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AMALFI MARTINEZ MEKLER

INTERNATIONAL CONGRESS OF

ADMINISTRATIVE SCIENCES, IIAS, 2012

THEME: SOCIO-ECONOMIC PRIORITIES AND PUBLIC ADMINISTRATION

SUBTHEME: Democratic Governance for Social and Economic Development

Co-responsibility between state and society. Political culture of

participation.

PAPER: THE IMPORTANCE OF SOCIAL PARTICIPATION IN

PROGRAMS FOR A NEW CULTURE OF HEALTH.

Contribution No. 193

Professor Amalfi Martínez Mekler

Sociologist Development Consultant

Associate of INAP

[email protected]

(5255) 5291-0405

Parque de Cádiz No. 96-11, Parques de la Herradura

Huixquilucan Estado de México, CP 52786

México

mailto:[email protected]


The Importance of Social Participation in Programs for a

New Culture of Health

ABSTRACT

Epidemiological transition, greater life expectancy and social transformation require a

change of paradigm in the health system: from a curative and reactive medicine to a

preventive:"New culture for health", which is in the process of implementation. Mexico

faces a critical juncture, in which citizen participation is essential to achieve democratic

governance capable of redefining strategies and promoting socioeconomic development in

a more accelerated and competitive world.

The State has had an active role in the heath sector, yet what it has accomplished is

insufficient to meet the needs and expectations of citizens. Health programs require

modern governance and the strengthening of social capital to face this challenge with new

schemes of co-responsibility and innovative processes of government-society interaction.

This document reinforces the above statements with the results of an evaluation of six

programs of prevention and promotion of health in three States of Mexico. The responses

are of users/beneficiaries, reflecting the voice of State officials who implement them, as

well as of the people that receive services of the Ministry of Health in traditional health

centers and hospitals. It privileges the study of new medical units created recently with a

holistic approach to the management of addictions, maternal death, cervical cancer,

HIV/AIDS, HINI influenza, and obesity.


Table of Content

INTRODUCTION ......................................................................................................................... 4

THE DIFFICULTIES OF PARTICIPATION ............................................................................... 5

COMPLEXITY IN THE DESIGNING OF PUBLIC HEALTH POLICIES ................................. 5

TO ILLUSTRATE THE ABOVE I PRESENT A RECENT STUDY OF: PUBLIC POLICY

ASSESSMENT OF DISEASE PREVENTION AND HEALTH PROMOTION ........................ 6

METHODOLOGY ........................................................................................................................ 6

OPINION OF THE BENEFICIARIES ......................................................................................... 7

CRITICAL OPINION OF BENEFICIARIES ............................................................................... 8

KEY FINDINGS FROM THE EVALUATION IN THREE STATES: HIDALGO, PUEBLA Y

QUERÉTARO. ........................................................................................................................... 10

CONCLUSIONS ........................................................................................................................ 10

REFERENCES .......................................................................................................................... 12


INTRODUCTION

Mexico faces critical moments. It requires a definition of strategies and the design of a

roadmap to boost its economic growth more rapidly. The challenge is to leave the

economy of medium income, and move to a higher model of increased productivity and

international competitiveness, and in the process it must consolidate a welfare system for

the population.

Citizen participation is essential to achieve democratic governance. It is a right that has

been on the public agenda for over three decades. However, building social participation is

not easy. There is not a culture of inclusion, there is apathy and it is an organizational

change still difficult to convince public policy decision makers.

Health is one of the pillars of welfare and human development The Mexican health system

requires a systemic response to its transformation, in order to consider financial and

structural emerging risks. The strategy undertaken by the Federal Government is through

the design and implementation of 23 cross-cutting programs for equal number of key and

strategic diseases that affect society.

Yet social participation alternatives are even more complex in the field of health, as its

nature is highly professional and specialized.

Also because of the huge dependence that is created by the recipients to those who

provide them with medical care. All Mexicans are entitled to be incorporated into the

Health Protection System in accordance with Article Four of the Constitution of the United

Mexican States, regardless of their status.

But In reality, what is happening with the delivery of public medical services?

There are two dimensions: at a national level, regulations are designed for multiple

fragmented programs, and since the health sector is decentralized, on a state level, the

operation of the Health Services System faces great pressure from citizens' demands,

which are difficult to meet.

The changing epidemiology, the increased life expectancy and social transformation

require a paradigm shift in the health system: from curative and reactive to a preventive,

"New Culture for Health".

This paper is supported by direct research and it confirms that citizen participation is an

important political element to achieve socioeconomic development, particularly in the

sphere of welfare.


State actions and programs alone are insufficient to solve public problems and the

expectations of the population..

It is required that there be:

Improved schemes of responsibility between state and social actors in planning,

implementation, follow -up, monitoring and evaluation of health public policies.

A strengthening of human capital so that local citizens are empowered and are the ones

who identify and understand specific needs of their environment.

New approaches to collective action that is able to demonstrate the rationality of

collaboration and encourage citizen intervention in the delivery of best quality public

services.

A new public management where there is control, efficiency, and democracy in the

processes of interaction between government and society.

THE DIFFICULTIES OF PARTICIPATION

Social organization in Mexico is still in a stage of underdevelopment.

9 out of 10 Mexicans say they have not sought to influence decision making within their

community, this reflects a culture of apathy.

In a comparison of 35 countries of the world, Mexico is in the last place regarding the

number of associations in the field of non-profit performing actions.

COMPLEXITY IN THE DESIGNING OF PUBLIC HEALTH POLICIES

Building social participation is not easy, especially if it is to be genuine, active and

legitimate .Also because

They address large scale problems and are of general application.

The number of beneficiaries is also of a large scale.

They involve a great responsibility.


TO ILLUSTRATE THE ABOVE I PRESENT A RECENT STUDY OF: PUBLIC

POLICY ASSESSMENT OF DISEASE PREVENTION AND HEALTH

PROMOTION

At the end of last year, I coordinated a study to evaluate six of the major programs for a

“New Culture of Health” from the point of view of the people that implement and those that

receive the benefits of the services. As I mentioned before, since 1982, the heath sector

has been decentralized, this means that legislation and normatively are discussed and

created at a federal level, but the operation, resources and responsibility are managed at

the State level. The main results of this study are summarized in this paper.

METHODOLOGY

The study is orientated to evaluate six preventive health programs from the point of view of

public servants and state authorities, as well as of the people who attend health centers,

hospitals, and new specialized medical units” UNEMES”.

The research instruments used consisted of:

Auto diagnosis, sessions of analysis with working groups that included different levels of

administrative officers: state, jurisdictional and local members of health projects.

Application of questionnaires to the specific target population of the six programs of

prevention and promotion of health: addictions (Centros Nueva Vida) Cervical Cancer,

maternal death (Arranque parejo a la Vida), HIV/AIDS (CAPASITS), Influenza HINI, and

obesity (Unidades médicas especializadas (UNEMES).

Interviews with open population that make use of public heath spaces.


OPINION OF THE BENEFICIARIES

The general public interviewed responded by more than 80%, that they are satisfied with

the services of health centers because they solve their health problems in most cases.

They consider that treatment and care is adequate and that they receive information about

prevention and early detection of critical illnesses.

Yet there is resistance to self-care and taking responsibility for their personal and family

health.

There is not a favorable coordination and communication between the health centers,

hospitals and the new specialized units.


The hospitals are overcrowded, with lack of space, material and human resources

The new health units for the prevention and treatment of obesity, UNEMES are not clearly

positioned or well known. This is important to solve because they are designed to manage

metabolism with a holistic approach in order to prevent diabetes, heart diseases, cancer,

and other chronic and degenerative problems.

CRITICAL OPINION OF BENEFICIARIES

The main problems mentioned are:

Frequent absence of medicines in health centers, they have resource problems or delays

in the supply chain, which affects patients and causes anger.


There is a constant complaint in relation to lack of specialized human resources in the

medical field, the need for a greater number of spaces in general and particularly for

pregnant women and patients in the area of gynecology and obstetrics. This becomes

critical in the emergency area.

