Social participation and quality of health care: the experience of citizens' health representatives in Mexico

OBJETIVO: Analizar la experiencia del aval ciudadano en el sistema de salud mexicano en la mejora de los servicios de salud. METODOS: Estudio de corte cualitativo en ocho estados de México en 2008. Se evaluaron diferentes aspectos del programa nacional para mejorar la calidad de los servicios de salud. Se compara la estrategia de México con otras experiencias en América Latina. RESULTADOS: Se exponen los avances y problemas del funcionamiento del aval ciudadano, figura que promueve la participación social en salud de la población. CONCLUSIONES: El aval ciudadano es una figura con gran potencial para representar a los usuarios en los servicios de salud y transmitir sus demandas de mejora de la calidad de la atención médica.OBJETIVO: Analisar a experiência do aval ciudadano (reforço cidadão) no sistema de saúde mexicano na melhora dos serviços de saúde. MÉTODOS: Estudo de coorte qualitativo em oito estados mexicanos, em 2008. Foram avaliados diferentes aspectos do programa nacional para melhora de qualidade nos serviços de saúde. Compara-se a estratégia no México com outras experiências na América Latina. RESULTADOS: Foram expostos os avanços e problemas de funcionamento do aval ciudadano (reforço cidadão), figura que promove a participação social na saúde da população. CONCLUSÕES: O aval ciudadano (reforço cidadão) é uma figura com grande potencial para representar os usuários dos serviços de saúde e transmitir suas exigências de melhorias na qualidade da atenção médica.OBJECTIVE: This article describes the experience of the aval ciudadano "Citizens' Representative" (CR) in improving the Mexican health care system. METHODS: This is a qualitative study which took place in eight Mexican states in 2008. It evaluates different aspects of a nationwide program to increase the quality of health care services (National Crusade for Quality in Health Services). The Mexican strategy is compared with experiences in other Latin American countries. RESULTS: In this paper, there is the description of achievements and problems encountered by the CR in promoting social participation in the health of the population. CONCLUSIONS: The CR has great influence when representing health service users and passing on their demands for improvements to health care quality

Motives for non-vaccination: critical review of the international literature, 1950-1990

Many countries have acknowledged that vaccination programs call for a mastery of technical and organizational elements if they are to become accesible to the population. One of these elements has been greatly understimated: the participation of populations and their motivations. Experiences in several countries are here analysed, on the basis of a bibliographic revision of the period 1950-1990. Results show that existing studies vary in their conceptual and methodological focuses, according to the region in which research was carried out and to the kind of researcher involved. This fact is to be explained by the posture, common among researchers, of believing that they know in depth the subjective determinants of the behavior of the societies to which they belong. Based on this, they only use methodologies that allow them to arrive at a superficial understanding regarding the response of populations to the offer of vaccines.En muchos países se reconoce que los programas de vacunación requieren del dominio de elementos técnicos y organizacionales para ser accesibles a las poblaciones. Uno de ellos ha sido menospreciado de manera importante: la participación de la población y las causas que la motivan. El presente trabajo analiza experiencias de diversos países, a partir de una revisión bibliográfica del período 1950-1990. Los resultados muestran que los estudios existentes varían en su enfoque metodológico y conceptual de acuerdo a la región del mundo en donde fueron realizados y de acuerdo al tipo de investigador. Este hecho se explica por el supuesto que existe en muchos investigadores de pensar que conocen a profundidad los determinantes ideológicos de la conducta de las culturas de las que son nativos. A partir de ello utilizan metodologías que apenas les permiten aproximarse a un nivel superficial del conocimiento de la realidad social para hacer inferencias de la respuesta de las poblaciones ante la oferta de las vacunas

The Gap in Human Resources to Deliver the Guaranteed Package of Prevention and Health Promotion Services at Urban and Rural Primary Care Facilities in Mexico

Background: The purpose of this study was to estimate the gap between the available and the ideal supply of human resources (physicians, nurses, and health promoters) to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico. Methods: We conducted a cross-sectional observational study using a convenience sample. We selected 20 primary health facilities in urban and rural areas in 10 states of Mexico. We calculated the available and the ideal supply of human resources in these facilities using estimates of time available, used, and required to deliver health prevention and promotion services. We performed descriptive statistics and bivariate hypothesis testing using Wilcoxon and Friedman tests. Finally, we conducted a sensitivity analysis to test whether the non-normal distribution of our time variables biased estimation of available and ideal supply of human resources. Results: The comparison between available and ideal supply for urban and rural primary health care facilities reveals a low supply of physicians. On average, primary health care facilities are lacking five physicians when they were estimated with time used and nine if they were estimated with time required (P \u3c 0.05). No difference was observed between available and ideal supply of nurses in either urban or rural primary health care facilities. There is a shortage of health promoters in urban primary health facilities (P \u3c 0.05). Conclusion: The available supply of physicians and health promoters is lower than the ideal supply to deliver the guaranteed package of prevention and health promotion services. Policies must address the level and distribution of human resources in primary health facilities

