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OBJETIVO: Analizar, desde la perspectiva de las trabajadoras comunitarias de salud (TCS), los conocimientos y experiencias en la atención de la salud mental (SM) en comunidades rurales de Chiapas. Material y métodos. Se utilizó el enfoque fenomenológico descriptivo. Se realizaron 18 entrevistas semiestructuradas a TCS, las cuales fueron audiograbadas, transcritas, codificadas y analizadas utilizando como técnica, el análisis cualitativo de contenido con ayuda del software Atlas ti. RESULTADOS: Las TCS mental tienen una amplia comprensión de la cultura, el lenguaje y los problemas de sus comunidades, permitiéndoles fungir como enlace entre los servicios de salud y la población. Identifican que hay buena SM cuando "una persona tiene ánimo de realizar su trabajo diario" y enfermedad cuando "las personas sufren o tienen pensamientos chuecos". Sus experiencias de trabajo están ligadas con el acompañamiento individual (psico-educación) y el apoyo de actividades realizadas por profesionales de Compañeros En Salud (CES). Conclusión. Las TCS mental que trabajan con CES desarrollan un papel importante en la promoción de la SM, de riesgos y acompañamiento de pacientes con trastornos mentales. Estos hallazgos consolidan la evidencia e importancia del desarrollo de las intervenciones comunitarias en SM a través de este personal, en contextos de escasa disponibilidad de servicios de salud.
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Providing evidence on mental disorders in indigenous adolescents is critical to achieving universal health coverage (UHC). The prevalence of symptoms of depression and generalized anxiety disorder symptoms were estimated for 2082 adolescents aged 14-20 years in Chiapas, Mexico. Mental disorders were assessed using the 9-item Patient-Health Questionnaire and the 7-item Generalized Anxiety Disorder Scale. Among the adolescents evaluated, 35.8% suffered from depression or generalized anxiety disorder. Of those, 6.1% reported a previous diagnosis. 32.1% of adolescents with both mental disorders reported having attempted suicide. Gender, substance use, adverse living experiences and living conditions were correlated to the presence of depression and/or generalized anxiety disorder. It is mandatory for Mexican health authorities to develop effective instruments aiming to screen and diagnose mental health conditions in adolescents, as well as to provide timely treatment in primary health-care units.
Subject(s)
Anxiety Disorders/epidemiology , Anxiety/epidemiology , Depression/epidemiology , Depressive Disorder/epidemiology , Indians, North American/psychology , Mental Health , Adolescent , Female , Humans , Male , Mexico , Prevalence , Primary Health Care , Young AdultABSTRACT
OBJECTIVE: To present a systematic narrative review, informed by international experience, on the use of genomic analysis technologies in the primary care of noncommunicable chronic diseases (NCDs) during the last 20 years. METHODS: We used the methodology for conducting systematic reviews proposed by the Center for Coordination and Information on Evidence for Policies and Practices. The selected articles were organized by time, place, study design, and type of DNA sequencing. Finally, we analyzed the implications of our findings for health systems in middle-income and low-income countries focusing on a NCD high prevalence country such as México. RESULTS: Evidence concerning the use of DNA sequencing in primary care for NCDs was scarce and geographically concentrated in high-income countries. Use was limited by costs, insufficient knowledge among health care personnel, and a lack of confidence on the part of users. CONCLUSIONS: The use of DNA sequencing for primary care of NCDs is a challenge for low- and middle-income countries. More evidence is needed on cost effectiveness, public funding mechanisms, and the training of health care personnel for its implementation.
