Local Health Service Response to COVID-19 in Mexico: Notes From an Exploratory Qualitative Study.

BACKGROUND: The main goal of a health system is to maintain or improve people's health. The COVID-19 pandemic showed the fragility of health systems worldwide. In Mexico, the pandemic affected the performance of the health system, along with the presence of contextual conditions such as its segmentation and high prevalence of chronic diseases. AIMS: To analyze from an approach to the functions of the health system, the service delivery, human resources, financing, and stewardship/governance in the local health services of five states of Mexico, from the perspective of the staff working in health centers. METHODS: This is an exploratory qualitative study conducted from November 2020 to August 2021, involving 124 health professionals from 39 health facilities (18 rural and 21 urban). The technique used was the semi-structured interview. Interview guides were developed according to core topics. Subsequently, the thematic analysis method was used. RESULTS: The lack of financial resources delayed prevention efforts and made it difficult for health centers to adapt to the crisis. Inequity was found in the distributive efficiency of staff between rural and urban areas and levels of care. In addition, there was evidence of capacity for coordination, capacity sharing, and joint participation between health institutions, civil authorities, and the population to face the emergency. CONCLUSIONS: We identified relevant public health actions that showed the capacity of local health services to organize a response to the pandemic at the level of the actors responsible for these services.

Local health systems resilience in managing the COVID-19 pandemic: lessons from Mexico.

The concept of resilience was applied to the public health field to investigate the way health systems are impacted by health crises, what conditions allow them to mitigate the blow and how they reorganize once the crisis is over. In 2020, the COVID-19 pandemic caused by the SARS-CoV-2 virus represented a global challenge demanding immediate response to an unprecedented health crisis. Various voices drew attention to the intensity of the crisis in countries with greater inequalities, where the pandemic converged with other social emergencies. We documented the experiences of health personnel who faced the pandemic at the primary care level while simultaneously maintaining the functioning of other areas of medical care. Our results derived from a qualitative study comprising 103 participants from five states of Mexico. We aimed to show through inferential analysis their perspective on what we call 'the resilience of local health systems'. We observed three stages of experience during the crisis: (a) Preparation (official guidelines received to organize care, training and planning of epidemiological surveillance); (b) Adaptation (performance of community-based prevention activities, infrastructure modifications, telehealth); and (c) Learning (participatory governance with city councils, business sector and organized population). The study suggests that the local health systems analysed benefited from the initiatives of health personnel that in some cases positively exceeded their duties. In terms of the resilience analysis, they were able to handle the impact of the crisis and cope with it. Their transformative capacity came from the strategies implemented to adapt health services by managing institutional resources. Their experience represents a lesson on the strengthening of the essential functions of health systems and shows a way to address successfully the increasingly complex health challenges of the present and future times.

Factores asociados al incremento de cesáreas en México, 2011-2014 / Factors associated with the increase in cesareans in Mexico, 2011-2014

Resumen Introducción: analizamos la prevalencia del parto vía cesárea en México para 2011-2014, buscando identificar algunos de los factores asociados a la presencia de cesárea durante el parto. Metodología: se realizó un análisis descriptivo y un modelo logístico multinivel con los registros de nacimientos del periodo 2011-2014, que incluye las características de la madre y del contexto. Resultados: se identificó que la presencia de factores relacionados con una mayor posibilidad de que el parto resulte en cesárea son mujeres que habitan municipios con población indígena, mayor escolaridad, mayor número de consultas prenatales, inicio temprano de estas y atenderse en clínicas privadas. También se identificó una mayor posibilidad de estancias prolongadas de hospitalización del parto si es por cesárea. Conclusiones: se observa un incremento en el número de cesáreas en hospitales públicos a partir del esquema de aseguramiento del Seguro Popular y se confirma la relación directa entre los múltiples factores analizados y la cesárea, entre ellos, mayor escolaridad, habitar en municipios predominantemente indígenas, así como en municipios con mayor índice de desarrollo humano.

Abstract Introduction: The objective is to analyze the prevalence of delivery by cesarean section in Mexico among 2011-2014, to identify some of the factors associated with its occurrence. Methods: A descriptive analysis and a multilevel logistic model was conducted among the data for Birth Information Subsystem, characteristics for the mother and context. Results: Identified that the factors associated with a greater likelihood that delivery result in cesarean section, are higher levels of education, greater number of prenatal visits, an early start to prenatal visits, giving birth in private health. Also a greater likelihood of prolonged hospitalization when delivery is by cesarean section. Conclusions: An increase in the number of caesarean sections in public hospitals is observed from the Popular Insurance assurance scheme; and the direct relationship between the multiple factors analyzed and the caesarean section is confirmed, including higher education, living in predominantly indigenous municipalities, as well as in municipalities with the highest human development index.

[Tobacco consumption, mortality and fiscal policy in Mexico]. / Consumo de tabaco, mortalidad y política fiscal en México.

OBJECTIVE: To analyze tobacco consumption in the last 12 years, its impact on chronic diseases mortality and the potential benefits of fiscal policy in Mexico. MATERIALS AND METHODS: Through the analysis of national health surveys (ENSA, ENSANUT), records of mortality and economic surveys between 2000 and 2012, smoking prevalence, chronic diseases mortality and consumption were estimated. RESULTS: In 2012, 9.2% and 19% of Mexican youths and adults were current smokers. Between 2000 and 2012, smoking prevalence did not change. However, the average consumption among adolescents and adults declined whilst the special tobacco tax has being increased. Mortality attributable to tobacco consumption for four diseases was estimated in 60 000 in 2010. CONCLUSIONS: Tobacco consumption remains the leading cause of preventable death. Increasing taxes on tobacco products could deter the tobacco epidemic and consequently chronic diseases mortality in Mexico.

