The United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases (NCDs) carried out a visit to Argentina from 23 to 24 October 2017 to discuss the loan issued by the World Bank to the Government of Argentina. This loan helps finance the scale up of actions for the prevention and control of NCDs, mainly cardiovascular diseases, diabetes, cancers, chronic respiratory diseases and associated risk factors.
The UN Task Force met in Buenos Aires with the Ministry of Health of Argentina, World Bank/Argentina, UN resident coordinator and the members of the UN country team to discuss the structure and components of the five-year World Bank loan (2015-20), titled “Protecting Vulnerable People Against Noncommunicable Diseases Project,” of US$ 350 million, and progress around implementation. This is the largest loan in the world designed to combat NCDs.
“I see a big added value of the UN family joining our government efforts to build a resilient NCD response at the state and provinces levels,” said Dr Veronica Irene Schoj, Director of the Department of the prevention and control of NCDs in the Ministry of Health for Argentina. “In particular we need support from the UN country team in our work in the area of nutrition and tackling obesity, alternative livelihoods for the tobacco producers and the development of the province-level multisectoral NCD action plans.”
NCDs account for three quarters of deaths in Argentina, with nearly 1 in 5 people dying prematurely (before the age of 70) from a NCD. More than half of Argentineans are physically inactive and overweight, and one in three have raised blood pressure. Tobacco consumption and exposure are major risk factors for NCDs with 25% of people using tobacco and almost 40% being exposed to secondhand smoke. Most worrying is that one in five children aged 13-15 smokes cigarettes.
While intake of fruits and vegetables is insufficient, Argentina has committed to regulating sodium levels in processed foods. The food industry has volunteered to decrease sodium in its products by 5-15% over two years. As a result, salt intake although still high has decreased. Argentina is also one of the first countries to eliminate trans-fats from the domestic food industry.
Road traffic accidents seriously contribute to premature death and disability in Argentina, where approximately one in three people do not use seat belts, and only 40% of motorcyclists use helmets.
The UN NCDs Task Force team included representatives from the United Nations Development Programme (UNDP), United Nations Children's Fund (UNICEF), the World Bank and the Pan American Health Organization/World Health Organization (PAHO/WHO) from headquarters, regional, and country levels.
The World Bank loan aims to protect Argentina’s most vulnerable people from NCDs and their risk factors. It builds on a previous partnership that focused on primary healthcare improvement and strengthening institutional and regulatory capacities of ministries of health at the provincial level.
The ongoing project has three mains components:
- Health services: the focus is on training medical teams in early detection and effective control of NCDs, updating health care models and implementing electronic medical records.
- Health promotion : to promote healthy behaviours and develop provincial NCD strategies.
- Institutional strengthening: targeting monitoring and surveillance capacities for NCDs and developing surveys and communication campaigns.
The health services and health promotion components focus on implementation at the provincial, municipal and primary care levels, while the institutional strengthening work targets the central level and building an operational platform.
During the visit, the Argentinian Ministry of Health highlighted the need for the UN country team to make NCDs a priority and for agencies to accelerate collective efforts to support the Government in utilizing the World Bank loan, especially with regards to multisectoral planning and enabling actions at the provincial level.
A road map for enhanced UN system engagement in Argentina will be finalized jointly by the UN Country Team and the Government of Argentina to ensure that the best technical expertise is available for the national NCD response, in order to best utilize the resources available.
To track progress in Argentina’s efforts to beat NCDs, several indicators require reporting on, including reducing levels of tobacco use and salt consumption, and improving primary health care services to deliver higher quality NCD-services.
The financing scheme targets improved provincial action plans, improved incentive mechanisms to guarantee sustainability at the provincial level, and primary health care services. Prior to getting new transfers provinces have to report on progress in obesity reduction, in particular childhood obesity, and increased power to implement regulations and sanctions.
“In a federalized country like Argentina, this loan is a ‘game changer’ for the Argentine government in scaling up implementation of its NCD strategy in every jurisdiction using a results-based management approach,” says Dr Maureen Birmingham, the PAHO/WHO representative in Argentina. “Ensuring timely, affordable and high quality care for NCDs at the primary level along with a focus on prevention is of utmost importance and a high priority for PAHO/WHO’s technical cooperation with the Argentine government.”
Ratification and implementation of WHO FCTC
The Task Force also met with Argentine Senators to discuss ratification of the WHO Framework Convention on Tobacco Control (WHO FCTC).The Senators and Task Force members discussed the critical importance of ratifying the Convention and a pathway towards this goal. The UN Team reiterated its commitment to provide any support required to help Argentina achieve ratification of the Convention.
“An effective NCD response in Argentina requires urgent efforts to ratify the WHO FCTC by the Parliament of Argentina and multi-sectorial action for its successful implementation,” says Mr René Mauricio Valdés, UN Resident Coordinator in Argentina. “The UN Country Team is committed to accompany and catalyze the Government’s actions across sectors at national and sub-national levels.”
The mission welcomed the progress on tobacco control that some provinces of Argentina have achieved. In 2011, a law was passed to regulate advertising, promotion and consumption of tobacco products. In May 2016, cigarette prices increased by 40% to further reduce tobacco consumption and generate public revenue.
“The ratification of the WHO FCTC will also protect tobacco producers,” says Dr Maureen Birmingham, PAHO/WHO Country Representative, “since article 17 calls for support for economically viable alternative activities.”
The mission noted increasingly aggressive industry interference in governmental decision-making on tobacco control, diet and nutrition. Authorities welcomed the UN Country Team’s support to identify and manage conflicts of interest at the central and provincial levels and to counteract interference and myths perpetuated by the tobacco industry.