Giving a Voice to Public Health

Q: Nosotrxs goal is to empower society to actively seek law and human rights compliance. How is Cero Desabasto contributing to that goal?

A: Nosotrxs, a political movement with no party affiliations, was born five years ago after our over 300 founders decided to help civil society gain back its political decision-making power. Democracy is created by society, not only by political parties. In 2019, Nosotrxs created the collective Cero Desabasto (Zero Shortages) alongside 83 patient associations in response to the increasing medicine shortages in Mexico. The collective is based on research and communication.

The authorities do not guarantee the right to healthcare in Mexico, which can be seen in the growth of private sector services. During the COVID-19 pandemic, only 34 percent of those who needed medical attention used public services. Moreover, many individuals commonly visit pharmacy-adjacent medical offices, which entail out-of-pocket expenditures, when they feel sick instead of visiting public institutions. Medicine shortages also caused out-of-pocket expenditures. In 2021, we saw a concerning increase in unfilled prescriptions and limited medical consultations across all public health services.

We also observed that drug counterfeiting is increasing. While most of this was revealed through citizen complaints to COFEPRIS, it was also observed that IMSS acquired drugs from unverified sources.

Q: How is Nosotrxs increasing awareness and helping address issues in the health sector?

A: To expose medicine shortages, Cero Desabasto created a Web App in which patients, doctors and medical professionals can report medicine and supply shortages at their medical centers. Our team validates this information and we then send it to the federal and local authorities. The government’s role is to secure access to healthcare and we want to support them in this journey by providing this information. This data is also used to generate quarterly and yearly reports.

We also generate reports for every social security institution and we are working on an INSABI and IMSS-Bienestar report due to their role as universal health providers. We want to showcase budgets, responsibilities, capacities and other indicators that will allow society to have a clear picture of an organization.

Alongside the UN Development Program (UNDP), we generated three proposals for the public health sector, including the Mexican Observatory of Access to Medicines and Devices for Health. This proposal was created with the support of Universidad Nacional Autónoma de México (UNAM), Colegio de México (COLMEX), the Mexican Institute of Public Health (INSP) and Universidad de Guadalajara (UDG). We are working with these institutions to generate a space for dialogue where all sectors can meet and discuss universal healthcare access.

Q: How will the change from INSABI to IMSS-Bienestar help alleviate the current medicine shortage?

A: Uncertainty in acquisition processes is at the root of medicine shortages. While the old medicine acquisition process did have flaws, it allowed more actors to participate and had clear procedures. These procedures often led to late payments to suppliers, a problem that the new process tried to avoid by modifying the Acquisitions Law to allow UNOPS to mediate tenders and pay suppliers. But this has not happened.

It is unclear how IMSS-Bienestar will manage demand and what role INSABI will play in the transfer of resources. However, IMSS-Bienestar is an attractive alternative from a universal health perspective because its functionality is better established than INSABI’s. But the mechanisms for its services to reach people are still unclear, as is the way its funds will be divided in the provision of healthcare. The future of IMSS-Bienestar’s regular funds, its own projects and its power to redirect patients to other institutions are also in question.

One of the most concerning problems is the neglect of public health programs in Mexico as good initiatives were paused to achieve the universal care project, which has been unsuccessful so far and caused medicine and supply shortages. Unilateral decision-making has been dominating Mexican public health, leading to poor results and severe repercussions for patient health, which will cause long-term problems for the system.

Q: What problems does Médicos en Formación aim to address and how?

A: Medical professionals face historic hurdles that limit their ability to exercise their profession. This problem is worsened by limited hiring by cash-strapped public health institutions, which leads to medical students filling in for doctors. This becomes a “cheap labor” dynamic that affects both medical residents, who are not being paid for the job they are doing, and patients, who end up receiving care from a student and not a qualified doctor. Even the largest national institutes in Mexico City participate in this dynamic.

Due to their vulnerable position at health centers, medical students suffer from many abuses, including sexual harassment, and we want to be their voice to ensure their working conditions improve.

Medicos en Formacion then focuses on gathering complaints from medical doctors under these circumstances so that we can be their voice. We have allied with doctors’ associations to enhance the impact of this project. Also, with the support of legal experts, we are creating a proposal to reform the norms and regulations on the subject.

Nosotrxs is an ONG that works to protect human rights, fight corruption and promote equality. Its Health and Wellness division leads two initiatives: Cero Desabasto (Zero Shortages) and Médicos en Formación (Doctors in Training).