Subject(s)
Developing Countries , Genetic Testing , Noncommunicable Diseases/therapy , Primary Health Care , Sequence Analysis, DNA , Genetic Predisposition to Disease/genetics , Humans , Noncommunicable Diseases/prevention & control , Primary Health Care/methodsABSTRACT
BACKGROUND: The recent increase of breast cancer mortality has put on alert to most countries in the region. However it has taken some time before breast cancer could be considered as a relevant problem. Only in recent years breast cancer has been considered a priority in some Latin American countries and resources have been mobilized to confront the problem at the institutional level. The article analyzes the efforts made in five Latin American countries (Argentina, Brazil, Colombia, Mexico and Venezuela) in the last 15 years to design and implement policies to address the growing incidence of breast cancer. METHODS: Data was collected between July and December 2010 from both primary and secondary sources. Semi-structured interviews were conducted with key informants from governmental and non-governmental organizations. Secondary data was obtained from publications in journals, government reports and official statistics in each country. Analysis combines information from both types of sources. RESULTS: Countries have followed different paths and are in different stages of policy implementation. In all cases early detection is a key strategy. Through the design of programs and guidelines, the allocation of financial resources to treat patients, as well as a formally structured information system, Brazil and Mexico have been able to set up comprehensive national policies. Argentina, Colombia and Venezuela have made important advancements but not yet capable of coordinating comprehensive national policies. CONCLUSION: Breast cancer is being considered a priority in all five countries but there are different stages in the rolling out of comprehensive national policies due to differences in their capacity to allocate resources, implement operational strategies and encourage the participation of relevant stakeholders.
Subject(s)
Breast Neoplasms/therapy , Health Policy/trends , Policy Making , Argentina , Brazil , Breast Neoplasms/mortality , Colombia , Early Detection of Cancer , Humans , Mexico , Surveys and Questionnaires , VenezuelaABSTRACT
OBJECTIVE:: To analyze efficiency indicators of human resources working at Mexico's Ministry of Health. MATERIALS AND METHODS:: Three dimensions of efficiency were explored: a) labor wastage, b) distribution of human resources (HR) across levels of care, and c) productivity. RESULTS:: Health workers present significant levels of unemployment and underemployment; distribution does not meet international recommendations, and heterogeneous levels of productivity were found among states. CONCLUSIONS:: Health and educational authorities should develop and implement a HR plan that takes into consideration the needs and demands of the covered population, and includes a clearly defined set of measures to regulate the future production of HR as well as their distribution among and within state health systems, and that allocates incentives to improve performance.
Subject(s)
Health Resources/organization & administration , Staff Development , Efficiency , Female , Forecasting , Geography, Medical , Health Personnel/statistics & numerical data , Health Resources/supply & distribution , Health Services Needs and Demand , Humans , Male , Mexico , Office Visits/statistics & numerical data , UnemploymentABSTRACT
OBJECTIVE: Characterize the capacity of public and private institutions in the Central American countries, the Dominican Republic, and the Mexican states of Chiapas and Quintana Roo to perform essential public health functions (EPHFs). METHODS: An online survey of 83 organizations in Belize, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Mexican states of Chiapas and Quintana Roo was conducted to learn about their capacity to perform each of the 11 EPHFs. The results were validated in a workshop with representatives of the ministries of health from the seven countries and the two participating Mexican states. RESULTS: High levels of performance capacity were found most often for EPHF 1 (monitoring, evaluation, and analysis of health status of the population), EPHF 2.1.1 (surveillance, research, and control of risks and threats to public health from infectious diseases), and EPHF 5 (policy development and health planning). The greatest weakness was found in EPHF 2.1.2 (surveillance, research, and monitoring of noninfectious diseases). Asymmetries in EPHF performance within each country mainly revealed weaknesses in the laboratory and public health research functions. CONCLUSIONS: In the countries and territories analyzed, there is a need to improve strategic performance in most of the EPHFs, as well as to strengthen infrastructure, upgrade equipment, and further develop human resources at both the strategic and the tactical levels. A regional approach should be used to take advantage of the different levels of capacity, with a view to greater strengthening and enhanced technical support and cooperation.
Subject(s)
Public Health Administration/standards , Central America , Dominican Republic , Humans , MexicoABSTRACT
BACKGROUND: Here, the educational and labour market characteristics of Mexican dentists are revised. Dentistry is a health profession that has been scarcely studied in developing countries. This analysis attempts to understand the relationships and gaps between the supply and demand of dentists in the country. Around 5000 new dentists graduate every year looking for a place in the labour market. METHODS: A cross-sectional study with exploratory, descriptive and correlational scope was carried out between 2006 and 2008. Analyses of quantitative data on dentists from national surveys and occupational statistics were complemented with qualitative information provided by 43 key informants in five Mexican states. RESULTS: The 2008 dentist labour market can be characterized as follows: 75% worked in the private sector, most of them independently; more than two-thirds were women; the proportion of specialists was low (slightly more than 10%); unemployment was more than 20% and labour wastage was nearly 40%, with most wastage corresponding with female dentists. The increase in the number of dentists entering the labour market during the last two decades is more related to the educational market than to the population's health needs and the number of dentists actually required to meet them. CONCLUSIONS: The problems identified in the Mexican dentist labour market necessitate urgent intervention on behalf of regulatory bodies in order to balance the tendencies of supply and demand in the number of trained professionals as well as in their incorporation into different market areas. Adequate policies are required to increase the likelihood of achieving this objective.
