Secretaria de Salud

Jaime Mier y Terán Suárez, MD

Guatemala, October 18, 2004

CONTENTSCONTENTS

I.- CONTEXT

2.- HEALTH CONDITIONS

3.- THE INSTITUTIONAL RESPONSE

3.2 NFRAESTRUCTURA SANITARIA4.- MANAGEMENT PERSPECTIVES

The Southern BorderThe Southern Border

Source: CONAPO Proj. 2004

GuerreroGuerrero

3’249,559 hab3’249,559 habOaxacaOaxaca

3’693,497 hab3’693,497 habChiapasChiapas

4’357,301 hab4’357,301 hab

PueblaPuebla

5’480,844 hab5’480,844 hab

TabascoTabasco

2’045,537 hab2’045,537 hab

CampecheCampeche

763,037 hab763,037 hab

YucatánYucatán

1’784,267 hab1’784,267 hab

Q. RooQ. Roo

1’053,084 hab1’053,084 hab

VeracruzVeracruz

7’274,772 hab7’274,772 hab

SOUTH-SOUTHEAST REGION

29’701,894 Inhabitants.

BORDER REGION

8’218,959

1,149 Km Border

High violence ratios

THE WORLD’S MOST COMPLEX BORDERTHE WORLD’S MOST COMPLEX BORDER

38.7% natural natural water water

availability*availability*

THE WORLD’S MOST THE WORLD’S MOST COMPLEX BORDERCOMPLEX BORDER

90% of Mexican 90% of Mexican petroleumpetroleum

The country’s The country’s agricultural basisagricultural basis

SOUTH-SOUTHEAST SOUTH-SOUTHEAST REGIONREGION

MalariaMalariaHIV/AIDSHIV/AIDSTuberculosisTuberculosis

Illegal Migration

*Includes Southern Border and Yucatán Peninsula

DETENTIONS IN THE BORDER STATES OF THE REGION

STATE NUMBERYEAR 2003

NUMBERYEAR 2004*

CAMPECHE 839 646

CHIAPAS 73,136 59,369

QUINTANA ROO

1,524 1,192

TABASCO 17,287 13,744

TOTAL 92,786 74,951

Source: INM. estadísticas de aseguramientos 2003 y 2004* (incluye solo Enero-Julio)

CHIAPAS

TABASCO

CAMPECHEQUINTANA

ROO

DETENTIONS IN THE COUNTRY BY ORIGIN 2003

43%

35%

17%

1%1%1% 2%

Guatemala Honduras El SalvadorNicaragua Ecuador Brasilotros

CentroamericanaGuatemalaMéxicoTren

Principales rutas de migración México Centroamérica

CentroamericanaGuatemalaMéxicoTren

Principales rutas de migración México Centroamérica

IMPACT

CAMPECHE

CHIAPAS

QUINTANA ROO

TABASCO

VERACRUZ

TAMAULIPAS

OAXACA

GUERRERO

PUEBLA

PERCENTAGES OF MARINALIZED POPULATION PERCENTAGES OF MARINALIZED POPULATION BY ENTITY AND REGION SOUTH-SOUTHEAST, BY ENTITY AND REGION SOUTH-SOUTHEAST,

20002000

Source: CONAPO, Índice de marginación, 2000

Percentages

0

1

2

3

4

5

6

7

8

Muy alta 0.1 0.15 0.72 0.1 0.18 0 0.77 0.17Alta 2.23 1.17 3.25 1.66 7.01 0.07 5.12 2

AGS B.C B.C.S COAH COL D.F JAL N.L

Entities with the lowest percentage of population in locations with a high and

very high marginalization

Percentages

05

1015

202530354045

Muy alta 4.19 22.85 22.65 18.3 7.11 1.4 1.15 11.18 1.37Alta 28.24 38.22 29.45 40.41 32.8 15.06 29.78 29.51 34.51

CAM CHIS GRO OAX PUE QRO TAB VER YUC

South-Southeast

Percentage of population in locations with high and very high marginalization

LIFE EXPECTANCY BY ENTITY AND REGION LIFE EXPECTANCY BY ENTITY AND REGION SOUTH-SOUTHEAST, 2000SOUTH-SOUTHEAST, 2000

AÑ

OS

70

71

72

73

74

75

76

77

NL COL AGS MEX DGO BCS J AL COAH QROO TAB CAMP YUC PUE VER GRO OAX CHIS

Entities with highest life expectancy

South-Southeast

Source: Estimates CONAPO.

