Luz María González-Robledo

Barreras de acceso al diagnóstico temprano del cáncer de mama en el Distrito Federal y en Oaxaca

Objective. To identify social, cultural and health service barriers that prevent timely access to early detection of breast cancer in two regions: Mexico City Federal District and the state of Oaxaca. Material and Methods. An exploratory cross-sectional qualitative study was carried out in 2008 among women under 25 years of age without pathology, with pathological diagnosis, their male partners and managers of several public and private institutions. Information was collected by focus groups and through interviews that were recorded and transcribed after having received informed consent. Results. Initial exploration allowed the identification of access barriers in three main areas: a) the availability of information for the general population, b) training of firstcontact general practitioners and gynecologists, and c) fears among couples and families. Conclusions. Barriers in the three levels identified are relevant as they reveal important deficiencies in the dissemination of information both to the general population and to health providers.

Acciones gubernamentales para la detección temprana del cáncer de mama en América Latina: Retos a futuro

Se presenta investigacion documental realizada en 2009 que pretende documentar el marco normativo y los programas vigentes para la deteccion temprana del cancer mamario en America Latina y establecer los retos mas importantes para contener la epidemia en la region. Se identificaron diversas iniciativas emprendidas por las autoridades gubernamentales de salud para contrarrestar el crecimiento de la morbi-mortalidad por esta causa mediante estrategias de deteccion temprana, atencion e investigacion. A pesar de los avances en el diseno de politicas, programas, protocolos y guias de manejo clinico, persisten importantes retos para lograr los objetivos propuestos y la contencion de este problema.

Evaluating the Implementation of Mexico's Health Reform: The Case of Seguro Popular

Abstract—In 2012, the Mexican government declared that Seguro Popular had reached the goal of providing health insurance to nearly 53 million individuals previously not enrolled with social security. This major achievement was reached in only nine years of operation of the new system. However, enormous challenges remain to guarantee that Seguro Popular will provide adequate services to the newly enrolled population. This article uses information collected by four external evaluations of Seguro Popular carried out between 2007 and 2012 to analyze how financial resources are transferred from the federal level to the states and how these resources are used to purchase services on behalf of the affiliated population. We focus on three topics: the financial transfer mechanisms, the purchasing of medicines, and the contracting of health workers. The analysis shows that the implementation of Seguro Popular has confronted major challenges due to limited institutional capacity at the federal and state levels, tension in federal–state relations, limited information systems, the influence of political interests, and the use of financial resources for unauthorized expenditures at the state level. Various legal, normative, and technical changes have been introduced during implementation of Seguro Popular to improve performance, with mixed results. Mexicos experiences with the implementation of health reform may offer important lessons for other countries seeking to expand health coverage.

Dentist education and labour market in Mexico: elements for policy definition

BackgroundHere, the educational and labour market characteristics of Mexican dentists are revised. Dentistry is a health profession that has been scarcely studied in developing countries. This analysis attempts to understand the relationships and gaps between the supply and demand of dentists in the country. Around 5000 new dentists graduate every year looking for a place in the labour market.MethodsA cross-sectional study with exploratory, descriptive and correlational scope was carried out between 2006 and 2008. Analyses of quantitative data on dentists from national surveys and occupational statistics were complemented with qualitative information provided by 43 key informants in five Mexican states.ResultsThe 2008 dentist labour market can be characterized as follows: 75% worked in the private sector, most of them independently; more than two-thirds were women; the proportion of specialists was low (slightly more than 10%); unemployment was more than 20% and labour wastage was nearly 40%, with most wastage corresponding with female dentists. The increase in the number of dentists entering the labour market during the last two decades is more related to the educational market than to the population’s health needs and the number of dentists actually required to meet them.ConclusionsThe problems identified in the Mexican dentist labour market necessitate urgent intervention on behalf of regulatory bodies in order to balance the tendencies of supply and demand in the number of trained professionals as well as in their incorporation into different market areas. Adequate policies are required to increase the likelihood of achieving this objective.

