The Road Towards Universal Coverage in Mexico

By Rocío López Iñigo

Mexico has taken gigantic steps towards universal health coverage in the last decade.  In 2012, a national program called Popular Insurance came into effect, offering coverage to more than 50 million people previously excluded from the health system. The program, first introduced in 2003, also seeks to prevent people from falling into the extreme poverty caused by repeated medical expenses. Although the results of this program have been positive, many families in the country's rural zones still face deficient primary care without adequate resources and qualified medical personnel.

The design of Mexico’s universal coverage often overlooks the situation of the most marginal communities, where many obstacles exist for true access to health care. The transport of resources—healthcare workers, medical equipment, and medicine—to the small communities remains a challenge. Clinics in these rural areas don't have permanent doctors. Most of the time they have only visiting physicians, and these are often recently graduated medical students. According to research by the UNAM School of Medicine, these residents treat 82% of the primary care clinics administered by the Secretary of Health in rural areas. Some 10 to 15 million Mexicans are attended by these recent graduates who work without supervision or professional support. This translates into bad medical attention for citizens and a disagreeable experience for these young doctors. 

In Chiapas, young doctors organized to create Compañeros en Salud (CES), an arm of the Harvard-affiliated Partners in Health in Mexico, to coordinate all the health care efforts with the aim of guaranteeing the fundamental human right to quality health care. In 2010 Harvard Medical School Professor Daniel Palazuelos, affiliated with Brigham and Women’s Hospital, met with Hugo Flores, a graduate of the Tecnológico de Monterrey and current CES director. Together with Lindsay Palazuelos, a Brown University graduate who is an expert in project development, they designed a model for quality  primary health care, based on efficient support for the region’s clinics.  The project stresses the training and constant supervision of the residents, who receive the necessary tools and work experience to confront the most complicated cases in their communities. They receive regular visits from supervisors, an adequate supply of medicines and other material and the support of specialists from around the world for complicated cases. Moreover, once a month, the residents attend a course designed to learn about the political, social and historic implications of illness and to deepen their knowledge about the causes of inequity in the administration of health care. 

This support to the medical residents translates into better attention to the community, and it also guides them in the navigation of the not always easy health care bureaucracy. CES also invests in programs adapted to the needs of the various communities such as mental health initiatives or the pioneering project of community social workers. These workers are trained in health and accompany people who have chronic diseases during their treatment. They act as a link between the doctor and patient, guaranteeing effective communication. 

CES currently works in eight clinics in Sierra Madre de Chiapas, although its sphere of indirect influence is calculated at some 25,000 people. Its model of strengthening provision of high-quality health and research has made this young, small organization with Harvard roots into a seed for change. Its evidence-based work relies on constant analysis of results, as well as the search for sustainable resources that will guarantee its development over time. Compañeros en Salud offers viable alternatives that can help to minimize the differences between public health policy as written on paper and the reality of thousands of Mexicans. 

Rocío López Iñigo is an Erasmus Mundus MA Global Studies candidate from the EMGS Consortium who has lived and worked as a journalist in Argentina and Mexico, experiencing different Latin American realities. She currently lives in Germany and hopes to eventually pursue a Ph.D. in International Relations.