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OBJECTIVE: To evaluate advancements and challenges in the separation of functions within Mexico's System of Social Protection in Health. MATERIAL AND METHODS: A 2009 evaluation study involving nine states and the National Commission for Social Protection in Health was carried out via semi-structured interviews with key actors and literature analysis. RESULTS: The main advancement has been the creation of the State Regimens for Social Protection in Health (REPSS in Spanish) which act as intermediaries between users and health service providers, making these state-level entities responsible for both managing financial resources and shaping and coordinating the health care delivery network. However, most of the REPSS studied were found to be in a state of inertia, leading to inadequate compliance with legally mandated functions. CONCLUSION: Normative, technical, political and managerial obstacles persist, impeding the successful separation of functions.
Subject(s)
Delivery of Health Care , Social Security/organization & administration , Humans , Mexico , Public PolicyABSTRACT
OBJECTIVE: To document the status of operational and managerial processes of the Fund for Protection against Catastrophic Expenses (FPGC), as well as to describe its evolution, and to explore the relationship between covered diseases and the Mexican health profile. MATERIAL AND METHODS: This is a joint management study, which included a qualitative and a quantitative phase. We conducted semi-structured interviews with key informants. We also analyzed the records of CNPSS, the hospital discharge and mortality data bases. RESULTS: Fifty two percent of the states take twice as long to report and validate the cases. From 2004-2009 the FPGC increased its coverage from 6 to 49 interventions, that means a spending increase of 2 306.4% in nominal terms and 1 659.3% in real terms. The HIV/AIDS was the intervention prioritized with 39.3% and Mexico City had the highest proportion of expenditure (25.1%). A few diseases included in the health profile are covered by the FPGC. CONCLUSIONS: The review of the inclusion criteria of diseases is urgent, so as to cover diseases of epidemiological importance.
Subject(s)
Insurance, Major Medical , Catastrophic Illness/economics , Catastrophic Illness/epidemiology , Humans , MexicoABSTRACT
Background: The use of health services is a complex behavioral phenomenon affected by multiple factors (availability, distance, cost, quality, attitudes, cultural beliefs, socioeconomic characteristics, and individuals' self-perception of health). Mexico has a segmented health system, and the access to it depends on the labor insertion and the population's ability to pay. Objective: To assess association between use of health services and cardiovascular and metabolic syndrome risk factors among Mexican adults. Methods: Analytical cross-sectional nationally representative study carried out on Mexican adults (≥20-year-old adults of both sexes; n = 4595). Socioeconomic factors, geographic area, health care coverage, information about the use of health services, previous medical diagnoses of diabetes and hypertension, and smoking were assessed. Anthropometrics, triglyceride, total cholesterol, HDL-cholesterol, and glucose plasma levels were measured. Metabolic syndrome (MetS) and cardiovascular risk factors were assessed. Prevalences were expressed in terms of percentages, and significant differences were calculated using χ2 test. Univariate and multivariate analysis was performed to evaluate the association between the use of health services and cardiovascular risk factors and sociodemographic variables. Results: The probability of using health services is higher and more significant in subjects with obesity, diabetes (OR (95% CI): 1.73 (1.49-2.00; p < 0.001), hypertension (OR (95% CI): 1.29 (1.14-1.45; p < 0.001), hypertriglyceridemia (OR (95% CI): 1.30 (1.15-1.46; p < 0.001), and in those with hypercholesterolemia (OR (95% CI): 1.23 (1.03-1.39; p = 0.001). Conclusions: Among health service users, there is a positive significant association between the use of health services and the presence of metabolic syndrome, obesity, diabetes, hypertension, hypertriglyceridemia, and hypercholesterolemia.
Subject(s)
Cardiovascular Diseases , Hypertension , Metabolic Syndrome , Adult , Cardiovascular Diseases/epidemiology , Cross-Sectional Studies , Female , Health Services , Heart Disease Risk Factors , Humans , Hypertension/epidemiology , Male , Metabolic Syndrome/epidemiology , Mexico/epidemiology , Prevalence , Risk Factors , Young AdultABSTRACT
BACKGROUND: While overall trends in tobacco use among men are declining, tobacco use continues to rise significantly among women in developing countries. This study aimed to explore the gender-related beliefs and attitudes about tobacco use and smoking cessation in Mexico, one of the top five Latin America countries with the highest prevalence of tobacco consumption. MATERIALS AND METHODS: This study was conducted using an explanatory qualitative methods design. Semi-structured interviews were conducted with 14 adults smokers (8 women & 6 men) who visited primary healthcare clinics in Mexico City. Two researchers independently coded the interviews and applied the final codes upon consensus. Inter-rater reliability was assessed for four groups of codewords (92% agreement), based on an ecological model on socio-cultural factors. FINDINGS: Initiation to smoking in women begins out of curiosity, and in men by imitation. Also, women start using tobacco at an older age compared to men. During maintenance of smoking, women report experiencing loneliness and anxiety about multiple responsibilities, e.g. women reveal that they feel guilty when they smoke due to their maternal role as caregivers. Additionally, some women report that smoking is a symbol of freedom, recalling the media messages associated with promoting tobacco products. Among men, the results show that they smoke for pleasure and to socialize, and consider that women smoke to imitate men and feel powerful. Regarding cessation, women are ambivalent about quitting smoking or not, and men mention not needing professional support. For organizational barriers, women mention the cost of treatment and men, the distance to clinics. CONCLUSION: Smoking cessation interventions should be proposed from an approach that involves changes in social norms, seeking a more equitable relationship between men and women. Therefore, there must be broad engagement from different sectors and not just at the health sector level.
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The outbreak of the COVID-19 pandemic has dramatically shaped higher education and seen the distinct rise of e-learning as a compulsory element of the modern educational landscape. Accordingly, this study highlights the factors which have influenced how students perceive their academic performance during this emergency changeover to e-learning. The empirical analysis is performed on a sample of 10,092 higher education students from 10 countries across 4 continents during the pandemic's first wave through an online survey. A structural equation model revealed the quality of e-learning was mainly derived from service quality, the teacher's active role in the process of online education, and the overall system quality, while the students' digital competencies and online interactions with their colleagues and teachers were considered to be slightly less important factors. The impact of e-learning quality on the students' performance was strongly mediated by their satisfaction with e-learning. In general, the model gave quite consistent results across countries, gender, study fields, and levels of study. The findings provide a basis for policy recommendations to support decision-makers incorporate e-learning issues in the current and any new similar circumstances.
Subject(s)
Academic Performance , COVID-19/epidemiology , Education, Distance , Pandemics , SARS-CoV-2 , Adolescent , Adult , Female , Humans , MaleABSTRACT
Documentary research carried out in 2009 aims to document the regulatory framework and existing programs for the early detection of breast cancer in Latin America and the Caribbean in order to establish the most important challenges for the containment of the epidemic in the region. The governments of the region have developed diverse efforts and initiatives to confront the rise in mortality due to said cause, including early detection, treatment and research strategies. Despite advances in the early detection of breast cancer, the challenge remains to link efforts to ensure continuity of care (diagnostic confirmation, treatment and monitoring) in order to achieve higher efficiency, effectiveness and benefits for women with this disease.
