Try and failure. This is how health policies have been during this six-year term. While the government experiments, the population suffers the consequences of some failed decisions that have caused drug shortages, insufficient medical attention and additional expenses, explained specialists in the sector.
The disappearance of the Seguro Popular, the change in the medicine purchasing model and the creation of the Health Institute for Well-being (Insabi) are the main health errors of the government of President Andrés Manuel López Obrador, the experts agreed.
“This government has created three tsunamis in terms of health,” described Salomón Chertorivski, former Secretary of Health.
“We have a serious problem in the care instruments for the non-entitlement; We have a serious unresolved problem in the planning, purchase and supply of medicines, and we have a serious problem with the delays generated from the pandemic”, he detailed in an interview.
The disappearance of Seguro Popular
Although it could be improved, he indicated, Seguro Popular served 53 million people and this government disappeared it without evaluating the impact of that decision.
To replace Seguro Popular, the authorities created Insabi. However, this body was a “telechy” because it was created without clear rules, functions and processes to serve the population without social security, he said.
The consequence was that more people were left without access to a health protection mechanism, he indicated.
“They decided to destroy everything without being clear about what they had to build. Simply, between 2018 and 2020, 15 million Mexican men and women who already had a mechanism to finance and care for their health declared that they no longer had it, that they had lost it,” he explained.
Two years later, after the Insabi failed to meet the goal of providing free medical care and drugs to the entire population without social security, the federal government transferred that responsibility to the IMSS-Well-being, transforming it from an institutional program to a decentralized public body.
“It is so clear that the Insabi attempt failed that the government itself, by trying a new mechanism, is confirming that, in effect, the previous one failed,” said Chertorivski, now a federal deputy for the Citizen Movement.
Although the IMSS-Well-being has been a successful program in the care of rural communities, it is likely that it will fail in the new assignment because the mistake is repeated: it was created without an accurate diagnosis and without the necessary resources, he said.
“It is very worrying because it will be two years lost again and the situation will worsen again for the population not entitled to social security, and with an addition: in the eagerness of the IMSS to fulfill this new occurrence of the president, they are going to have to divert IMSS resources from the ordinary regime to attend to the new system. So, we are destined for a new failure”, he considered.
Salomón Chertorivski mentioned that the second bad decision of this government was the destruction of the drug purchase and distribution system. First, he recalled, that responsibility was taken away from IMSS to be transferred to the Ministry of Finance.
Later, the government decided that the purchases would be carried out by the United Nations Office for Project Services (UNOPS).
“Another improvisation is tried and it goes wrong again. We are in the worst case scenario because it has not been resolved, the purchase was pulverized and the institutions were almost almost instructed to ‘hey, save yourself as much as you can’. So, today the market is more expensive, it is worse. We are experiencing a shortage that does not seem to have a solution and we are all paying for it,” he lamented.
Enrique Martínez Moreno , general director of the Pharmaceutical Institute (Inefam), explained that the purchasing agreement with UNOPS was unnecessary because Mexico has institutions, laws and experience to make large purchases.
“It was a complete improvisation,” he said.
He explained that the results show it. For the 2021 supplies, UNOPS managed to award just 50% of the required keys, he explained. What led health institutions to make emerging purchases through direct awards to cover the shortages.
He pointed out that in 2021, for every contract with UNOPS, there were another 40 contracts in parallel to acquire the same drug code. In other cases there were up to 200 parallel contracts.
Although the government said that with the purchases made by UNOPS, 11,000 million pesos were saved, the acquisition of supplies that this international organization did not achieve represented an additional expense of 4,500 million pesos, he said.
He added that 2021 is the year with the most shortages in two decades. While, on average, between 1,600 and 1,800 million pieces of medical supplies are purchased in Mexico each year, in 2021 only 1,300 were purchased.
Among the supplies that UNOPS did not award are highly consumed drugs, such as those for diabetes and high blood pressure. This meant that health institutions could not comply with full care for patients, he said, and that they faced greater financial pressures.
“And, of course, other costs would have to be added. The simple and straightforward fact that an unattended patient has surely had greater health complications and will generate higher costs in the following years,” he explained in an interview.
After the results of this agreement, Insabi announced that it would close the contracts with UNOPS and that the purchases would be made again by the institute with the Ministry of Finance.
However, Martínez Moreno is also concerned about this decision because, he considered, Insabi has not been an effective purchasing manager either.
“The challenge that comes now for 2023-2024 seems to be able to increase the uncertainty to guarantee an adequate supply,” he warned.
Carlos Salazar, president of the National Association of Health Providers, explained that in this government the purchase of medical supplies has been a challenge due to the lack of planning.
Manufacturers of medical devices and drugs, he explained, require at least 6 months of planning to obtain raw materials and complete the manufacturing processes. For this reason, some participants stopped participating in the tenders.
The management of the pandemic
Federal deputy Salomón Chertorivski pointed out that another serious mistake was the mismanagement of the covid-19 pandemic.
This caused greater lags in health due to the lack of medical attention to other ailments and due to the consequences caused by the new coronavirus, he explained.
“So, in addition to the more than 750,000 people who died in the pandemic, that in itself is already the greatest health tragedy that Mexico has had, and that we must continue to question and there must be responsibility, we have many consultations that were not made, cancers that were not treated, diabetes that was not treated, vaccination that fell. And we are going to have to make up for all those lags in the near future.”