Today, we heard a lecture from Dr. Guillermo Williams, a former National Ministry of Health representative. There, he spoke about how Argentina has a federalist government and the implications that has on the functioning of national and provincial Ministries of Health. The federalist system, designed to give autonomy to the twenty-four provinces and unite them via the central, national government, is somewhat similar to our government back home in the United States. This system ends up posing both unique challenges and benefits to the delivery of healthcare in Argentina.
Argentina is the second largest country in South America, meaning its size can be unwieldy to manage efficiently. So, breaking the countries up into provinces and allowing them to create policy and govern themselves is a large benefit of the federalist system. Additionally, because Argentina is so large, we see a great amount of diversity within the country and amongst the provinces. We attended an Argentinian culture lecture today, and we learned that Argentina is often split into the traditionally cosmopolitan Buenos Aires and the less glamorous interior of the country. Because of this, the federal system is a great advantage. Provincial government leaders know their constituents more closely than a national government does, so they know what is needed in terms of policy and resources, whereas national policy may miss the mark in that regard. The provincial governments are able to do what they feel is best for their unique constituents while also having some backing from the national government, which may also run its own national campaigns.
On the other hand, the delegation of power to the provinces leaves Argentina with a much weaker national system, especially in terms of the Ministry of Health. Because of this, the national government has much less leverage within the provinces to influence policy and spending. The national government can really only act as a power to influence unity amongst the provinces, but it cannot force them to comply with their guidelines. Dr. Williams noted that Córdoba, one of the provinces, typically follows their own interest and is notoriously difficult to influence into compliance. The national system has the “power of the purse,” meaning they can allocate their own funds and any international funding, whether it be from the World Bank or Latin American Bank, etc., but it has much less true power of the law.
This is important to consider for the Ministry of Health in Argentina because it directly affects the quality of care variation throughout the country. As we’ve learned on previous site visits, the quality of care in public hospitals varies significantly amongst the provinces. In some provinces, public hospitals outrank their private counterparts, whereas in others, they are short-staffed and lack basic necessities. This wide variance is due to the fact that the National Ministry of Health may set regulations for healthcare, but it is up to the provinces to decide if they will comply with the suggested guidelines or not. This has important implications for poverty and access, as well as the quality of care that patients receive. The federalist system poses its own unique risks and rewards, and I am interested to see how it affects the rest of the healthcare stakeholders we will visit on the trip.