[Impact of harmful consumption of alcohol in accident-related mortality and chronic diseases in Mexico]. / Impacto del consumo nocivo de alcohol en accidentes y enfermedades crónicas en México.

OBJECTIVE: To analyze alcohol consumption, and its impact on road traffic-related mortality and chronic diseases. MATERIALS AND METHODS: Through the analysis of national health surveys, registry of traffic collisions, mortality records and economic surveys, we estimated prevalence, mortality and consumption indicators. RESULTS: Between 2000 and 2012, alcohol consumption in adolescents remained stable, with a significant increase among adults. Traffic collision rates related with alcohol were 0.36 and 0.58 among adolescents and adults, respectively; 8.4% of the population who suffered traffic injuries was under alcohol effects when the accident occurred. The trend in mortality from two alcohol-attributable diseases has been constant, with an average of 18 000 deaths per year. CONCLUSION: Alcohol abuse causes serious health damages. Tax raises to alcohol, along with other policies, could reduce harmful alcohol consumption and its associated mortality.

Consumo de tabaco, mortalidad y política fiscal en México / Tobacco consumption, mortality and fiscal policy in Mexico

Objetivo. Analizar el tabaquismo, su impacto en mortalidad por enfermedades crónicas y su política fiscal en México. Material y métodos. Se analizaron las encuestas nacionales de salud (ENSA, ENSANUT), registros de mortalidad y encuestas económicas para el periodo 2000-2012 y se estimaron prevalencia, mortalidad y consumo. Resultados. En 2012, 9.2% de los adolescentes y 19% de los adultos son fumadores activos. Entre 2000 y 2012 la prevalencia de tabaquismo permaneció estable. Sin embargo, la cantidad de cigarros promedio consumida se redujo, al tiempo que se han implementado incrementos al impuesto especial a los productos de tabaco. Las muertes atribuibles al consumo de tabaco por cuatro enfermedades se calculó en cerca de 60 000 para 2010. Conclusiones. El tabaquismo es la principal causa de muerte prevenible. El incremento sustancial de los impuestos a los productos de tabaco puede abatir la epidemia de tabaquismo y en consecuencia la mortalidad por enfermedades crónicas en México.

Objective. To analyze tobacco consumption in the last 12 years, its impact on chronic diseases mortality and the potential benefits of fiscal policy in Mexico. Materials and methods. Through the analysis of national health surveys (ENSA, ENSANUT), records of mortality and economic surveys between 2000 and 2012, smoking prevalence, chronic diseases mortality and consumption were estimated. Results. In 2012, 9.2% and 19% of Mexican youths and adults were current smokers. Between 2000 and 2012, smoking prevalence did not change. However, the average consumption among adolescents and adults declined whilst the special tobacco tax has being increased. Mortality attributable to tobacco consumption for four diseases was estimated in 60 000 in 2010. Conclusions. Tobacco consumption remains the leading cause of preventable death. Increasing taxes on tobacco products could deter the tobacco epidemic and consequently chronic diseases mortality in Mexico.

Impacto del consumo nocivo de alcohol en accidentes y enfermedades crónicas en México / Impact of harmful consumption of alcohol in accident-related mortality and chronic diseasses in Mexico

Objetivo. Analizar el consumo de alcohol, su relación con accidentes de tránsito y su impacto en enfermedades crónicas. Material y métodos. Usando encuestas nacionales de salud, registros de colisiones, lesionados y muertes, así como encuestas económicas, se estimaron indicadores de prevalencia, mortalidad y consumo. Resultados. Entre 2000 y 2012, la prevalencia de consumo de alcohol en adolescentes se mantuvo estable con un incremento importante en adultos. La tasa de colisiones de tránsito con presencia de alcohol fue de 0.36 y 0.58 en adolescentes y adultos, respectivamente. De la población con lesiones de tránsito, 8.4% estaba bajo efectos del alcohol al momento de lesionarse. La mortalidad por dos enfermedades atribuibles al alcohol se ha mantenido en alrededor de 18 000 fallecimientos anuales. Conclusiones. El abuso en el consumo alcohol implica graves daños a la salud. El incremento de impuestos al alcohol, junto con otras medidas, reduciría el consumo nocivo y la mortalidad asociada.

Objective. To analyze alcohol consumption, and its impact on road traffic-related mortality and chronic diseases. Materials and methods. Through the analysis of national health surveys, registry of traffic collisions, mortality records and economic surveys, we estimated prevalence, mortality and consumption indicators. Results. Between 2000 and 2012, alcohol consumption in adolescents remained stable, with a significant increase among adults. Traffic collision rates related with alcohol were 0.36 and 0.58 among adolescents and adults, respectively; 8.4% of the population who suffered traffic injuries was under alcohol effects when the accident occurred. The trend in mortality from two alcohol-attributable diseases has been constant, with an average of 18 000 deaths per year. Conclusion. Alcohol abuse causes serious health damages. Tax raises to alcohol, along with other policies, could reduce harmful alcohol consumption and its associated mortality.