AÑOS

HEALTH RISKS AND PROBLEMSHEALTH RISKS AND PROBLEMS

Epidemic Outbreaks

Haemorrhage Dengue Fever

E. Zapata September 2004

Conjunctivitis Second Semester 2003

Rotavirus March 2004

Tuberculosis Balancán First Quarter 2004

Malaria Tenosique First Quarter 2004

Threats

1.- HIV/AIDS

PREVALENCeTabasco: 0.2% Guatemala: 1% Belize: 2%

2.- Malaria Falciparum

Migrant deaths in Veracruz

CASES IN THE SOUTH-SOUTHEAST REGIONCASES IN THE SOUTH-SOUTHEAST REGIONMALARIA

DENGUE FEVER

Fuente: SUIVE semana 35, 2004.

STATE P.VIVAX P. FALCIPARUM TOTALCAMPECHE 4 0 4CHIAPAS 800 4 804GUERRERO 3 0 3OAXACA 850 0 850PUEBLA 0 0 0QUINTANA ROO 28 0 28TABASCO 97 14 111VERACRUZ 0 0 0YUCATAN 4 0 4REGION 1786 18 1804PAIS 2115 18 2133

STATE D. FEVER D.F. W/HAEMORR. TOTALCAMPECHE 1 0 1CHIAPAS 77 16 93GUERRERO 94 18 112OAXACA 43 12 55PUEBLA 10 0 10QUINTANA ROO 113 2 115TABASCO 8 0 8VERACRUZ 1617 573 2190YUCATAN 23 1 24REGION 1986 622 2608PAIS 2243 664 2907

84.57% comes from the region

89.7% comes from the region

Fuente: SUIVE semana 35, 2004.

0

5

10

15

20

25

30

35

40

45

Falcip. 0 0 0 0 0 0 0 0 0 0 0 1 3 0 0 0 0 0 0 1 5 4 28 0 16 2 0 0 0 0 0 0 0 0 0 0 0 0 0

Vivax 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 1 0 2 14 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2 3 4 5 6 7 8 9 10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

MALARIA OUTBREAK IN GUAYACANMALARIA OUTBREAK IN GUAYACAN2004*2004*

Fuente: Informe Semanal del ISPFuente: Informe Semanal del ISP *Hasta la Sem. 39*Hasta la Sem. 39

P. Vivax 20

P. Falciparum 60

TOTAL 80

CONTROL OPERATIONDIAGNOSIS OPERATION

Source: www.conac org.mxSALUD MEXICO 2002, ANEXOS ESTADISTICOS (COUNTRY AND SOUTH-SOUTHEAST REGION)

HEALTH EXPENSES AS PERCENTAGE OF GDP HEALTH EXPENSES AS PERCENTAGE OF GDP 20022002

6.96

5.79

5.8%

8.7%

9.3%

10.0%

13.7%

0.00 2.00 4.00 6.00 8.00 10.00 12.00 14.00

SOUTH-S.E.

MEX

BOL

COST. RICA

COLOM

URUG

USA

HEALTH INFRASTRUCTUREHEALTH INFRASTRUCTUREINDICATOR OF BEDS TO BE

INCLUDED IN CENSUSPUBLIC SECTOR PHYSICIANS

BY FEDERATIVE ENTITY1.73

0.79

1.081.02

0.88

1.26

1.53

1.18

1.43

1.211.28

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.80.81

0.360.42 0.43

0.520.48

0.620.58

0.8

0.55

0.68

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

CAM

CHIA

GUER

OAX

PUE

Q.ROO

TAB

VER YUC

REGIO

N

PAIS

Fuente: Salud México 2003* Camas por 1000 hab.

Fuente: Salud México 2003* Médicos del Sector Público por 1000 hab.