There is need of more systematic impact assessments in regard to Groups of Mutual

Support (GAM) hospitals, volunteer citizens, extramural activities and interdisciplinary

teams in the area of psychology, nutrition, exercise, recreation and social work.

Finally there is a repeated insistence that there should be more studies and evaluations of

this kind in order to convey opinions, perceptions, problems and needs to the Central

Government and be taken into account in the formulation of public policies and decision

making a state, local and regional level.


KEY FINDINGS FROM THE EVALUATION IN THREE STATES: HIDALGO,

PUEBLA Y QUERÉTARO.

At the state level there is acceptance and understanding of the six programs, each state

operates them according to its epidemiological profile. The problem is their

implementation with a functional operational structure and sufficient flexibility to suit

regional characteristics and conditions. There is need of more communication and

understanding between national and state authorities as well as among multiple

institutions that offer heath services.

A failure to recognize the importance of professionalizing health promoters and volunteer

citizens who are in direct contact with the urban and rural population and the different

public officials.

The scheme of “Seguro Popular” created during the last two periods of government, has a

growing demand that provokes pressure on the health system which does not grow at the

same speed that the population needs. This program has generated high expectations that

cannot always be met.

.CONCLUSIONS

Strategic assessment of the programs that we studied for the Federal Health Secretary

with the collaboration of three State Governments point out that one of the most important

factors for achieving the goals and success in performance is through an active

participation of society. To stay healthy and learn to handle degenerative diseases is a

responsibility of individuals and families, as well as of communities, society and

Governments.

The rise of life expectancy, and increase in the number of people with chronic diseases

determine that no public institution alone can meet the challenge of offering the population

efficient attention.

Social involvement becomes very important as well as self awareness and empowerment

of the population.

It is essential to strengthen the figure of health promoters in the states, and of volunteer

citizens (“Avales Ciudadanos”) in Mexico City. They play a major role in two ways:

towards the institution (public policy) and in connecting with the population (participation)


seeking to create consciousness and empower the people in the direction of assuming

more responsibility for their health and welfare

The management, administration and delivery of health care programs are a complex task.

The New Culture for Health which includes the promotion of a comprehensive and

preventive approach is not yet consolidated.

The current policy of an open government and administration based on transparency,

collaboration and participation is an option for democracy and a better quality of life, both

important priorities for our new government.(2012-2018)


REFERENCES

SPECIALIZED STUDIES

Evaluación desde el punto de vista del usuario/beneficiario de seis programas prioritarios

de salud. Instituto Nacional de Administración Pública A.C. (INAP) para la Subsecretaría

de Prevención y promoción de la salud. Secretaria de Salud, Gobierno Federal.

Diciembre 2011.

Informes de la evaluación específica del desempeño 2009-2010, Sistema integral de

calidad en salud. Consejo Nacional de Evaluación de la política de desarrollo social.

CONEVAL.

Información, programas y evaluaciones de salud de los gobiernos del Estado de

Guanajuato, Hidalgo, Puebla y Querétaro.

La salud en México 2006/2012 Visión de Funsalud. Organismo de la sociedad civil:

Fundación Mexicana para la Salud A. C.

INSTITUTIONS

Comisión Nacional de Protección en Salud. Seguro Popular.

Unidades de Especialidades Médicas (UNEMES), Unidades entre los hospitales

regionales y los Centros de Salud. Plan Maestro de Infraestructura Física en Salud.

LAWS

Constitución política de los Estados Unidos Mexicanos.

Ley General de Salud del Estado Mexicano. Sistema Nacional de Salud.

Reglamento de la Ley General de Salud en materia Protección Social en Salud.

Leyes estatales de Salud.


PROGRAMS

Programa Nacional de rendición de cuentas, transparencia y combate a la corrupción

2008-2012, Secretaría de la Función Pública.

Programa sectorial de salud 2007-2012, Secretaría de Salud, Gobierno Federal.

Programa de Acción Específico 2007-2012. Promoción de la salud: “Una nueva cultura”.

Secretaría de salud, Subsecretaría de Prevención y Promoción de la Salud.

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