September 2, 2006
Submitted by: Viola Krebs (ICVolunteers); Contributors: Jean-Pierre Joly (ICVolunteers)
Health reform is badly needed in many countries in the developing world in order to stop the burden of catastrophic healthcare costs remaining on the shoulders of individual families. We talked to Dr. Frenk, Minister of Health for Mexico, where an important healthcare system reform was launched in 2003. The reform implemented, among other things, a 7-year plan to finance "el seguro popular" or popular insurance.
Q: How do you see the development of a global health policy? What are the major issues?
Let me give you the example of Mexico to illustrate my views. It is about a real life experience regarding the deep transformation undertaken by my country in the field of developing and managing a health system. It has been a process of shared learning and innovation, inspired by other countries, including European nations. It is our aim to share our experience with others and make it available to them.
Many barriers have to be overcome when putting in place a coherent health system which provides equal access to health for all. Barriers are geographical, cultural and organizational. For example, bureaucracy will generate long queues and alter quality. In addition, a major stumbling block to enhancing health programmes is their financing. We, in Mexico, have understood that we need to demolish the financial barriers to make progress. Financing is of course not just an issue for Mexico. Indeed, nearly everywhere in the world, financing of health systems has not kept up with existing and forecasted needs. However, developing countries have to bear a double burden. Not only do they have to face health problems due to epidemic diseases but, at the same time, they have to build their infrastructure.
Hence, many low and medium income countries have been unable to adapt their health systems. But the changing environment requires them to do so. Several factors can provide pressure to trigger change. Today, we have to face new epidemic diseases such as AIDS which did not exist 25 years ago. Another factor is brought by technological evolution: there are new drugs available that can save lives. And then there is the growing pressure and awareness of populations that health is a fundamental right. Good pressures can help adjust health systems in order for them to respond better to needs.
Q: So, how did you go about bringing change to the health system in Mexico?
We decided to tackle the issue on several fronts, in particular the social, the financial and the cultural ones. What we have done is not perfect but it has produced good evidence. First, one has to understand the reality and become aware of the unacceptable paradox that the lack of financing healthcare in a country can itself create poverty. Next, you can transfer experience from elsewhere to adapt and improve the existing or non-existing system, taking into account the social, financial and cultural characteristics or limitations of the country. Once you have been able to produce good results of the interdependence between improvement of health systems and poverty reduction a new global dynamic appears.
In the Mexican case we took the decision to invest heavily in research to guarantee quality in the long run. Finally, it seems of utmost importance to me to articulate a clear ethical framework in which you can reflect the challenges of your people. Another element is the use of the ethical (universal human right) argument, to obtain the necessary political support in order to have your projects accepted.
Mexico has created a social protection scheme which is social insurance similar to what exists in several European countries and which allows poor people access to health care. This system of protection, also called popular insurance or "seguro popular" avoids that people are excluded from basic healthcare.
As I mentioned before, it is important to implement these new policies gradually in order to keep the finances of the country in balance. The Ministry of Finance only supported the changes on the basis of a sound financial plan. We adopted a 7-year horizon for the reform. A strict follow-up on the expenditure side increases credibility among parliamentarians and increases the chances of funding being continued in the future. Thanks to the support of the whole government we could create 2700 new facilities. It is true that in our case we started from a very low level and had a huge shortage, which explains why there were so many health facilities needed and created, in particular in the poorest parts of Mexico.
Our programmes also include education and training of medical staff. Another significant effort has been produced on the drug supply side. In this context, measures are taken that drugs are only obtained through prescriptions in order to have better control. And everything is done to spend the money in an efficient way.
We also are constantly assessing our policy, the state of the technology in place. A number of challenges need to be addressed. There are still existing geographical discrepancies, bureaucracy treating people without dignity, organizational and cultural barriers. 10% of the Mexican population is indigenous and more than 50 languages are spoken in the country. Health care in the patient's language is needed. Monitoring tools are being put in place and the reports are made public. The results of the present system are needed to convince members of parliament and taxpayers to continue their investment in the new social contract for health.
Q: Just some words about your candidacy to the World Health Organization (WHO) and what your plans are?
I very much value the legacy of Dr. Lee. We had the honour of working together under Dr. Bruntland. We were colleagues. Later, I followed his work being on the Mexican delegation to the World Health Assembly. Also, Mexico hosted the conference on health research for development in November of 2005, which was an opportunity to welcome Dr. Lee to Mexico. Unfortunately, his term was cut short by his sudden death. I would like to continue many of the reforms that were started under him. I was very much in line and agreed with Dr. Lee's approach, in particular his focus on Africa, AIDS treatment, partnerships and financing mechanism in those partnerships. The focus on the internal management being more accountable will also be one of my priorities. The improvements initiated by Dr. Lee must continue.