Breast cancer policy in Latin America: account of achievements and challenges in five countries

BackgroundThe recent increase of breast cancer mortality has put on alert to most countries in the region. However it has taken some time before breast cancer could be considered as a relevant problem. Only in recent years breast cancer has been considered a priority in some Latin American countries and resources have been mobilized to confront the problem at the institutional level. The article analyzes the efforts made in five Latin American countries (Argentina, Brazil, Colombia, Mexico and Venezuela) in the last 15 years to design and implement policies to address the growing incidence of breast cancer.MethodsData was collected between July and December 2010 from both primary and secondary sources. Semi-structured interviews were conducted with key informants from governmental and non-governmental organizations. Secondary data was obtained from publications in journals, government reports and official statistics in each country. Analysis combines information from both types of sources.ResultsCountries have followed different paths and are in different stages of policy implementation. In all cases early detection is a key strategy. Through the design of programs and guidelines, the allocation of financial resources to treat patients, as well as a formally structured information system, Brazil and Mexico have been able to set up comprehensive national policies. Argentina, Colombia and Venezuela have made important advancements but not yet capable of coordinating comprehensive national policies.ConclusionBreast cancer is being considered a priority in all five countries but there are different stages in the rolling out of comprehensive national policies due to differences in their capacity to allocate resources, implement operational strategies and encourage the participation of relevant stakeholders.

El Fondo de Protección contra Gastos Catastróficos: tendencia, evolución y operación

OBJETIVO. Documentar los procesos operativos y de gestion del Fondo de Proteccion contra Gastos Catastroficos (FPGC), evolucion y distribucion del gasto y explorar semejanza entre padecimientos cubiertos y perfil epidemiologico. MATERIAL Y METODOS. Estudio mixto, de naturaleza gerencial, que incluyo entrevistas semiestructuradas, revision de bases de datos de la Comision Nacional de Proteccion Social en Salud (CNPSS), egresos hospitalarios y mortalidad. RESULTADOS. El 52% de los estados tardan el doble del tiempo establecido para notificar y validar los casos. De 2004 a 2009 el FPGC paso de 6 a 49 intervenciones, equivalente a un incremento nominal y real del gasto de 2 306.4 y 1 659.3%, respectivamente. La intervencion priorizada fue VIH/SIDA con 39.3%; el Distrito Federal obtuvo la mayor proporcion del gasto (25.1%). Algunas de las principales causas de mortalidad son cubiertas por el FPGC. CONCLUSIONES. La revision de los criterios de inclusion de enfermedades y la adecuacion del fondo para atender la demanda creciente es impostergable.

Formación de médicos y enfermeras para la detección temprana del cáncer de mama en México

Objetivo Analizar la formacion academica que reciben los estudiantes de medicina y enfermeria sobre el cancer de mama (CaMa) durante el trascurso de su carrera universitaria. Materiales y Metodos Estudio exploratorio realizado en 2009. Basado en entrevistas semi-estructuradas a actores clave y revision documental. Poblacion de estudio: 199 Facultades/Escuelas de medicina y 108 Escuelas/Institutos de enfermeria. Unidad de analisis: plan de estudios. Resultados En 16,8 % de los planes de estudio de medicina y 6,3 % de enfermeria se encontro informacion especifica de contenidos sobre CaMa. La capacitacion que reciben los medicos es predominantemente desarrollada por las areas biomedica y clinica y en menor proporcion en el area socio-medica. En enfermeria los temas que mas se desarrollan son en areas comunitarias, abordando contenidos de promocion de la salud y prevencion de la enfermedad (estilos de vida saludable e identificacion de mujeres con alto riesgo de padecer CaMa). Discusion Se encontro escasa evidencia sobre entrenamiento especifico para la deteccion y atencion del cancer de mama en los planes de estudio. Por los resultados encontrados es necesario fortalecer los curriculos para formar a los futuros profesionales con capacidades para trabajar en la solucion de los problemas y necesidades especificos de salud de la poblacion particularmente en acciones de prevencion primaria y secundariaOBJECTIVE Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. MATERIALS AND METHODS This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. RESULTS 16.8% of the medical courses and 6.3% of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). DISCUSSION Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.Objective Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. Materials and Methods This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. Results 16.8 % of the medical courses and 6.3 % of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). Discussion Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.

An Assessment of Health Services Contracting in Mexico's Seguro Popular de Salud, 2006–2014

Abstract Abstract—The introduction of Seguro Popular de Salud (SPS) expanded the practice of contracting in the Mexican health system. Specifically, SPS established that formal relationships among institutional agencies should be mediated by written agreements and contracts. These contracts were supposed to ensure a technically sound interaction between financing and service provision agencies. This study aims to assess the degree to which the contracts adhere to five characteristics of cost-effective contracting proposed by Figueras et al. Information was extracted from a purposive sample of 30 institutional agreements and contracts formalizing the relationship among federal, state, and local public agencies and between public and private agencies. Contracts and management agreements were obtained from of a series of SPS evaluations carried out between 2007 and 2012 (including some agreements signed in 2006); additional contracts signed after 2012 were obtained through an Internet search. Most of the five framework characteristics were identified in the sample of contracts, but certain elements such as pay-for-performance and the explicit definition of the volume of services to be provided were clearly deficient. This analysis found that over time SPS contracts have been modified to better establish inter-institutional relationships in compliance with guidelines regarding the allocation of funds and the purchasing of services, but they still need further improvements to accomplish their role of increasing efficiency in the flow of funds through the Mexican health system.

Separación de funciones en el Sistema de Protección Social en Salud, México 2009: avances y retos

Objective. To evaluate advancements and challenges in the separation of functions within Mexico’s System of Social Protection in Health. Material and Methods. A 2009 evaluation study involving nine states and the National Commission for Social Protection in Health was carried out via semi-structured interviews with key actors and literature analysis. Results. The main advancement has been the creation of the State Regimens for Social Protection in Health (REPSS in Spanish) which act as intermediaries between users and health service providers, making these state-level entities responsible for both managing financial resources and shaping and coordinating the health care delivery network. However, most of the REPSS studied were found to be in a state of inertia, leading to inadequate compliance with legally mandated functions. Conclusion. Normative, technical, political and managerial obstacles persist, impeding the successful separation of functions.

Doctors and nurses' training for the early detection of the breast cancer in Mexico

Objetivo Analizar la formacion academica que reciben los estudiantes de medicina y enfermeria sobre el cancer de mama (CaMa) durante el trascurso de su carrera universitaria. Materiales y Metodos Estudio exploratorio realizado en 2009. Basado en entrevistas semi-estructuradas a actores clave y revision documental. Poblacion de estudio: 199 Facultades/Escuelas de medicina y 108 Escuelas/Institutos de enfermeria. Unidad de analisis: plan de estudios. Resultados En 16,8 % de los planes de estudio de medicina y 6,3 % de enfermeria se encontro informacion especifica de contenidos sobre CaMa. La capacitacion que reciben los medicos es predominantemente desarrollada por las areas biomedica y clinica y en menor proporcion en el area socio-medica. En enfermeria los temas que mas se desarrollan son en areas comunitarias, abordando contenidos de promocion de la salud y prevencion de la enfermedad (estilos de vida saludable e identificacion de mujeres con alto riesgo de padecer CaMa). Discusion Se encontro escasa evidencia sobre entrenamiento especifico para la deteccion y atencion del cancer de mama en los planes de estudio. Por los resultados encontrados es necesario fortalecer los curriculos para formar a los futuros profesionales con capacidades para trabajar en la solucion de los problemas y necesidades especificos de salud de la poblacion particularmente en acciones de prevencion primaria y secundariaOBJECTIVE Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. MATERIALS AND METHODS This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. RESULTS 16.8% of the medical courses and 6.3% of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). DISCUSSION Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.Objective Analyzing formal knowledge about breast cancer (BC) issues that medical and nursing students receive from different syllabuses and courses during their undergraduate studies. Materials and Methods This exploratory study was conducted in 2009; it was based on semi-structured interviews applied to key stakeholders and complemented by an analysis of their undergraduate courses. The study population consisted of 199 Faculties and Schools of Medicine and 108 Schools and Colleges of Nursing and the unit of analysis consisted of the syllabuses for the undergraduate courses. Results 16.8 % of the medical courses and 6.3 % of the nursing courses had specific information about BC. Medical students predominantly received their training in biomedical and clinical areas and the socio-medical area to a lesser extent. The issues in nursing courses was mainly focused (in community areas) on promoting health and preventing disease (healthy lifestyles and recognition of women at high risk regarding BC). Discussion Little evidence was found that medicine and nursing syllabuses contain issues related to BC. Medical and nursing curricula should be strengthened to improve professional skills and abilities related to BC to solve the affected populations problems and health needs, particularly regarding primary and secondary prevention.