INSABI, which replaced Seguro Popular in 2020, has only delivered 9.5 percent of the drugs requested by states across the country, according to an investigation by Animal Político.
Besides COVID-19, public medicine supply has been one of the main issues to address in the health industry. The first sights of inconsistencies came with changes to the Acquisition Law for medicines and medical supplies, which unleashed inconformity from local manufacturers and distributors of medicine as they learned that new regulations involved a consolidated purchasing model that would centralize operations through INSABI. The move was meant to bring savings and support the current federal administration’s austerity and anti-corruption policies, as a single institution would be acquiring medicines for all states.
The federal government shunned distribution companies (which were in charge of consolidating supplies from different laboratories and distributing them) from the drug purchasing process. As a result, each public institution and state had to send its own orders, unlike the previous 2013-2018 system, which allowed IMSS to buy medicines for all its units, as well as for ISSSTE, PEMEX, SEDENA, SEMAR and the health institutions of 22 states.
The complexity of this first change drove the government to implement a new adjustment, bringing UNOPS as a supplier in the acquisition process and making INSABI the main purchaser and distributor of medicines for 2021-2024. This new acquisition process was set to begin in October 2020 but this was delayed until December 2020.
Earlier this year, Mexico saw dozens of protests, hundreds of appeals and over 550 complaints to the CNDH due to medicine shortages going back to 2019, reports Animal Político. NGO Zero Shortage also highlighted shortage conditions and on February 20, 2021, the Superior Audit of the Federation (ASF) confirmed these accusations. ASF reported that “the tender LA-012000991-E82-2019, corresponding to the consolidated acquisition of medicines from 2019, did not feature clear and comprehensive information nor did it place enough orders to guarantee sufficient stock to meet medicine demand.”
The first protests against the present shortages were seen in 2019 in Mexico City led by people with HIV demanding their medicines. After that came constant protests from parents of cancer patients, which began in 2020. The latter group has been accused of plotting a “coup” against López Obrador’s administration, “exaggerating the situation and using the protest for other purposes,” according to Minister of Health Jorge Alcocer and Deputy Minister of Health Hugo López- Gatell.
Against public complaints and protests, Alcocer shared back in June that Mexico saved MX$11.88 million (US$600 million) thanks to UNOPS purchases, saying that this mechanism “guarantees supply and access to quality drugs for the main diseases that affect the Mexican population.”
Animal Politico’s recent report, which found that as of Oct. 1, 2021, INSABI had only delivered 9.5 percent of all the drugs requested by states, also highlighted that the entities with the lowest percentage of drugs delivered are Mexico City with 0.3 percent of its orders fulfilled, Campeche with 1.7 percent, Coahuila with 2.2 percent, Sinaloa with 3.6 percent and Chiapas with 3.9 percent.
Besides preventing proper treatment follow up, this situation has increased out-of-pocket expenditure. According to an MBN interview with Rafael Maciel, President of AMEGI, the use of generics in the public sector decreased by 22 percent in units and by 8.5 percent in value as a result of new acquisition processes, which caused many implementation challenges and led to further shortages. The decrease was mostly seen at IMSS, which was missing 30 percent of the units it required. “The shortages drove patients to seek medications in the private market. The majority of the missing drugs were for cancer or other high impact diseases,” shared Maciel.