Medicine Supply, Primary Care in the Spotlight

Q: What is the outlook for Mexican public health?

A: Public health is facing several challenges due to changes that occurred in late 2019. When social security transformed into INSABI, no one could have known that only two months later the COVID-19 pandemic would hit Mexico, leaving an unclear transition that left 60 million users in confusion.

INSABI needed to clarify its operating rules immediately but this only happened almost a year later. Users should not be put in second place. While Mexico’ Constitution says that all citizens have the right to access to healthcare, it is clear that our rights are not being respected.

Q: What is your view of the government’s agreement with UNOPS in regard to medicinal supplies?

A: To fight corruption, the Mexican government hired an international body that lacked the necessary experience to handle medicine supply in Mexico. It is not only about buying the medicines but also about distributing them across the country, which is large, complex and full of inaccessible roads. The government even tried to compare the distribution of medicines with the distribution of supermarket goods.

There are still several private, robust companies with expertise and clear logistics that used to handle the distribution of medicines in Mexico. However, the government decided to hire UNOPS to do the job and unfortunately medicine shortages have not been fixed.

Q: What would be the optimal strategy to address constant medicine shortages?

A: It would be difficult to return to the old model because the corresponding structure was completely dismantled. Rebuilding it could take several years. We must seek the expertise of the private sector and create a health system that combines public resources for hospital maintenance and healthcare, while moving other responsibilities to the private sector through collaboration agreements. Private companies have more resources and experience with new technologies and health modalities.

Before the transition, IMSS focused on a consolidated purchase scheme for the entire country. While this model also had faults, it worked better than the current model. The federal government’s major interest should be to guarantee supplies and foster prevention. In Mexico, we have good doctors and great hospitals. But it is necessary to improve primary and secondary care hospitals, so patients can avoid the medical complications that would drive them to seek tertiary care.

Q: How does the transition from INSABI to IMSS-Bienestar advance the country’s goal to provide universal care?

A: We cannot expect anything good from this transition. States are transferring their goods and capabilities to IMSS-Bienestar. Monopolizing healthcare concentrates power and resources, which will only generate greater bottlenecks because IMSS-Bienestar is a much smaller entity with limited resources. It also lacks transparency in the management of resources. This move will again cause confusion among users and increase demand for resources and care at IMSS-Bienestar.

Q: How could promoting preventive healthcare result in future savings for the healthcare system?

A: A key preventive measure in public health is vaccination. The government concentrated COVID-19 vaccines but by allowing clinics across the country to apply them, the vaccines could have been distributed further, faster. The basic vaccination scheme for children also has faced supply issues.

In addition, primary care must be improved. Diabetes, hypertension, obesity and cardiovascular diseases have a high prevalence in Mexico but they are all preventable and the health system must work on their prevention. Follow-ups and monitoring these patients are also crucial. Chronic diseases require continuous treatment and medicines must be available. These diseases cause large out-of-pocket expenses that many families in Mexico cannot afford. Prevention campaigns are also important.

Q: How did the conversion of hospitals to 100 percent COVID-19 care impact healthcare?

A: During the pandemic, the conversion of hospitals to 100 percent COVID-19 care was a mistake. There are many diseases that require continuous care and around 16 million Mexicans chose not to go to their medical appointments. In public health, risks must be communicated in an understandable, correct and brief way to patients. The stay-at-home policy confused many people. Staying home impacted the health decisions of many families.

Q: What has society learned about spreading misinformation and its impact on public health?

A: A great deal of misinformation was produced during the pandemic, such as the mistaken belief that chlorine dioxide could treat a COVID-19 infection. In reality, we have not learned that much. Information must be based on scientific proof. Social media is not the best source for medical information. During this period, Facebook became the home for the infodemic.

Scientists learned the importance of immediately reporting new COVID-19 variants or general information to international health authorities. Omicron monitoring in South Africa is a great example of a precise job, as the variant was immediately reported to the global community.

Q: What role should digitalization play within the Mexican health system?

A: Digital health involves different technologies to help the patient. Training and education of our medical personnel must be a priority in Mexico. We do not need more Cuban doctors; we have great schools here but we should leverage technology to avoid the lag caused by the pandemic.

Telemedicine is amazing. In rural areas, it can bring uncountable benefits. Other tech topics, such as electronic health records, have been discussed for over 20 years. Despite having other tools, such as the Unique Population Registry Code (CURP), Mexico still has not been able to develop an electronic health record, which would be very helpful for the entire health system.