Subject(s)
Breast Neoplasms/diagnosis , Early Diagnosis , Government Programs/statistics & numerical data , Health Policy , Breast Neoplasms/epidemiology , Breast Self-Examination , Caribbean Region/epidemiology , Clinical Protocols , Female , Forecasting , Government Programs/legislation & jurisprudence , Government Programs/organization & administration , Government Publications as Topic , Health Promotion/legislation & jurisprudence , Health Promotion/methods , Health Promotion/statistics & numerical data , Humans , Latin America/epidemiology , Mammography , Mass Screening/legislation & jurisprudence , Mass Screening/organization & administration , Mass Screening/statistics & numerical data , Patient Education as Topic/legislation & jurisprudence , Patient Education as Topic/methods , Patient Education as Topic/statistics & numerical data , Women's Health Services/legislation & jurisprudenceABSTRACT
OBJECTIVE: To identify social, cultural and health service barriers that prevent timely access to early detection of breast cancer in two regions: Mexico City Federal District and the state of Oaxaca. MATERIAL AND METHODS: An exploratory cross-sectional qualitative study was carried out in 2008 among women under 25 years of age without pathology, with pathological diagnosis, their male partners and managers of several public and private institutions. Information was collected by focus groups and through interviews that were recorded and transcribed after having received informed consent. RESULTS: Initial exploration allowed the identification of access barriers in three main areas: a) the availability of information for the general population, b) training of first-contact general practitioners and gynecologists, and c) fears among couples and families. CONCLUSIONS: Barriers in the three levels identified are relevant as they reveal important deficiencies in the dissemination of information both to the general population and to health providers.
Subject(s)
Breast Neoplasms/diagnosis , Early Detection of Cancer , Health Services Accessibility , Cross-Sectional Studies , Female , Humans , Mexico , Middle AgedABSTRACT
Abstract-The introduction of Seguro Popular de Salud (SPS) expanded the practice of contracting in the Mexican health system. Specifically, SPS established that formal relationships among institutional agencies should be mediated by written agreements and contracts. These contracts were supposed to ensure a technically sound interaction between financing and service provision agencies. This study aims to assess the degree to which the contracts adhere to five characteristics of cost-effective contracting proposed by Figueras et al. Information was extracted from a purposive sample of 30 institutional agreements and contracts formalizing the relationship among federal, state, and local public agencies and between public and private agencies. Contracts and management agreements were obtained from of a series of SPS evaluations carried out between 2007 and 2012 (including some agreements signed in 2006); additional contracts signed after 2012 were obtained through an Internet search. Most of the five framework characteristics were identified in the sample of contracts, but certain elements such as pay-for-performance and the explicit definition of the volume of services to be provided were clearly deficient. This analysis found that over time SPS contracts have been modified to better establish inter-institutional relationships in compliance with guidelines regarding the allocation of funds and the purchasing of services, but they still need further improvements to accomplish their role of increasing efficiency in the flow of funds through the Mexican health system.
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Objetivo: El presente artículo analiza la experiencia de mujeres cuidadoras familiares de adultos con parálisis cerebral (PC), identificando elementos capacitistas y heteronormativosen el discurso médico sobre personas con PC que subyacen a la violencia obstétrica (VO) y confieren el trabajo de cuidados a las mujeres. Metodología: Estudio cualitativo de diseño fenomenológico con 25 sujetos de trece familias de la Zona Metropolitana de Cuernavaca, México con integrantes adultos con PC. Se realizaron entrevistas semiestructuradas, grabadas previo consentimiento informado, transcritas y analizadas mediante descripción interpretativa. Resultados: Los relatos sobre la atención médica arrojaron experiencias de violencia obstétrica, violencia pediátrica y negligencia que marcaron la vida de las madres y sus hijos con PC. El trabajo de cuidados especiales recae principalmente en las madres y otras mujeres de sus familias, estimulado por discursos médicos de poder operando sobre los cuerpos de los/as otros/as;cuando se trata de mujeres-madres,el género es fundamental en la construcción de dichodiscurso, del que emanan capacidades normativas, como la capacidad de tolerar sufrimiento en el partoy el deber de cuidar de por vida a hijos/as con PC, a quienes el discurso define como sujetosdependientes. Conclusiones: Coincidiendo con otros estudios sobre VO, ésta problemática va más allá de la calidad de la atención médica; es una manifestación de violencia estructural sustentada en ideas capacitistas y heteronormativas que delegan el trabajo de cuidado en las mujeres con base en su "capacidad natural" y aspiracional para cuidar de otros, en detrimento del conocimiento y ejercicio de derechos. (AU)
Objective: This article analyzes the experience of female family caregivers of adults with cerebral palsy (CP), identifying ableistand heteronormative elements in the medical discourse about people with CP that underlie obstetric violence (OV) and confer care work on women. Methodology: Qualitative study of phenomenological design with 25 subjects from thirteen families of the Metropolitan Area of Cuernavaca, Mexico with adult members with CP. Semi-structured interviews were conducted, recorded with prior informed consent, transcribed and analyzed by interpretive description. Results: The reports about medical care showed experiences of OV, pediatric violence and neglect that marked the lives of mothers and their children with CP. Special care work falls mainly on mothers and other women in their families, stimulated by medical discourses of power operating on the bodies of others; When it comes to women-mothers, gender is fundamental in the construction of this discourse, from which normative capacities emanate, such as the ability to tolerate suffering in childbirth and the duty to care for children with CP for life, whom the discourse defines as dependent subjects. Conclusions: Coinciding with other studies on OV, this problem goes beyond the quality of medical care; It is a manifestation of structural violence supported by ableist and heteronormative ideas that delegate care work to women based on their "natural" and aspirational capacity to care for others, to the detriment of the knowledge and exercise of rights.