Towards the construction of health workforce metrics for Latin America and the Caribbean

<p>Abstract</p> <p>Introduction</p> <p>One of the components of the Health Observatory for Latin American and the Caribbean (HO-LAC) is the design and implementation of metrics for human resources for health. Under the HO-LAC initiative, researchers from nine countries in the region formed the Collaborative Community on Human Resources for Health in Latin America and the Caribbean to identify common metrics applicable to the field of human resources for health (HRH).</p> <p>Case description</p> <p>The case description comprises three stages: a) the origins of an initiative in which a non-governmental organization brings together researchers involved in HRH policy in LAC, b) a literature search to identify initiatives to develop methods and metrics to assess the HRH field in the region, and c) subsequent discussions held by the group of researchers regarding the possibilities of identifying an appropriate set of metrics and indicators to assess HRH throughout the region.</p> <p>Discussion and evaluation</p> <p>A total of 101 documents produced between 1985 and 2008 in the LAC region were identified. Thirty-three of the papers included a variety of measurements comprising counts, percentages, proportions, indicators, averages and metrics, but only 13 were able to fully describe the methods used to identify these metrics and indicators. Of the 33 articles with measurements, 47% addressed labor market issues, 25% were about working conditions, 23% were on HRH training and 5% addressed regulations. Based on these results, through iterative discussions, metrics were defined into three broad categories (training, labor market and working conditions) and available sources of information for their estimation were proposed. While only three of the countries have data on working conditions, all countries have sufficient data to measure at least one aspect of HRH training and the HRH labor market.</p> <p>Conclusions</p> <p>Information gleaned from HRH metrics makes it possible to carry out comparisons on a determined experience in space and time, in a given country and/or region. The results should then constitute evidence for policy formulation and HRH planning and programs, with improved health system performance ultimately contributing to improved population health. The results of this study are expected to guide decision making by incentivizing the construction of metrics that provide information about HRH problems in LAC countries.</p

Sexual and Reproductive Health and Health Sector Reform in Latin America and the Caribbean: Challenges and Opportunities

Most countries in Latin America and the Caribbean (LAC) are at varying stages of a reform process to improve the response capacity of health systems by upgrading the effectiveness and sustainability of programs and services. Changes promoted by the reform focus on priority health needs and underprivileged society groups. Some problems, such as sexual and reproductive health (SRH), can be tackled with cost-effective technologies. Reform projects offer a unique opportunity to reconsider policies, programs, and services aimed at facing the issues encompassed in the term SRH. Nonetheless, the formulation of a strategy and the identification of concrete measures represent a challenge, as previous experiences that could sustain such efforts are few. This report describes one of the first projects carried out in LAC to explore strategies to promote the convergence of health sector reform processes and SRH improvement. The report presents a description of the fundamental concepts related to SRH and the general situation in the region, and examples of key contributions of research, policies, and programs. It describes the general aspects of health sector reform, presents relevant cases, and includes results of three subregional meetings held in 1999

An Overview of Mexico’s Medical Tourism Industry: The Cases of Mexico City and Monterrey. version 1.0

In this report we offer some general information on Mexico and its health system before going into detail about key developments in its medical tourism industry. Complementing the main text, nine Appendices provide additional detailed insights. Appendix 1 offers a synthesis of media coverage of medical tourism in Mexico City’s main newspapers in recent years, while Appendix 2 is a synthesis of media coverage of 2 | P a g e medical tourism in Monterrey. In Appendix 3 we share a summary of policy documents central to medical tourism in Mexico. In this Appendix we consider five health equity indicators most often discussed in the medical tourism literature: (1) impacts on health human resources; (2) government involvement in the industry; (3) foreign investment in the industry; (4) impacts on private health care; and (5) impacts on public health care. In Appendix 4 we provide a list of agencies involved in medical tourism in Mexico City and Monterrey. Appendices 5 and 6 are respectively a map of facilities in Mexico City and Monterrey interested in medical tourism. Appendix 7 summarizes the advertised medical services and Appendix 8 lists the accepted national and international insurance agencies for select hospitals in Mexico City. Finally, the trade and investment treaties in Mexico are included in Appendix 9

Identificação dos usuários segundo nível de satisfação nos módulos gerontológicos empregando a análise de conglomerados

