Advances and challenges on the path toward the SDGs: subnational inequalities in Mexico, 1990-2017.

BACKGROUND: The sustainable development goals (SDGs) have generated momentum for global health, aligning efforts from governments and international organisations toward a set of goals that are expected to reflect improvements in life conditions across the globe. Mexico has huge social inequalities that can affect access to quality care and health outcomes. The objective of this study is to analyse inequalities among Mexico's 32 states on the health-related SDG indicators (HRSDGIs) from 1990 to 2017. METHODS: These analyses rely on the estimation of HRSDGIs as part of the Global Burden of Disease study 2017. We estimated the concentration index for 40+3 HRSDGI stratified by Socio-demographic Index and marginalisation index, and then for indicators where inequalities were identified, we ran decomposition analyses using structural variables such as gross domestic product per capita, poverty and health expenditure. FINDINGS: Mexico has made progress on most HRSDGIs, but current trends in improvement do not appear to fast enough to meet 2030 targets. Out of 43 HRSDGIs, we identified evidence of inequality between Mexico's states for 30 indicators; of those, 23 HRSDGIs were unequal distributed affecting states with lower development and seven affecting states with higher development. The decomposition analysis indicates that social determinants of health are major drivers of HRSDGI inequalities in Mexico. INTERPRETATION: Modifying current trends for HRSDGIs will require subnational-level and national-level policy action, of which should be informed by the latest available data and monitoring on the health-related SDGs. The SDGs' overarching objective of leaving no-one behind should be prioritised not only for individuals but also for communities and other subnational levels.

Efectividad de una intervención educativa semipresencial para la formación docente en el área de salud pública / Effectiveness of a blended learning education intervention for the teaching training in the Public Health area

Introducción. La formación docente debe orientarse a la actualización en contenidos específicos de una asignatura y en aspectos pedagógicos según los cambios educativos globales. En la Facultad de Medicina de la UNAM se imparten cursos dirigidos a estudiantes de pregrado que se formarán como docentes. El objetivo de este estudio fue diseñar, implementar y evaluar un curso-taller semipresencial de formación docente, dirigido a estudiantes con interés en profesionalizarse en una materia de salud pública. Sujetos y métodos. Ejes del curso: fundamentos de la asignatura y bases pedagógicas (impartido en 60 horas, 40 presenciales y 20 en línea). Se evaluó el avance con un test pre-postintervención, un instrumento de escenarios simulados y una rúbrica de presentación frente a grupo. Se calcularon medidas de resumen, pruebas de diferencias de medianas y dos modelos MANOVA para las calificaciones pre-post. Resultados. 49 participantes; un 73% concluyó el curso. La mediana de edad fue de 20 años, y la razón hombre-mujer, de 0,65. Medianas de calificaciones: preintervención, 4,53; postintervención, 7,24 (p < 0,05); bases pedagógicas, 9; presentación frente a grupo, 8,8. En ambos modelos MANOVA se observó que pertenecer a años avanzados de la carrera se relaciona con mayores puntuaciones (p < 0,05). El 16% de los participantes fueron seleccionados como docentes en formación para formar parte de la plantilla académica de la institución. Conclusiones. Este estudio puede considerarse como un referente para propiciar el reporte detallado de otros cursos, considerando el diseño instruccional, la evaluación de su impacto y su éxito en la incorporación temprana de estudiantes como profesores (AU)

Introduction. Teacher training must focus on updating specific contents of a subject and on pedagogical aspects according to global educational changes. At the Faculty of Medicine in UNAM there are courses addressed to undergraduate students who will be trained as teachers. The aim of the study was to design, implement and assess a blended learning course workshop in teacher training for medical students with an interest in specializing in Public Health subject. Subjects and methods. Course's axes: subject's foundations and pedagogical basis (taught in 60 hours, 40 on-site class and 20 online). The advancement was assessed with a pre- and post-test, a simulated scenario tool and a rubric for in front of a group presentation. Summary measurements were calculated, median differences tests and two MANOVA models for pre- and post-test grades. Results. 49 participants; 73% concluded the course. The age range was 20 years old and the male-female ratio was 0.65. Grades' median: pre-intervention, 4.53; post-intervention, 7.24 (p < 0.05); pedagogical bases, 9; in front of a group presentation, 8.8. In both MANOVA models it was observed that being at advanced levels of the career was related with higher scores (p < 0.05). Sixteen percent of the participants were chosen as 'teachers in training' to conform the academic board of our institution. Conclusions. This study may be considered as a referent to promote a detained report of other teacher training courses for students, considering the instructional design, the impact of its assessment and the success in an early incorporation of students as teachers (AU)

[Evaluation of Mexican 'Sicalidad' health quality program]. / Evaluación de la implementación del programa Sicalidad en México.