Subject(s)
Disabled Persons , Gender-Based Violence , Obstetric Violence , Cerebral Palsy , Caregivers , Gender NormsABSTRACT
BACKGROUND: In 2003, Mexico's Seguro Popular de Salud (SPS), was launched as an innovative financial mechanism implemented to channel new funds to provide health insurance to 50 million Mexicans and to reduce systemic financial inequities. The objective of this article is to understand the complexity and dynamics that contributed to the adaptation of the policy in the implementation stage, how these changes occurred, and why, from a complex and adaptive systems perspective. METHODS: A complex adaptive systems (CAS) framework was used to carry out a secondary analysis of data obtained from four SPS's implementation evaluations. We first identified key actors, their roles, incentives and power, and their responses to the policy and guidelines. We then developed a causal loop diagram to disentangle the feedback dynamics associated with the modifications of the policy implementation which we then analyzed using a CAS perspective. RESULTS: Implementation variations were identified in seven core design features during the first 10 years of implementation period, and in each case, the SPS's central coordination introduced modifications in response to the reactions of the different actors. We identified several CAS phenomena associated with these changes including phase transitions, network emergence, resistance to change, history dependence, and feedback loops. CONCLUSIONS: Our findings generate valuable lessons to policy implementation processes, especially those involving a monetary component, where the emergence of coping mechanisms and other CAS phenomena inevitably lead to modifications of policies and their interpretation by those who implement them. These include the difficulty of implementing strategies that aim to pool funds through solidarity among beneficiaries where the rich support the poor when there are no incentives for the rich to do so. Also, how resistance to change and history dependence can pose significant challenges to implementing changes, where the local actors use their significant power to oppose or modify these changes.
Subject(s)
Health Plan Implementation/methods , Health Policy , Insurance, Health , Humans , Mexico , Universal Health InsuranceABSTRACT
Abstract-In 2012, the Mexican government declared that Seguro Popular had reached the goal of providing health insurance to nearly 53 million individuals previously not enrolled with social security. This major achievement was reached in only nine years of operation of the new system. However, enormous challenges remain to guarantee that Seguro Popular will provide adequate services to the newly enrolled population. This article uses information collected by four external evaluations of Seguro Popular carried out between 2007 and 2012 to analyze how financial resources are transferred from the federal level to the states and how these resources are used to purchase services on behalf of the affiliated population. We focus on three topics: the financial transfer mechanisms, the purchasing of medicines, and the contracting of health workers. The analysis shows that the implementation of Seguro Popular has confronted major challenges due to limited institutional capacity at the federal and state levels, tension in federal-state relations, limited information systems, the influence of political interests, and the use of financial resources for unauthorized expenditures at the state level. Various legal, normative, and technical changes have been introduced during implementation of Seguro Popular to improve performance, with mixed results. Mexico's experiences with the implementation of health reform may offer important lessons for other countries seeking to expand health coverage.
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Resumen: Objetivo: Analizar indicadores de eficiencia de los recursos humanos (RH) de la Secretaría de Salud de México. Material y métodos: Utilizando información secundaria se exploraron tres dimensiones de eficiencia: a) desperdicio de fuerza laboral, b) distribución de RH entre niveles de atención, y c) productividad. Resultados: El grupo de trabajadores de salud analizado se caracteriza por presentar niveles importantes de desempleo y subempleo de RH, una distribución distante de las recomendaciones internacionales y niveles de producción heterogéneos entre los estados. Conclusiones: Es imperativo diseñar e implementar un plan de RH en salud alineado a las necesidades y demandas de las poblaciones cubiertas que contemple medidas regulatorias del mercado de formación de estos recursos, su distribución entre y al interior de los sistemas estatales de salud y la generación de incentivos para el desempeño.
