A Policy for the Delivery of Essential Medicines to Vulnerable Population in Argentina: A Case Study of the REMEDIAR Program.

The REMEDIAR Program, established during Argentina's 2001-2002 crisis, provides free essential medicines to the uninsured population through direct delivery to more than 8,000 primary healthcare centers. Over two decades, the program has alternated between two financing models: international concessional loans from the Inter-American Development Bank (IDB) and national treasury funding. Using the Nexus Working Group framework linking public financial management to supply chain performance, this longitudinal single-case study (2002-2024) examines how each financing model shaped the program's funding, procurement, and distribution. This study analyzes the two financing models of the REMEDIAR Program from 2002 to 2024, focusing on budgetary planning, procurement efficiency, and supply chain performance. We combined descriptive time-series analysis of budgetary and operational indicators with a review of normative and administrative documents; no causal effects are estimated. IDB-financed operations showed more stable budget execution, procurement timelines 48% shorter than nationally financed processes, and lower awarded prices, while treasury financing exhibited greater volatility tied to fiscal cycles and currency depreciation. Centralized procurement averaged 25% of market prices versus 46% under a decentralized subnational benchmark, though at the cost of slower formulary adaptation. Per-capita distribution was highest in poorer provinces, and declining household out-of-pocket spending on medicines was associated with periods of higher program intensity. The efficiencies observed under international financing reflect its associated management rules-multi-year budgeting, ring-fenced funds, predictable payments-rather than the source of funds itself. Internalizing these rules under domestic financing emerges as a key priority for the program's sustainability.