OBJECTIVE: To analize the implementation of the Sistema Integral de Calidad en Salud (Sicalidad) program of the Ministry of Health in the 2011. MATERIALS AND METHODS: The study follows a cross sectional design, hybrid, with a qualitative and quantitative components. A cluster probabilístic sample was used with two stages. A total of 3 034 interviews were carried out in 13 states to evaluate the implementation of the eight components of the Sicalidad program. General indexes of performance (GIP) were formulated for structure process and satisfaction of users, physicians and nurses with the program. RESULTS: The GIP with the lower score was accreditation of health facilities with a range of scores between 25.4 and 28% in the medical units evaluated; The highest range of scores was in the component of nosocomial infection prevention between 78.3 and 92%. CONCLUSION: In brief the Sicalidad components evaluated suggest problems with both structure and critical process elements in the implementation of the quality initiatives.

Evaluación de la implementación del programa Sicalidad en México / Evaluation of Mexican 'Sicalidad' health quality program

Objetivo. Analizar la implementación del programa Sistema Integral de Calidad en Salud (Sicalidad) en México, en 2011. Material y métodos. Estudio transversal, cualicuantitativo, con una muestra probabilística de conglomerados y dos etapas de selección. Se realizaron 3 034 entrevistas en 13 entidades federativas para evaluar ocho componentes del programa. Se formularon índices generales de desempeño (IGD) para evaluar la implementación en términos de estructura, proceso y satisfacción de los usuarios, médicos y enfermeras con el programa. Resultados. El IGD peor evaluado fue acreditación, con 25.4 y con 28% de unidades evaluadas; el mejor fue prevención y reducción de la infección nosocomial, con IGD de 78.3 y con 92% de implementación. Conclusiones. Los componentes de Sicalidad evaluados evidencian problemas en su implementación relacionados con la estructura y los procesos críticos de los servicios.

Objective. To analize the implementation of the Sistema Integral de Calidad en Salud (Sicalidad) program of the Ministry of Health in the 2011. Materials and methods. The study follows a cross sectional design, hybrid, with a qualitative and quantitative components. A cluster probabilístic sample was used with two stages. A total of 3 034 interviews were carried out in 13 states to evaluate the implementation of the eight components of the Sicalidad program. General indexes of performance (GIP) were formulated for structure process and satisfaction of users, physicians and nurses with the program. Results. The GIP with the lower score was accreditation of health facilities with a range of scores between 25.4 and 28% in the medical units evaluated; The highest range of scores was in the component of nosocomial infection prevention between 78.3 and 92%. Conclusion. In brief the Sicalidad components evaluated suggest problems with both structure and critical process elements in the implementation of the quality initiatives.

[Health in Mexico: old and rising challenges. An updated assessment]. / La salud en México: antiguos y nacientes desafíos. Un examen actualizado.

In recent decades, Mexico has come a long way in health care matters, which has influenced the standard of living of the population and the development of the country. However, much remains to be done and changes should happen faster. Some of the main challenges Mexico faces currently are presented in this document and include: the challenge of reducing poverty in order to improve the health status of society; the development of health services that affect the slowdown in the pace of evolution of demographic indicators, life expectancy at birth and infant mortality; the challenge of reducing inequality; the challenge of great infrastructure available in the country for health care and the limited performance obtained in terms of organization, management and financing; the challenge resulting from human resources training systems, both undergraduate and postgraduate; the challenge that relates to academic and scientific productivity; the challenge of diabetes as an example of a serious public health problem; and the challenge of ethical implications in the organization and administration of health services, specifically, the allocation of public resources to them.