Abstract: Objective: To analyze efficiency indicators of human resources working at Mexico's Ministry of Health. Materials and methods: Three dimensions of efficiency were explored: a) labor wastage, b) distribution of human resources (HR) across levels of care, and c) productivity. Results: Health workers present significant levels of unemployment and underemployment; distribution does not meet international recommendations, and heterogeneous levels of productivity were found among states. Conclusions: Health and educational authorities should develop and implement a HR plan that takes into consideration the needs and demands of the covered population, and includes a clearly defined set of measures to regulate the future production of HR as well as their distribution among and within state health systems, and that allocates incentives to improve performance.
Subject(s)
Humans , Male , Female , Staff Development , Health Resources/organization & administration , Office Visits/statistics & numerical data , Unemployment , Health Personnel/statistics & numerical data , Efficiency , Geography, Medical , Forecasting , Health Resources/supply & distribution , Health Services Needs and Demand , MexicoABSTRACT
OBJETIVO: Caracterizar la capacidad para el desempeño de las funciones esenciales de la salud pública (FESP) de las instituciones públicas y privadas en países de Mesoamérica, los estados mexicanos de Chiapas y Quintana Roo y la República Dominicana. MÉTODOS: Se aplicó una encuesta en línea a 83 organizaciones de Belice, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panamá, la República Dominicana y los estados mexicanos de Chiapas y Quintana Roo sobre la capacidad de cumplir cada una de las 11 FESP. Los resultados se validaron en un taller con representantes de los ministerios de salud de los siete países y los dos estados mexicanos participantes. RESULTADOS: La mayor capacidad para el desempeño se identificó en la FESP 1 (monitoreo, evaluación y análisis del estado de salud de la población), la FESP 2.1.1 (vigilancia, investigación y control de riesgos y amenazas a la salud pública para enfermedades infecciosas) y la FESP 5 (desarrollo de políticas y planificación en salud). La mayor debilidad se encontró en la FESP 2.1.2 (vigilancia, investigación y monitoreo de las enfermedades no infecciosas). Las asimetrías en el desempeño de las FESP al interior de cada país indican debilidades en las funciones de los laboratorios y de la investigación en salud pública. CONCLUSIONES: Se requiere mejorar el desempeño estratégico en la mayor parte de las FESP en los países y territorios analizados y reforzar la infraestructura, el equipamiento y los recursos humanos, tanto a nivel estratégico como táctico. Se debe aplicar un enfoque regional para aprovechar la capacidad diferencial con vistas al fortalecimiento y el apoyo técnico cooperativo.
OBJECTIVE: Characterize the capacity of public and private institutions in the Central American countries, the Dominican Republic, and the Mexican states of Chiapas and Quintana Roo to perform essential public health functions (EPHFs). METHODS: An online survey of 83 organizations in Belize, Costa Rica, the Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, Panama, and the Mexican states of Chiapas and Quintana Roo was conducted to learn about their capacity to perform each of the 11 EPHFs. The results were validated in a workshop with representatives of the ministries of health from the seven countries and the two participating Mexican states. RESULTS: High levels of performance capacity were found most often for EPHF 1 (monitoring, evaluation, and analysis of health status of the population), EPHF 2.1.1 (surveillance, research, and control of risks and threats to public health from infectious diseases), and EPHF 5 (policy development and health planning). The greatest weakness was found in EPHF 2.1.2 (surveillance, research, and monitoring of noninfectious diseases). Asymmetries in EPHF performance within each country mainly revealed weaknesses in the laboratory and public health research functions. CONCLUSIONS: In the countries and territories analyzed, there is a need to improve strategic performance in most of the EPHFs, as well as to strengthen infrastructure, upgrade equipment, and further develop human resources at both the strategic and the tactical levels. A regional approach should be used to take advantage of the different levels of capacity, with a view to greater strengthening and enhanced technical support and cooperation.