The aim of this study was to identify groups of users according to their degree of satisfaction with geriatric care services and determine the primary factors associated with satisfaction. This was a cross-sectional study of 181 people enrolled in 36 modules pertaining to the State Workers Social Security Institute (ISSSTE) in Mexico. Degree of satisfaction was measured according to the following three areas: general characteristics of services offered, friendliness of staff and infrastructure. A cluster analysis was performed to identify groups of users according to their level of satisfaction, and an ordinal logistic regression model was used to determine the associated factors. Fifty-three percent were satisfied with the services, 34.3% were fairly satisfied and 12.7% were dissatisfied. The main characteristics associated with a greater degree of satisfaction were being female, older and the head of household. The health system must address this growing population and ensure the development of quality care to meet their needs.Esta pesquisa teve como objetivos identificar os grupos de usuários segundo o grau de satisfação com a atenção recebida nos Módulos Gerontológicos e determinar os principais fatores associados. Trata-se de estudo transversal realizado com 181 usuários nos 36 módulos do Seguro Social dos Trabalhadores Públicos, no México. O nível de satisfação foi avaliado segundo três aspectos: características gerais da atenção recebida, amabilidade no trato e infraestrutura. Foi realizada uma análise de conglomerados para identificar grupos de usuários segundo o grau de satisfação e um modelo de regressão logística ordinal para identificar os fatores associados. Estiveram satisfeitos com o serviço 53% dos usuários; medianamente satisfeitos, 34,3%; e insatisfeitos, 12,7%. Os principais fatores associados com maior grau de satisfação foram: ser mulher, maior idade e ser chefe/a de família. O sistema de saúde deve dirigir sua atenção para esse grupo populacional que é crescente e incentivar o desenvolvimento de uma atenção de qualidade que contemple as suas necessidades.Se objetivó identificar grupos de usuarios según grado de satisfacción con la atención recibida en Módulos Gerontológicos, y determinar los principales factores asociados. Estudio transversal, muestra de 181 pacientes de los 36 módulos del Seguro Social de Trabajadores Estatales, en México. El nivel de satisfacción fue evaluado bajo tres aspectos: características generales de la atención recibida; amabilidad en el trato e infraestructura. Se realizó análisis de conglomerados para identificar grupos de pacientes según grado de satisfacción y un modelo de regresión logística ordinal para identificar factores asociados. Resultaron satisfechos con el servicio 53% de los pacientes; medianamente satisfechos 34,3% e insatisfechos 12,7%. Los principales factores asociados a mayor grado de satisfacción fueron: ser mujer, mayor edad, ser jefe/a de familia. El sistema de salud debe dirigir su atención a este grupo poblacional creciente, e incentivar el desarrollo de una atención calificada que contemple sus necesidades

Recent Developments in Public Health Nursing in the Americas

This study presents an assessment of the participation and training of nurses in public health areas in the Americas. Information was gathered through a literature review and interviews with key informants from Mexico, Colombia, and Paraguay. Results demonstrate that there is significant variation in definitions of public health nursing across the region and current systematized data about the workforce profile of public health nursing personnel is not available for many countries in the Americas. There are significant regional differences in the levels and types of training of nurses working in public health areas and an increasing number of nurses are pursuing training in public health at the master’s and doctoral levels. Many nurses carry out some or all of the essential functions of public health, but are not considered to be public health nurses. Generally, auxiliary and technical nurses have a broader presence in public health areas than professional nurses. In the future, regional health systems reforms should support increased recruitment and training of public health nurses, as well as stronger roles in public health research and health care at the individual, community, and population levels

Educational and labor wastage of doctors in Mexico: towards the construction of a common methodology

BACKGROUND: This paper addresses the problem of wastage of the qualified labor force, which takes place both during the education process and when trained personnel try to find jobs in the local market. METHODS: Secondary sources were used, mainly the Statistical yearbooks of the National Association of Universities and Higher Education Institutions (ANUIES in Spanish). Also, the 2000 Population Census was used to estimate the different sources of labor market wastage. The formulas were modified to estimate educational and labor wastage rates. RESULTS: Out of every 1000 students who started a medical training in 1996, over 20% were not able to finish the training by 2000. Furthermore, out of every 1000 graduates, 31% were not able to find a remunerated position in the labor market that would enable them to put into practice the abilities and capacities obtained at school. Important differences can be observed between generalists and specialists, as well as between men and women. In the case of specialists and men, lower wastage rates can be observed as compared to the wastage rates of generalists and women. A large percentage of women dedicate themselves exclusively to household duties, which in labor terms represents a wastage of their capacity to participate in the production of formal health services. CONCLUSION: Women are becoming a majority in most medical schools, yet their participation in the labor market does not reflect the same trend. Among men, policies should be formulated to incorporate doctors in the specific health field for which they were trained. Regarding women, specific policies should target those who are dedicated full-time to household activities in order to create the possibility of having them occupy a remunerated job if they are willing to do so. Reducing wastage at both the educational and labor levels should improve the capacity of social investment, thereby increasing the capacity of the health system as a whole to provide services, particularly to those populations who are most in need

The quest for universal health coverage: achieving social protection for all in Mexico

Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries