Healthcare Workers: Foundation Of Universal Access

Healthcare workers are the cornerstone of health systems. Worldwide, there are around 59.8 million health workers but according to WHO, this number is insufficient to face the global disease burden. A report by Global Health Learning states that 57 countries, most of them in Africa and Asia, face a severe health workforce crisis. WHO estimates that at least 2.36 million health service providers and 1.89 million management support workers are needed to fill the gap. Just as in Mexico, health workers around the world are unequally distributed. If the situation remains unchanged, WHO estimates that by 2030, there will be a 18 million deficit of healthcare workers.

Healthcare Workers in Mexico

In Mexico, according to the most recent data from the Ministry of Health, there are 277,287 practicing doctors, meaning that Mexico is still below the basic healthcare standards established by the OECD. A report by IMCO found that from 2012 to 2019, the number of doctors and nurses per 1,000 inhabitants in the country decreased from 2.2 to 2.0 and from 2.6 to 2.4, respectively. The OECD establishes an average 1.7 and 3.8 times higher than Mexico’s results. In an ideal scenario, countries would have at least 3.4 doctors and nine nurses per 1,000 people.

There is a number of reasons for this shortage related to the difficulties of deploying healthcare workers to rural or remote areas, a mismatch between education and employment opportunities and the lack of investment in education and training, which eventually leads to brain drain.

German Fajardo, Director of UNAM’s School of Health Sciences, explained to MBN that Mexico has enough graduating doctors per year. “From the 18,000 doctors that graduate per year, almost all of them look forward to entering a specialty by completing the National Exam of Candidates to Medical Residences (ENARM). Mexico has a large number of general doctors; passing the ENARM test and then finding a job is the challenge.” Fajardo mentioned that many of these doctors end up working at one of the 20,000 pharmacy-adjacent offices in Mexico, which, depending on the shifts, can employ more than one doctor.

Challenges for Healthcare Workers

Infrastructure, technology in medicine and an adequate staff are also fundamental for a correct medical practice. According to Fajardo, many rural towns or remote communities do not have a fixed work place for doctors to receive patients. “This lack of access to medical attention means a disadvantage for the patient, who lacks medical attention, and for the doctor due to them receiving a lower salary or lacking development opportunities for themselves and their families.”

Low salaries for healthcare workers and specially for doctors are another problem in the country. “This profession is totally vocational. Doctors in Mexico are not highly paid, at least not compared to other countries and to the cost of the career itself,” shared Misael Uribe, President of Médica Sur, with MBN. A general doctor in the Mexican public sector earns around MX$13,190 (US$663.78) per month, which is around MX$65 (US$3) per hour worked. A specialist earns approximately MX$18,000 (US$ 862.78) per month or MX$111 (US$5.32) per hour. A general nurse in the public sector earns around MX$9,890 (US$497.71) and a nursing specialist earns around MX$14,771 (US$743.34). The exact number depends on their level of expertise and area of care. However, salaries are often MX$300-1,000 (US$15.10-50.32) lower in rural or remote areas of the country.

In Mexico, 72 percent of the total number doctors work in the public sector. Meanwhile, doctor specialists work largely in the private sector. Approximately 55 percent of these specialists are concentrated in Mexico City, State of Mexico, Jalisco, Nuevo Leon, Guanajuato and Puebla.

According to Medscape, in the US, primary care doctors earn US$20,250 per month, while specialists earn around US$28,833 per month. Nurses earn approximately US$6,108 per month and nursing specialists an average of US$8,853 per month.

Infrastructure has been called out as a major problem by other industry experts. In an interview with MBN, Jorge Eugenio Valdez, Dean of the School of Medicine and Health Sciences of TecSalud, explained that poor infrastructure for primary care is an obstacle for doctors to access basic tools to provide dignified care, including equipment, facilities and communication channels to provide consultation. “A fair economic remuneration should also be enough to allow health professionals to have a good quality of life and the possibility to start a family.”

The latter was also addressed by Adrián Ceballos, Medical Director of the Mother-Enfant Unit at Centro Médico Dalinde, during an interview with MBN. “The government has proposed salary raises for doctors in rural areas with the goal of drawing doctors to areas in need. It is good that doctors’ work starts to be dignified.” However, Ceballos explains that the job goes much further because in the end, doctors who would move to these remote places must have the peace of mind that their family will grow in an environment with access to services (schools, hospitals, etc.) and that, above all, these communities or municipalities are safe places for them and their families.

This lack of healthcare workers in both rural and urban areas has led to a wastage of the current workforce. Even in the capital, where there are public health institutes and large private hospitals, a study by the UAEM showed that 30 percent of workers in the public sector had conflicts in their work environment, 25.9 percent had low motivation and job dissatisfaction and 28.3 percent presented burnout syndrome. A study by UNAM showed that the general working conditions at public hospitals or clinics showed excessive workload, pressure and strenuous hours.

Fajardo mentioned two actions that can be effective to eradicate the general doctor shortage problem. One is to send medical students to those remote areas of the country before their residency to learn and provide healthcare. This way, they can receive a proper training and meet the needs of those populations. Second, doctors who do not pass ENARM should be allowed to spend a couple of years in a community and after that, they should enter their residency.

Vaccination Hurdles

The COVID-19 pandemic exacerbated the precarious conditions of health workers in Mexico, who have suffered public harassment, discrimination and even violence from society. They have also faced a lack of medical supplies to face the pandemic safely. In 2020, Mexico had the highest number of healthcare worker deaths from COVID-19. Amnesty International found that globally, more than 3,000 healthcare workers had died after contracting COVID-19. The countries with the highest mortality rates were Mexico (1,320), USA (1,077) and the UK (649). The Lancet launched a special study on the subject and reported that less than 3 weeks after Mexico recorded its first COVID-19 case, around 70 protests had taken place, with medical staff evidencing shortages of supplies and tests, along with a lack of hospital infrastructure and even proper training.

Protests for better conditions prevailed throughout 2020 and 2021. However, current demands have shifted. With the arrival of COVID-19 vaccines, health workers were first on the list of the vaccination campaign in Mexico. However, this first phase n mainly considered public workers, leaving out health professionals from the private sector who are now protesting for their vaccines.

The protest intensified in April, when around 500 workers accused the federal government of discrimination, realizing that a large majority of them were left out of the campaign. The workers organized a census to determine if the situation was a fluke or a crisis. The census revealed 28,700 health professionals had been left out of the vaccination lists. David Berrones, the leader of the initiative, told Animal Político that “the registry could fall short from the reality” as it only includes doctors and dentists. However, there are many other professionals that should be considered for the vaccine.

Despite Mexico heading the list of deaths among healthcare workers from both the public and private sector, President López Obrador asked private workers to “wait for their turn.” “It has been complex to have clear, refined, up-to-date lists of health professionals in the private sector and of course this is a challenge,” said Deputy Minister of Health Hugo López-Gatell. “Instead of protests, I ask for the collaboration of those who can integrate clear, defined lists of those exposed to COVID-19 risk in the private sector with the same clarity that we have in the public sector.”

López-Gatell did approach the private sector, according to a statement from Marcos Pascual, Commercial Director of ANAFARMEX, to MBN. “Deputy Minister of Health López-Gatell asked us for a doctors’ census at the end of January. This was a voluntary census aiming to support the official census of the government.” The association has registered 2,750 doctors and it is checking the data to avoid registry duplications. This is because around 5 percent of these doctors also work at public hospitals, such as IMSS or ISSSTE, so they are already contemplated on those lists. Pascual explains that this has been particularly prioritized by the government of Mexico City. According to the government, doctors working at the City’s PAMOs are contemplated on their vaccination priority list but vaccination moves forward depending on general vaccine availability.