Health under Mexico’s new President

Claudia Sheinbaum’s health agenda must contend with the legacy of her predecessor, reports David Agren in The Lancet.

Claudia Sheinbaum swept Mexico’s June 2 presidential elections, giving her an opportunity to realise her priorities for improving health in the country. Sheinbaum, who beat her closest opponent by more than 30 points and nearly taking supermajorities in both houses of Congress, campaigned on a platform of continuity, promising to expand on the populist political project of her mentor, outgoing President Andres Manuel Lopez Obrador, who is constitutionally prohibited from seeking re-election.

Health failed to figure prominently in the campaign, although Xochitl Galvez, Sheinbaum’s main opponent, promised to bring back a social insurance scheme known as Seguro Popular, which Lopez Obrador scrapped in 2019. Both Sheinbaum and Galvez pledged to keep the president’s landmark social programmes, a popular series of cash stipends for seniors, students, and single mothers, reported The Lancet.

But Sheinbaum, a climate scientist and former Mexico City Mayor, has promised to improve health care through a focus on prevention, modernisation, and improved training for practitioners. Her 10-point plan prioritised attention for the very young and very old, increasing homecare visits, along with introducing incentives for family members to care for loved ones with illness at home, and carrying out widespread vaccination campaigns.

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The plan, termed -Republica Sana-, or Healthy Republic, also aims to create a “culture of prevention”, which includes the promotion of healthy lifestyles. It speaks of reducing high rates of hypertension and diabetes, diseases that, along with renal failure, account for 24% of spending of the Mexican Social Security Institute -IMSS- It also proposes signing agreements between the Health Secretary and pharmacies to make many generic drugs and supplements such as antidiarrhoeal medicines, folic acid, and contraceptives available free of charge to patients enrolled in IMSS Bienestar, the programme that replaced Seguro Popular, reported The Lancet.

“What we have realised is that people arrive late to health services. Incorporating the concept of health: primary, timely care, preventive measures, is very important”, David Kershenobich Stalnikowitz, who oversaw the forums for designing Sheinbaum’s health platform, told Radio Formula. He declined comment for this story.

Sheinbaum’s plan also proposes improving hospital infrastructure, introducing technology such as the digitisation of patient files, and investing in training health professionals, along with gradually increasing salaries for health professionals. ‘‘I think it is very wise to improve salaries and be more competitive in terms of health personnel”, said Andres Castaneda Prado, a physician and professor at the National Autonomous University of Mexico. “What’s beginning to happen more frequently is that many of our professionals are going to other countries”,  said Castaneda and reported The Lancet.

Sheinbaum pledged to follow her predecessor’s philosophy of limiting private participation in the public system. “We are the only ones who are convinced that access to health is a right. It is not a commodity. It is not a privilege”, Sheinbaum said at the March 25 unveiling of her proposals. Sheinbaum’s office did not make a representative available for comment.

Mexico enshrines the right to health care in its constitution. However, funding has often been lacking and poses a challenge for Sheinbaum, who has not spoken of increasing health spending beyond the current 2.9% of GDP, the lowest in the OECD. Her administration also faces a record budget deficit as Lopez Obrador increased spending on social programmes ahead of the elections, reported The Lancet.

“There is no way to improve the health system if we do not increase health spending by at least 1 percentage point of GDP”, said Octavio Gomez Dantes, a researcher in health systems at the National Institute of Public Health. Gomez Dantes described the Sheinbaum proposals as, “a list of the usual suspects”, which could be presented almost anywhere. He also questioned the absence of a critical assessment of the current state of the country’s health system. “They couldn’t start from a diagnosis that showed a disaster” under Lopez Obrador, he said. “So, they went directly to their proposals.”

Lopez Obrador, who insisted that Mexico would have a health system on par with Denmark by the time he left office, oversaw a Covid 19 pandemic response of minimal intervention, while an attempt to revamp the procurement process for medicines, ostensibly to curb corruption, provoked widespread shortages. Eliminating Seguro Popular left 39.1% of Mexicans without health coverage in 2022, an increase from 16.2% in 2018, according to a 2022 survey by the National Council for the Evaluation of Social Development Policy –CONEVAL-, reported The Lancet.

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CONEVAL also found that 3.1% of Mexican households incurred catastrophic health expenses in 2020, an increase of 1.8 percentage points from 2 years earlier. “We haven’t seen these statistics in Mexico since 15 years ago”, Gomez Dantes said, as reported by The Lancet.

All Credit To: thelancet.com  /  David Agren