sector

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Also available in: Español

The President of Argentina faces a government crisis: economic and political crises caused by the poor administration. The President decided to close the Ministry of Health and transformed it into a Secretariat. A few days before such measure, Sergio Maulen, Director of the National Program, submitted his resignation.

By: Javier Hourcade Bellocq

As is publicly known, the Republic of Argentina is currently facing one of its biggest economic and political crises since its return to democracy. A huge crisis caused by the current administration, which has been unable to stop hyperinflation during its three years in office. A 40-percent hyperinflation is projected for 2018, as well as an unstoppable devaluation of the Argentine peso, among others problems. Due to the President’s poor administration, aimless measures implemented by government have raised serious concerns in the public and private sectors. The country’s situation is so serious that Argentina requested a new loan to the International Monetary Fund (IMF) months ago. The resources granted are now being wasted in the government’s clumsy attempt to control this complex financial situation.

One of Argentina’s commitments with the IMF in order to be granted a bailout was to have a zero deficit, which is impossible in our countries. Such commitment translates into serious cuts in the national budget, which are estimated to reach more than 30% next year, plus the impact of the final inflation rate.

One of the most drastic decisions this week was the closing of the Ministry of Health and its incorporation –as a Secretariat– into the Ministry of Social Development. This decision has brought back Argentina to year 1946. During that period, Argentina’s health sector was under the responsibility of a Secretariat, which later became the Ministry of Public Health as a result of a constitutional reform, which has Ramon Carrillo as a historical referent. During the 1955 coup d’état, the Ministry was first transformed into a secretariat. However, during the period of return to democracy, the Ministry was reopened as such and then closed in 1966 by de facto President Ongania. In 1981, the dictator and general Viola incorporated it into the Ministry of Public Health and Environment. Furthermore, from the return to democracy to the first government of Cristina Fernandez de Kirchner, the merger and dissolution of the health and social development authorities were constant.

In the same act of desperation, Argentina’s government has also incorporated the Ministry of Science and Technology as part of the Ministry of Education, which evinces the priorities of this government.

Resignation of the Director of the HIV Program

Last week, the Director of the National Program for HIV, STD, Hepatitis, TB and Leprosy Control, Sergio Maulen, submitted his resignation, probably because he found out about the future and dangerous budgetary adjustments. Within the last few hours, the HIV Bureau has published its position on this matter (available at ). The media has covered the news at http://bit.ly/Maulen. A public confirmation by the Director is currently pending.

Doctor Maulen’s resignation is a great loss to the response to HIV and other health-related problems. His administration set an example and has been faithful to his work as a social activist, as well as to his technical knowledge. He consolidated an excellent team. Without any doubt, his work in the program will be remembered as one of the best administrations in history. Furthermore, Sergio has presided over the Horizontal Technical Cooperation Group (GCTH) of Latin America Programs for less than one year now.

Why is it important to have a portfolio?

Section 23 of the Act on Ministries establishes that the Ministry of Health is in charge of assisting the President and the Chief of the Cabinet of Ministers in order to establish authorities in all matters related to health and promotion of healthy behaviors.

In our countries, the Ministries of Health are the regulatory, auditing and governing authorities in charge of public health matters. These ministries are designed to implement long- and medium-term annual plans and programs regarding matters on immunizations, motherhood, preventive and community health, monitoring and control of epidemics, as well as the treatment of diseases with major economic impact, such as HIV and cancer. In turn, such authorities must observe other health subsystems. In Argentina, these subsystems include social works from trade unions and private health insurance (called prepaid medicine plans).

The Ministry of Health’s role is to participate in the control of pharmaceutical industries

Likewise, the national health authority is responsible for ensuring the development of guidelines and issuing national rulings. In a federal State, this portfolio leads and bring together the Federal Health Council in meetings, where national Ministries of Health participate, to coordinate policies and programs nationwide. This State authority is vested with the power to act as sanitary police in matters related to health products, technology, equipment, instruments and proceedings, and to control pharmaceutical companies and health-service providers.

The national government decided that such key roles may be subsumed by the Ministry of Social Development, led by Carolina Stanley, who is a loyal member of the governing party, but who has little or no idea in matters related to the health sector. Minister Stanley administers allowances and social schemes, which will have her very busy during this crisis and the forthcoming election campaign. Thus, it is clear that this administration believes it is possible to deprioritize the Health sector.

The role of the State in the Health Sector

Closing key ministries in a country, such as the Ministry of Health, Labor, and Science and Technology, is a demagogic ploy with scarce financial impact, which seeks to overemphasize the country’s “commitment with the Monetary Fund to reduce the public expenditure.” The real adjustment will be applied to all plans and programs according to the 2019 budgetary reduction, as well as the permanence of government personnel. No doubts Argentine is big, but its presence is required for all population, in particular for the most vulnerable ones.

The poor financial administration of the national executive has caused companies to close, significant job losses (which will increase in time) and an economic downturn. With the devaluation of the Argentine peso, the uncontrollable inflation and the rapid growth of poverty, these phenomena will cause many people to migrate from trade unions and private subsystems (who depend on formal employment and income) to the public health system, which has no funds at this point. Only until August 2018, the value of private insurance has increased by 30% and families who withdrawn from those insurance schemes increased the demand in hospitals.

This week one of the most drastic decisions was the closing of the Ministry of Health

Soon after the measures were implemented, the Ministries of Health inland expressed their concern and rejection: “Closing the National Ministry of Health and give it a lower rank will be a significant step backwards in institutional terms for the implementation of plans, programs and projects aimed at aiding the population, particularly to the most vulnerable people,” as claimed in the statement of provincial ministries. They considered the decision “exposes a political approach which does not consider Health as a fundamental Human Right since it relegates health as a social good of the population.”

As a conclusion, the press release stated that “there is no possible way to coordinate, articulate or supplement the state health service system at a national, provincial and municipal level, social security and private sector, if there is no National Ministry of Health acting as an authority in charge of establishing key sector policies.”

Likewise, the Trade Union Federation of Health Professionals of the Argentine Republic (FesProsa) also issued a press release on its official web site, through which it states its position with regard to the same problem: “On behalf of our 30 thousand physicians, professionals and health employees in 600 public hospitals across the country, we express our absolute rejection to the possible closing of the Ministry of Health ordered by president Mauricio Macri… It is not just a mere change in the name, it is about transforming the Ministry of Health into a Secretariat, a situation to that before the appearance of the first minister of Health, Ramon Carrillo, as proposed during the Menemism and military governments, with the purpose of closing departments, discharging personnel, cancelling budgets, and definitely restricting to a minimum the aid provided to those most in need.”

The rapid incorporation of national key ministries into others constitutes clumsy and harmful governmental measures to overemphasize the commitments agreed with the IMF, which guarantees that an important percentage of the loan will be granted in order to deal with the uncontrolled economic crisis.

Unfortunately, resignations (similar to that of doctor Maulen) and the dismissal of technical personnel required for the implementation of national programs are expected. Furthermore, the 2019 budget shows that there will be a huge lack of medicines and supplies due to the serious economic difficulties and clumsy budgetary cuts. In addition to the problems that the country and health-care system face, the response to HIV/AIDS, TB and Hepatitis also faces a severe crisis.