MOBILE MOBILE POPULATIONSPOPULATIONS

IN SOUTH-IN SOUTH-SOUTHEASTSOUTHEAST

74,951 INSURED PEOPLE IN THE INSURED PEOPLE IN THE COUNTRY IN 2003COUNTRY IN 2003

1.- THE GROUP OF SOUTH-SOUTH 1.- THE GROUP OF SOUTH-SOUTH EAST SECRETARIESEAST SECRETARIES

2.- BORDER HEALTH COMMISSION 2.- BORDER HEALTH COMMISSION MX - GUATEMALAMX - GUATEMALA

3.- OPERATIVE COORDINATION3.- OPERATIVE COORDINATION TABASCO - GUATEMALATABASCO - GUATEMALA

4.- CONAGO4.- CONAGO

Source: INM. estadísticas de aseguramientos 2003

SOUTH-SOUTHEAST GROUP – HEALTH CHAPTER

MEMBERSMEMBERS

OaxacaOaxaca

ChiapasChiapas

PueblaPuebla

CampecheCampeche

GuerreroGuerrero

TabascoTabasco

Quintana Quintana RooRoo

VeracruzVeracruz

YucatánYucatán

DR. ALVARO EMILIO ARCEO ORTIZ SECRETARIO DE SALUD

DR. ANGEL R. ESTRADA AREVALOSECRETARIO DE SALUD

DRA. VERONICA MUÑOZ PARRASECRETARIA DE SALUD

DR. FELIPE GAMAS CASASSECRETARIO DE SALUD

DR. JESUS LORENZO AARUN RAMESECRETARIO DE SALUD

DR. DAGOBERTO GARCIA GARCIASECRETARIO DE SALUD

DR. JAIME MIER Y TERAN SUAREZSECRETARIO DE SALUD

DRA. MAURO LOYO VARELASECRETARIO DE SALUD

DR. JOSE A. PEREYRA CARCAÑOSECRETARIO DE SALUD

NATIONAL REPRESENTATIVESNATIONAL REPRESENTATIVES

Dr. Roberto Tapia Conyer.- Subsecretario de Prevención y Protección a la SaludDr. Enrique Ruelas Barajas.- Subsecretario de Innovación y CalidadDr. Rodolfo Rojas Rubí.- Secretario Técnico del C.N.SDr. Oscar Velázquez Monroy.- Director General del C.E.N.A.V.E.

SOUTH-SOUTHEAST WORK SESSIONSDATE LOCATION

I REUNION REGIONAL 07/ 07/ 2002 VILLAHERMOSA, TAB

II REUNION REGIONAL 23/ 07/ 2002 MEXICO, D.F. (AEROPUERTO)

III REUNION REGIONAL 02/ 08/ 2002 VILLAHERMOSA, TAB

IV REUNION REGIONAL 16/ 08/ 2002 CANCUN, QUINTANA ROO

V REUNION REGIONAL 17/ 03/ 2003 OAXACA, OAXACA

VI REUNION REGIONAL 10/ 10/ 2003 PUEBLA, PUEBLA

VII REUNION REGIONAL 06/ 02/ 2004 MERIDA, YUCATAN

IX REUNION REGIONAL 21/ 05/ 2004 VERACRUZ, VER.

X REUNION REGIONAL OCTUBRE (PENDIENTE) CAMPECHE, CAMPECHE

MEETINGS

Tabasco

Tabasco

Cancun

Oaxaca

P uebla

Mérida, Yucatán

Veracruz

Campeche

PROGRESS

1. Epidemiological Surveillance Projects(Proposal by Subsecretariat for

Prevention and Health)

2. Projects Proyecto Contra Riesgos SanitariosDel Plan Puebla Panamá(Propuesta de la COFEPRIS)

3. Proyecto Regional de Infraestructura

(Propuesta de las Secretarías de Salud del Sur - Sureste)

Comisión Federal para la Proteccióncontra Riesgos Sanitarios

Protección es salud

BACKGROUNDBACKGROUND

Agreement betweenGovernments of Guatemala and México to establish:Agreement betweenGovernments of Guatemala and México to establish:

BORDER HEALTH COMMISSION MEXICO - GUATEMALABORDER HEALTH COMMISSION MEXICO - GUATEMALA

By the Mexican GovernmentBy the Mexican Government By the Government of By the Government of GuatemalaGuatemala

Lic. Luis Ernesto DerbezLic. Luis Ernesto DerbezSecretario de Relaciones ExterioresSecretario de Relaciones Exteriores

Lic. Edgar Armando Gutiérrez GirónLic. Edgar Armando Gutiérrez GirónMinistro de Relaciones ExterioresMinistro de Relaciones Exteriores

Guatemala, May 12, 2003Guatemala, May 12, 2003

MéxicoMéxico GuatemalaGuatemala

RESPONSIBILITIES OF THE RESPONSIBILITIES OF THE COMMISSIONCOMMISSION

1.1. Diagnoses, projects, and studies Diagnoses, projects, and studies on Public Health needs at the on Public Health needs at the South Southeast Border. South Southeast Border.

3. Management support and financing. 3. Management support and financing.

2. Action programs on epidemiologic 2. Action programs on epidemiologic surveillance, risk protection and medical surveillance, risk protection and medical care.care.

THE COMMISSIONTHE COMMISSION

MEXICAN SECTIONMEXICAN SECTION

COMMISSIONER:SUB-SECRETARY FOR PREVENTION AND HEALTH PROMOTION

6 MEMBERS DESIGNATED BY THE MEXICAN GOVERNMENT

ONE TECHNICAL SECRETARY

GUATEMALAN SECTIONGUATEMALAN SECTION

COMMISSIONER:VICE-MINISTER OF PUBLIC HEALTH AND SOCIAL ASSISTANCE

6 MEMBERS DESIGNATED BY THE GUATEMALAN GOVERNMENT

ONE TECHNICAL SECRETARY

MEETINGS OF AUTHORITIES MEETINGS OF AUTHORITIES

TABASCO, MEXICO – PETÉN, GUATEMALA.TABASCO, MEXICO – PETÉN, GUATEMALA.

Las Flores, Petén 15/jun/2004 Villahermosa., Tabasco. 29/jul/2004

OPERATIVE STAFF MEETINGSOPERATIVE STAFF MEETINGS

Civilian sanitary representatives and social Civilian sanitary representatives and social representatives. representatives.

..Guayacán, Guatemala 29/jun/2004

At the XVIII Ordinary Meeting of the National Conference of Governors that was held in Valle de Bravo, State of Mexico, on July 9, 2004, the proposal of the Governor of the State of Chiapas to organize a Forum to discuss the topic of a Comprehensive Migratory Policy for the Southern Border was approved.

A NEW MANAGEMENT PERSPECTIVE AND A NEW SPACEA NEW MANAGEMENT PERSPECTIVE AND A NEW SPACE

FORUM ON INTEGRAL MIGRATION POLICY FORUM ON INTEGRAL MIGRATION POLICY

FOR THE SOUTHERN BORDER FOR THE SOUTHERN BORDER WORK SESSIONSWORK SESSIONS

Villahermosa, Tabasco (13/agos/04)Villahermosa, Tabasco (13/agos/04)

San Cristobal de las Casas; Chiapas San Cristobal de las Casas; Chiapas 09/agos/0409/agos/04

FORO DE GOBERNADORES SOBRE DESARROLLO FORO DE GOBERNADORES SOBRE DESARROLLO INTEGRAL DE LA FRONTERA SUR INTEGRAL DE LA FRONTERA SUR Villahermosa, Tabasco (Oct 13/04)Villahermosa, Tabasco (Oct 13/04)

The growing incidence of illnesses that were under effective control and that occur as a result of the intense movement of migrants.

To integrate the Health Support perspectives in the Border To integrate the Health Support perspectives in the Border Commission Mexico - GuatemalaCommission Mexico - Guatemala

Joint solutions of the 3 Government levels and active participation of Civilian and Sanitary Authorities from Central America.

GENERAL CONCLUSIONSGENERAL CONCLUSIONS

Mexico’s future lies in the South-Southeast region due to its natural wealth.

. Daniel Cosío Villegas